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Article

The Cross-Sectional and Longitudinal Associations between Household Chaos, Perceived Stress, and Borderline Personality Disorder Features in Outpatient Youth

by
Anouk Aleva
1,2,
Geerte de Boois
1,
Christel J. Hessels
1 and
Odilia M. Laceulle
2,*
1
HYPE Centre of Expertise on Early Intervention for Borderline Personality Disorder, GGz Centraal, 3800 BP Amersfoort, The Netherlands
2
Department of Developmental Psychology, Utrecht University, 3584 CS Utrecht, The Netherlands
*
Author to whom correspondence should be addressed.
Youth 2024, 4(4), 1469-1480; https://doi.org/10.3390/youth4040093
Submission received: 10 July 2024 / Revised: 28 September 2024 / Accepted: 30 September 2024 / Published: 8 October 2024
Browse Figure
Versions Notes

Abstract

:
This study examined how household chaos, perceived stress, and their interaction are related to borderline personality disorder (BPD) features both cross-sectionally and at 1-year follow-up in outpatient youth. Data from 143 youth were analysed. Their mean age was 18.72 years (SD = 2.98) and 80.4% self-identified as female. The results indicated that both perceived stress and household chaos were positively associated with BPD features at baseline. Additionally, the link between perceived stress and BPD features was slightly stronger in youth with more household chaos. The associations were not maintained in the longitudinal analyses. The discrepancy between the cross-sectional and longitudinal findings suggests that household chaos and perceived stress might be intertwined with BPD features, rather than predictive of change in BPD features over time.

1. Introduction

Borderline personality disorder (BPD) is a psychiatric disorder characterized by instability in emotions, relationships and the sense of self [1]. BPD has a severe and pervasive impact on an individual’s life, with the prospect of persistent psychosocial impairments and a heightened risk of premature mortality [2,3,4,5]. Until recently, there has been reluctance and ambivalence regarding the assessment of BPD in youth, even though the diagnosis has similar reliability and validity in this population compared to adults [3,6,7]. Recognition that BPD often first emerges during adolescence is growing, leading to an increasing call to improve the understanding, early detection, and intervention in youth to prevent pervasive and long-term psychosocial and health problems [8].
Over the past decade, research aimed at understanding the causes and correlates of BPD predominantly focused on associations between (i) BPD and person(ality) characteristics [9,10], (ii) BPD and comorbid psychopathology (e.g., mood and substance disorders) [11] and, (iii) BPD and childhood traumatic experiences [10]. Far less scientific attention has been given to the individual’s current contextual factors, such as the household one lives in. In the context of early intervention in youth, the association between BPD features and the household may be particularly significant. The household is still a central part of youth’s daily life and serves as a crucial environment for the development of social and emotional skills [12]. As such, challenges related to the household youth grow up in may play a role in the emergence and maintenance of BPD features in youth. Another contextual factor that may contribute to the maintenance of psychopathology in youth is stress induced by the psychosocial challenges they face [13,14,15,16]. Youth with BPD features show poor and enduring problems in psychosocial functioning [17], raising the question whether the related perceived stress might be related to BPD features.

1.1. Household Chaos

Household chaos is defined as living in a chaotic home environment that includes high levels of noise, crowding, disorganization, and a lack of family routines [18]. While short-term bouts of chaos in the home are common, prolonged exposure to household chaos can have a profound impact on child development [19]. High levels of household chaos during childhood have consistently been associated with various adverse outcomes later in life, including poor social-emotional functioning and behavioral problems [20]. Moreover, a chaotic home environment may also be a proxy of a high-risk family environment, as parenting behaviors and parent-child interactions are often compromised in these households (i.e., less parental responsivity, more likely to engage in harsher discipline) [20].
In highly emotionally reactive children, household chaos has been found to be directly predictive of emotional and behavioral psychological problems in adolescence [21]. Since emotional reactivity is considered central to BPD [22,23], household chaos may be particularly significant in relation to BPD features in youth. Given that adolescence is often regarded as the period during which BPD typically emerges [24], household chaos may play a crucial role in the expression of these features in youth. Although grounded in theory [25], only a handful of studies have sought to test the hypothesized association between BPD features and an invalidating family environment [26,27,28,29].
The vast majority of the research on chaotic home environments has focused on young children, leaving a gap in understanding the impact on youth. This gap is problematic, as during adolescence aspects of the home environment, such as adequate structure and parental sensitivity, become increasingly important as youth strive for autonomy and self-identity [12]. Examining the cross-sectional and longitudinal association between household chaos and BPD features in youth could bring new insights regarding the emergence and maintenance of these features during adolescence and young adulthood.

