Behavioral Sleep Problems in Childhood May Increase Risk of Psychosis, Borderline Personality Disorder in Adolescence

Behavioral sleep problems in childhood, such as impaired sleep duration and irregular routines, were associated with the onset of either psychosis or borderline personality disorder later in adolescence, signaling potentially different pathways based on personalized sleep issues.

Behavioral sleep problems in childhood, such as sleep duration and routines, were associated with the onset of psychosis and borderline personality disorder (BPD) later in adolescence, according to study findings published today in JAMA Psychiatry.

As study authors note, prior research has pointed to adolescence as a crucial developmental period for the onset of several mental disorders, including psychosis and BPD. Notably, the brain and hormonal changes occurring during adolescence create an increased risk of developing psychopathologic symptoms, with sleep serving as a key factor.

Moreover, sleep’s impact in childhood may signal the development of these conditions even earlier than adolescence. “Adequate sleep in childhood is essential for optimal cognitive and emotional functioning, and the potential association of sleep with frontal lobe functions is especially relevant in early childhood, when the brain shows substantial dynamic plasticity,” explained study authors.

While prospective studies have linked persistent nightmares in childhood with psychosis and BPD in adolescence, researchers note that distinguishable mechanisms and the extent to which behavioral sleep problems are associated remain unknown.

The study authors sought to further examine these potential associations by deriving data from the Avon Longitudinal Study of Parents and Children birth cohort on 13,488 participants born between April 1, 1991, to December 31, 1992, who were followed up for more than 13 years.

Of these participants, 7155 adolescents reported psychotic experiences at ages 12 to 13 years (3718 girls [52%]) and 6333 (3280 girls [52%]) reported BPD symptoms at ages 11 to 12.

In the study, psychotic experiences were assessed using the Psychosis-Like Symptom Interview, and BPD symptoms were tested using the UK Childhood Interview for DSM-IV Borderline Personality Disorder. Participants were assessed via parent-reported nighttime sleep duration, night awakening frequency, bedtime, and regularity of sleep routines, when each child was 6, 18, and 30 months, and 3.5, 4.8, and 5.8 years of age.

Researchers also examined whether depression at 10 years of age served as a potential mediator of associations to BPD and psychosis.

Based on analyses, higher night awakening frequency at 18 months of age (odds ratio [OR], 1.13; 95% CI, 1.01-1.26) and less regular sleep routines at 6 months (OR, 0.68; 95% CI, 0.50-0.93), 30 months (OR, 0.64; 95% CI, 0.44-0.95), and 5.8 years of age (OR, 0.32; 95% CI, 0.19-0.53) were significantly associated with psychosis in adolescence.

For those experiencing BPD symptoms in adolescence, shorter nighttime sleep duration (OR, 0.78; 95% CI, 0.66-0.92) and later bedtime at 3.5 years of age (OR, 1.32; 95% CI, 1.09-1.60) were significantly associated.

In the mediation analysis, depression at 10 years of age was found to mediate associations of frequent night awakenings at 18 months of age (bias-corrected estimate = −0.005; 95% CI, −0.008 to −0.002; P = .002) and irregular sleep routines at 5.8 years of age (bias-corrected estimate = −0.006; 95% CI, −0.010 to −0.003; P = .003) in those reporting symptoms of psychosis. However, depression was not found to mediate associations in those reporting symptoms of BPD.

“These findings suggest that the associations between childhood sleep and psychotic experiences as well as childhood sleep and BPD symptoms in adolescence follow different pathways. These results could contribute to the design of more personalized sleep and psychological interventions in psychosis and BPD,” concluded the study authors.


Morales-Muñoz I, Broome MR, Marwaha S. Association of parent-reported sleep problems in early childhood with psychotic and borderline personality disorder symptoms in adolescence. JAMA Psychiatry. Published July 1, 2020. doi:10.1001/jamapsychiatry.2020.1875