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Outcomes in adult life after specialized treatment for this population are unknown. We examined adult life outcomes in adolescents with recurrent suicidal and self-harming behavior and borderline features having participated in a randomized trial of dialectical behavior therapy (DBT-A) or enhanced usual care (EUC). Of the original 77 study participants, 61 (79%) were followed-up at a mean age of 28\u00a0years, an average of 12.4\u00a0years post-baseline. Primary outcomes were frequency of self-harm episodes and levels of suicidal ideation and depressive symptoms over the follow-up intervals. Secondary outcomes were borderline symptoms, psychiatric morbidity, occupational and psychosocial functioning. Self-harm frequency was consistently lower throughout the 12.4\u00a0year follow-up period in participants who had received DBT-A, although differences were not statistically significant at the final follow-up. Whereas suicide attempts were infrequent in both groups, self-harm episodes were more than twice as common in the EUC group compared to the DBT-A group with a mean difference of 90 episodes per person from baseline to 12.4\u00a0years follow-up. DBT-A was associated with significantly stronger reductions in suicidal ideation, depressive and borderline symptoms at end of treatment but differences tapered off until not statistically significant at the final follow-up. There were no significant trend differences in current psychiatric morbidity, self-reported depressive symptoms and global functioning. This first study of adult life outcomes of specialized psychosocial interventions for adolescents with recurrent suicidal and self-harming behavior and borderline features suggests that adolescents may have a realistic hope of sustained recovery as adults.<\/jats:p>\n                  <jats:p>\n                    Trial Registration:\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/ClinicalTrials.gov\/;NCT04298190\" ext-link-type=\"uri\">http:\/\/ClinicalTrials.gov\/;NCT04298190<\/jats:ext-link>\n                  <\/jats:p>","DOI":"10.1007\/s00787-025-02856-w","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T08:53:55Z","timestamp":1768553635000},"page":"983-994","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Adult life outcomes for adolescents 12.4\u00a0years after dialectical behavior therapy - a randomized clinical trial"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2813-0045","authenticated-orcid":false,"given":"Lars","family":"Mehlum","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1257-1906","authenticated-orcid":false,"given":"Iselin Soler\u00f8d","family":"Dibaj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1554-2326","authenticated-orcid":false,"given":"Egil","family":"Haga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6213-8578","authenticated-orcid":false,"given":"Sofie Egidius","family":"Helle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4158-4829","authenticated-orcid":false,"given":"Katharina T. 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