1.2. Perceived Stress

More than in any other period in life, adolescence and young adulthood are characterized by psychosocial developments and challenges which are often accompanied by stress [30]. While most youth seem to cope well, some experience this stress as overwhelming, and their development comes to a halt [31]. The accumulation of the psychosocial challenges and the accompanied stress is most likely to overtax an individuals’ current coping capacity during adolescence [32]. Not surprisingly, this is also the period in life when the onset of psychopathology most commonly occurs [33]. Research has substantiated the link between perceived stress and psychopathology by showing that youth who experience high levels of stress are more likely to develop a mental disorder one year later [34]. For those already struggling with psychopathology, the experience of stress during adolescence has been found to be a maintaining factor of their symptoms [15].
Youth with BPD have been found to be especially prone to experiencing high levels of stress [35,36]. Although no research has yet been conducted on perceived stress as a predictive factor in the maintenance of BPD features in youth, research on impulsivity does suggest such a link. Impulsivity can be considered one of the core features of BPD [23] and has been found to elevate in response to stress in youth with BPD [37]. As such, BPD features might also be reinforced in the face of stress.

1.3. Interaction between Household Chaos and Perceived Stress

In addition to their potential unique association with BPD features, there may also be an interaction effect between household chaos and perceived stress on BPD features. It has been suggested that a stable household with established family routines protects children’s mental health from daily stressors [38]. This suggestion is supported by research showing that family routines enhanced the cohesiveness and expressiveness among household members, which were negatively associated with children’s externalizing and internalizing behaviors [38]. Additionally, the stressful context of the COVID-19 pandemic provided a global example, where household routines were found to be associated with better individual well-being [39]. Thus, family routines may play a protective role in youths’ mental health in the context of perceived stress by providing a place of comfort, validation, and advice. Conversely, perceived stress may be accentuated in the context of household chaos (i.e., the lack of organization and routines).

1.4. Current Study

Insight into the factors related to the emergence and maintenance of BPD features in youth has value for early detection and intervention. The current study examines both cross-sectional and longitudinal (i.e., 1-year later) associations between household chaos, perceived stress, and BPD features in youth. Youth reporting more household chaos and/or higher levels of perceived stress are expected to present with more BPD features. Moreover, youth experiencing higher levels of perceived stress are expected to report more BPD features when experiencing more household chaos. Longitudinally (i.e., after 1 year), perceived stress, household chaos, and the interaction of both factors were expected to predict BPD features while controlling for baseline level of BPD features.

2. Methods

2.1. Study Design

In the current study, data were used from a Dutch ongoing, longitudinal study on personality development and psychosocial functioning in outpatient youth [40]. Ethical approval for the longitudinal study was granted by the Utrecht University Faculty for Social and Behavioral Sciences (FETC 17-090 and FETC 23-0135). Youth aged 12 to 25 who were referred to the participating mental healthcare center for assessment and treatment of various mental disorders were asked to participate. Filling out the questionnaires was an integral part of the diagnostic assessment and systematic treatment evaluations every six months. All participants (and a parent or legal guardian for those aged < 16 years) provided written consent for their data being used for scientific purposes. Participants did not receive compensation for participating. Data were collected at the start of care (i.e., baseline), six months later, and a year after baseline.
For the current study, participants who filled out the measures concerning BPD features, household chaos, and perceived stress at baseline and 1-year follow-up were included in the sample. The participants were enrolled between January 2018 and January 2024. There was no minimum requirement regarding number of BPD features.

2.2. Participants

The sample originally comprised 147 participants who provided data at baseline and 1-year follow-up (with a margin of ±1 month) on the primary measures (i.e., BPD features, household chaos, and perceived stress). Of those, 4 participants specified their sex as ‘other’. As this group was too small to include in the analyses, these participants were excluded. Hence, the sample used in the current study comprised 143 participants. The mean age of participants was 18.72 years (SD = 2.98), 80.4% self-identified as female.
The current sample comprised 22% of the participants that had a baseline measurement in the longitudinal study as only those participants who filled out both baseline and 1-year follow-up measures were included (i.e., completers). The attrition is likely explained by a slow start of the study procedures around the follow-up recruitment (i.e., resulting in an exceedance of the follow-up period for some participants), participants exiting care before the 1-year follow-up measurement and thereby being harder to reach and less inclined to participate (i.e., no direct profit from the systematic treatment evaluations). The completers (n = 143) and non-completers (n = 522) were compared and did not significantly differ on any of the variables included in this study.

