Testing a Biosocial Model of Borderline Personality Features in Youth

Project Summary Gender diverse youth assigned female at birth (AFAB) experience high rates of suicide-related behavior, including suicidal ideation, suicide attempts, and non-suicidal self-injury that are associated with long-term and costly treatment, inpatient hospitalizations, and emergency room visits. Yet very little is known about mechanisms underlying the profound risk for suicide among gender diverse youth AFAB, hindering efforts to address the personal and societal burden associated with suicide in this vulnerable population. The need to belong is central to prominent models of suicide, and failure to acquire close, reciprocal relationships is posited to beget suicide-related behaviors. As many gender diverse youth AFAB report profound loneliness, the NIMH RDoC Social Processes construct of Attachment and Affiliation may be of primary relevance to understanding the emergence of suicide-related behavior. Attachment and Affiliation deficits, namely heightened sensitivity to peer rejection cues and blunted responses to peer acceptance cues, have been associated with difficulties forming and maintaining relationships with others and have also been associated with risk for suicide-related behaviors. However, most work has relied on self-report measures of social processing, which may be limited in detecting the precise deficits involved in social processing. A priori prospective research examining neural alterations in social processing is needed to clarify the pathway through which Attachment and Affiliation deficits beget suicide-related behavior. Indeed, emerging research suggests gender diverse youth AFAB have particularly high rates of social dysfunction and suicide-related behavior compared to other sexual and gender minority youth groups. In response to NOT-OD-22-030, we seek to critically examine gender diversity using developmentally sensitive measures, including felt-gender, gender noncontentedness, and gender nonconformity, in a clinically diverse sample of 180 early adolescent youth AFAB (10-14 years old) recruited from R21 MH125052 and R21 MH124027. Neural alterations in processing of peer rejection and acceptance cues will be tested as mechanisms underlying the emergence of suicide-related behavior measured one year later in gender diverse youth AFAB. Parent and peer risk and resilience factors will also be explored. It is anticipated that findings from this work will clarify targets for intervention and direct efforts to mitigate risk for suicide-related behaviors in gender diverse youth AFAB.