2.3. Measures

Borderline Personality Disorder Features The BPD section of the screening questionnaire of the Structured Clinical Interview for DSM-IV Axis II (SCID-II BPD-PQ) [41,42] was used to measure BPD features at baseline and 1-year follow-up. The SCID-II BPD-PQ is a widely used self-report screening questionnaire and has proven to be a reliable and valid screening for BPD in youth [43,44]. It comprises 15 statements about feelings or behaviors, for which the participants indicate whether they are on average applicable to them (e.g., “Do your relationships with people you really care about have lots of extreme ups and downs?”). Answers can be either yes (1) or no (0). A sum score was calculated by adding up the number of yes answers. A higher score indicated a higher level of BPD features. Cronbach’s alpha at baseline was 0.79 at baseline and 0.82 at 1-year follow-up.
Household Chaos The Confusion, Hubbub, and Order Scale (CHAOS) [45] was used to measure the degree of household chaos at baseline. The CHAOS is a self-report questionnaire comprising 17 items. The items reflect the characteristics of a chaotic home environment (e.g., “No matter what our family plans, it usually doesn’t seem to work out.”). Answers are given on a 5-point Likert scale ranging from 1 (completely false) to 5 (completely true). The indicated items were reverse coded and a mean score was used (i.e., summing all item scores and dividing by 17). A higher score reflected a higher level of household chaos. Cronbach’s alpha in the current study was 0.84.
Perceived Stress The Perceived Stress Scale (PSS) was used at baseline to measure the extent to which participants generally appraised situations in their life as stressful over the last month [46]. The PSS is a self-report questionnaire comprising 10 items (e.g., “In the last month, how often have you found that you could not cope with all the things that you had to do?”). The items were answered on a 5-point Likert Scale (0 = never to 4 = very often). The indicated items were reverse coded and a total score was calculated by adding up the scores. A higher score reflected a higher level of perceived stress. Cronbach’s alpha in the current study was 0.81.

2.4. Statistical Analyses

The data analyses were performed in IBM Statistical Package for Social Science (SPSS; version 29). After calculating the descriptive statistics and correlations between the measures, independent variables were centred in order to conduct regression analyses. A significance level op p < 0.05 was adhered to for all results.
A two-step linear regression analysis was conducted to examine the cross-sectional and longitudinal associations between the variables (i.e., BPD features, household chaos, perceived stress). First, a stepwise regression analysis was conducted to examine the cross-sectional associations at baseline, with perceived stress and household chaos as the independent variables and BPD features as the dependent variable. Sex and age were added to the model as control variables. Household chaos and perceived stress were first separately added to the model. Subsequently, a ‘household chaos x perceived stress’ interaction variable was added to the model. Next, the longitudinal association of perceived stress and household chaos at baseline to BPD features at 1-year follow-up (after correction by BPD features at baseline) was examined.

3. Results

3.1. Sample Characteristics

The descriptive statistics are reported in Table 1. The correlation coefficients between the variables are presented in Table 2.

3.2. Cross-Sectional Associations

Estimates of the cross-sectional analyses are reported in Table 3. A model with only the control variables (i.e., sex and age) explained just 1.1% of the variance in BPD features and was not significant (F(2, 140) = 1.76, p = 0.176). This model was expanded by including perceived stress and household chaos which significantly increased the explained variance to 29.8% (∆F(2, 138) = 29.61, p < 0.001). Finally, the interaction variable ‘household chaos x perceived stress’ was added to the model, which significantly increased the explained variance to 31.3% (∆F(1, 137) = 4.049, p = 0.046).
Household chaos and BPD features were positively associated, i.e., more household chaos was related to more BPD features. Perceived stress and BPD features were also positively associated, i.e., more perceived stress was related to more BPD features. The joint effect of household chaos x perceived stress on BPD features was also significant. Specifically, the association between perceived stress and BPD features was slightly stronger in youth with more household chaos. However, this effect was very small (see Figure 1).

3.3. Longitudinal Associations

The estimates for the longitudinal analyses are reported in Table 4. A model with only the control variables (i.e., BPD features at baseline, age, and sex) explained 35.0% of the variance in BPD features at 1-year follow-up (F(3, 139) = 26.51, p < 0.001). Adding perceived stress and household chaos to the model changed the explained variance to 34.3% (∆F(2, 137) = 0.229, p = 0.796). Finally, the interaction variable ‘household chaos x perceived stress’ was added to the model and changed the explained variance to 33.8% (∆F(1, 136) = 0.038, p = 0.846).
The level of BPD features at baseline was the only significant predictor of BPD features at 1-year follow-up. Neither, age, sex, household chaos, perceived stress, nor the interaction between household chaos and perceived stress added to the model predicting the level of BPD features at 1-year follow-up.

4. Discussion

The current study aimed to extend the knowledge on BPD features in youth by examining the link between household chaos, perceived stress, and BPD features in an outpatient sample of youth. Associations between the variables were examined at baseline (i.e., cross-sectional) and as predictors for the level of BPD features at 1-year follow-up (i.e., longitudinal). The cross-sectional results showed that household chaos and perceived stress were both positively related to BPD features. Together with age and sex, these variables explained 29.8% of the variance in BPD features at baseline. Although the interaction of household chaos and perceived stress was significant, further inspection showed the effect was too small to be considered meaningful. Longitudinally, BPD features at baseline was the only significant predictor of the level of BPD features at 1-year follow-up.
To the best of our knowledge, the current study was the first to examine household chaos specifically in the context of BPD. The identified positive association between household chaos and BPD features at baseline suggests that youth who experienced more household chaos reported more BPD features. These cross-sectional findings align with consistent evidence of the association between household chaos in childhood and its immediate adverse impact, for example on socio-emotional functioning [20]. However, in the current study, the association did not hold up longitudinally, as household chaos at baseline was not associated with the level of BPD features at 1-year follow-up. As such, the negative longitudinal outcomes of a chaotic home environment that have been generally observed [20] were not replicated specifically for BPD features. A possible explanation for this lack of longitudinal findings might be that the 1-year follow-up period in the current study was too short to capture changes in BPD features. The stability of BPD features over time in the current study (r = 0.58) may substantiate this explanation. Nevertheless, previous studies did identify a change in BPD features over relatively short periods of time [47]. Further research is necessary to determine the significance of the difference between the cross-sectional and longitudinal findings in the current study.
The exploration of the role of household chaos in relation to other environmental factors associated with BPD may also be of interest. For instance, household chaos has been shown to mediate the adverse effects of low socio-economic status (SES) on more general childhood outcomes [20], and this may also apply to the link between lower SES and BPD [48,49]. Factors specific to the household makeup for different age groups with BPD could also be considered in future research. A study comparing the characteristics of adolescent (15 to 17 years) and young adult (18 to 25 years) outpatients with BPDs found one of the few distinctions in presentation between these groups to be household composition: adolescents were more likely to live with their parent(s) [50].
The positive association that was found between perceived stress and BPD features in youth extends similar findings in adults with BPD [35]. Theoretically, perceived stress in youth has also been prospectively linked to the worsening of BPD features [51]. To the best of our knowledge, the current study is the first to provide an empirical test of this longitudinal assumption. Our findings do not underscore this hypothesis, as BPD features at 1-year follow-up were not predicted by perceived stress at baseline. The discrepancy between the cross-sectional and longitudinal findings raises questions regarding the underlying mechanisms of the association. Although stress and BPD have been found to be related [36,52], the current findings suggest that this association may be limited to present conditions rather than predictive of future outcomes. Perhaps insights into how youth manage perceived stress can provide more prognostic information regarding BPD. Studies showing that youth with BPD use less efficient coping mechanisms [53] and show a lack of self-perception with regard to stress [36] indicate maladaptive ways of dealing with perceived stress. In addition, person-characteristics such as high neuroticism could play a role in the link between (perceived) stress and BPD features. The strongest determinant of perceived stress in adolescents has been suggested to be high neuroticism [54], and in adults neuroticism has been linked to poor stress regulation [55]. Moreover, neuroticism shares genetic variation with BPD [56,57]. Future research may look into the role of both coping and neuroticism to deepen our understanding of the link between perceived stress and BPD features.
In addition to the individual effects of household chaos and perceived stress, their combined effect was also assessed. The results indicated a significant interaction effect. That is, household chaos slightly strengthened the association between perceived stress and BPD features. This finding is in line with the Diathesis Stress Model [58], which describes how multiple risk factors may accumulate in predicting adverse outcomes. However, the effect size of the interaction in the current study was very small, so conceptual and clinical conclusions should not be drawn at this stage. Additionally, the effect did not persist in the longitudinal analyses. Perceived stress, household chaos, and BPD features seemed to be intertwined in the present rather than over time. This is in line with the identified associations between household chaos and BPD features, and perceived stress and BPD features, which were also restricted to the present. Previous research also indicated the complex interplay between individual and environmental factors prospectively linked to BPD [59], while at the same time emphasizing the importance of disentangling these factors to identify youth at risk of maladaptive development and provide targeted interventions. Multiple, intertwined factors are at play in the context of BPD, but the causal relationships in its development and maintenance have yet to be uncovered.

Limitations

Although the findings from the current study provide important insights, several limitations should be considered when interpreting the results. First of all, it should be mentioned that all the measures were self-reported. While individuals may often be the best informants of their own mental health and stress, it has been suggested that youth with BPD features show a lack of self-perception of stress [36]. Therefore, additional informants, like parents, could provide useful information when measuring constructs such as stress and household chaos.
The attrition rate in the current study should also be noted as a limitation. Although efforts were continuously made to include participants at 1-year follow-up, the drop-out was considerable. As has been the case in similar studies, recruiting and retraining youth with BPD features is challenging and the attrition rates are often high [50]. In the current study, the completers and non-completers did not differ on most study variables. Hence, the findings might not have been different had more participants been included at follow-up. Although following participants over a longer period of time is advised for future research, such a longitudinal design is often unfeasible in a clinical context. Instead, focusing on changes in age-appropriate functioning and activating growth could be a more relevant approach for youth with BPD [60].
Finally, the current study examined cross-sectional associations between the study variables and sought to predict change in BPD features, but the potential associations between baseline BPD and changes in perceived stress and/or household chaos were not examined. To gain a complete picture of the direction of effects, these associations should also be considered. This was beyond the scope of the current study because of the primary focus on BPD features. Moreover, the available data did not allow the application of more complicated statistical techniques required to examine bidirectional associations. A larger sample size and at least three waves would be needed to provide a robust test, ideally a random-intercept cross-lagged panel model [61]. This approach would also allow for a distinction of between- and within-person processes. Additionally, exploring the association of potential sex differences may be important. Due to the limited number of males in the present sample (n = 20), such differences could not be reliably explored in the current study. Future research could aim for a more balanced sex distribution to examine potential sex differences.

5. Conclusions

This study revealed that household chaos and perceived stress were concurrently related to BPD features in outpatient youth. These findings highlight the importance of addressing the stress and household chaos that youth with BPD features may experience in their daily lives. For vulnerable youth, exploring effective coping strategies may be especially important. While it may be tempting to interpret the associations as an indication of causality, our longitudinal analyses demonstrated that neither household chaos nor perceived stress (nor their interaction) was predictive of changes in BPD features over a 1-year period. The discrepancy between the cross-sectional and the longitudinal findings suggests that perceived stress and household chaos may be intertwined with BPD features, rather than being predictive for BPD features 1-year later. These findings emphasize the need for more longitudinal research to distinguish correlations from predictive factors and unravel the developmental course of BPD.

Author Contributions

A.A.: data cleaning, formal data analysis, writing—original draft, writing—review & editing. G.d.B.: data cleaning, formal data analysis, writing—original draft, writing. C.J.H.: project conceptualization, project coordination, writing—review & editing. O.M.L.: project conceptualization, project coordination, paper conceptualization, supervision, writing—original draft, writing—review & editing. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and ethical approval for the longitudinal study from which data were used was granted by the Utrecht University Faculty for Social and Behavioral Sciences (FETC 17-090 and FETC 23-0135).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available upon request from the corresponding author due to sensitive nature of the data and because the project is still ongoing.

Conflicts of Interest

The authors declare no conflict of interest.

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Youth 04 00093 g001
Figure 1. Interaction effect between household chaos and perceived stress on BPD features at baseline.
Figure 1. Interaction effect between household chaos and perceived stress on BPD features at baseline.
Youth 04 00093 g001
Table 1. Descriptive statistics (N = 143).
Table 1. Descriptive statistics (N = 143).
Demographics
AgeM (SD)18.72 (2.98)
Femalen (%)115 (80.4)
Variables
BPD features at baselineM (SD)9.84 (3.40)
BPD features at 1-year follow-upM (SD)8.82 (3.78)
Household chaosM (SD)2.61 (0.55)
Perceived stressM (SD)26.25 (5.53)
Abbreviations: SCID-II BPD-PQ = the BPD section of the screening questionnaire of the Structured Clinical Interview for DSM-IV Axis II, CHAOS = Confusion, Hubbub, and Order Scale, PSS = Perceived Stress Scale.
Table 2. Correlation coefficients between variables.
Table 2. Correlation coefficients between variables.
AgeSexBPD Features
at Baseline		BPD Features
at 1-Year Follow-Up		Household ChaosPerceived Stress
Age-
Sex−0.11-
BPD features
at baseline		−0.130.10-
BPD features
at 1-year follow-up		−0.150.100.60 **-
Household chaos−0.100.110.38 **26 **-
Perceived stress−0.100.150.50 **0.33 **0.28 **-
Abbreviations: BPD = Borderline Personality Disorder; Note: Sex 1 = male, 2 = female; ** p < 0.01.
Table 3. Estimates of cross-sectional regression analysis of household chaos and perceived stress on BPD features at baseline.
Table 3. Estimates of cross-sectional regression analysis of household chaos and perceived stress on BPD features at baseline.
BSEβp
Step 1Age−0.140.10−0.120.141
Sex (female)0.710.720.080.325
Step 2Age−0.080.08−0.070.355
Sex (female)−0.010.61−0.0020.983
Household chaos1.560.450.25<0.001 **
Perceived stress0.260.050.43<0.001 **
Step 3Age−0.050.08−0.050.508
Sex (female)−0.070.61−0.010.914
Household chaos1.680.450.27<0.001 **
Perceived stress0.250.050.40<0.001 **
Interaction between Household chaos and Perceived stress−0.130.06−0.140.046 *
* p < 0.05; ** p < 0.01.
Table 4. Estimates of longitudinal regression analysis for household chaos and perceived stress on BPD features at 1-year follow-up.
Table 4. Estimates of longitudinal regression analysis for household chaos and perceived stress on BPD features at 1-year follow-up.
BSEβp
Step 1Age−0.080.09−0.070.344
Sex (female)0.330.650.040.613
BPD features at baseline0.650.080.59<0.001 **
Step 2Age−0.080.09−0.060.365
Sex (female)0.270.660.030.679
BPD features at baseline0.620.090.56<0.001 **
Household chaos0.240.510.030.643
Perceived stress0.020.050.040.658
Step 3Age−0.080.09−0.060.358
Sex (female)0.280.660.030.674
BPD features at baseline0.620.090.56<0.001 **
Household chaos0.220.520.030.674
Perceived stress0.030.060.040.650
Household chaos x Perceived stress0.010.070.010.846
Abbreviations: BPD = Borderline Personality Disorder; ** p < 0.01.
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Aleva, A.; de Boois, G.; Hessels, C.J.; Laceulle, O.M. The Cross-Sectional and Longitudinal Associations between Household Chaos, Perceived Stress, and Borderline Personality Disorder Features in Outpatient Youth. Youth 2024, 4, 1469-1480. https://doi.org/10.3390/youth4040093

AMA Style

Aleva A, de Boois G, Hessels CJ, Laceulle OM. The Cross-Sectional and Longitudinal Associations between Household Chaos, Perceived Stress, and Borderline Personality Disorder Features in Outpatient Youth. Youth. 2024; 4(4):1469-1480. https://doi.org/10.3390/youth4040093

Chicago/Turabian Style

Aleva, Anouk, Geerte de Boois, Christel J. Hessels, and Odilia M. Laceulle. 2024. "The Cross-Sectional and Longitudinal Associations between Household Chaos, Perceived Stress, and Borderline Personality Disorder Features in Outpatient Youth" Youth 4, no. 4: 1469-1480. https://doi.org/10.3390/youth4040093

APA Style

Aleva, A., de Boois, G., Hessels, C. J., & Laceulle, O. M. (2024). The Cross-Sectional and Longitudinal Associations between Household Chaos, Perceived Stress, and Borderline Personality Disorder Features in Outpatient Youth. Youth, 4(4), 1469-1480. https://doi.org/10.3390/youth4040093

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