Teens and BPD: Understanding the Signs, Struggles, and Support That Matters

Understanding Borderline Personality Disorder

Borderline personality disorder (BPD) is a complex mental health condition in which people often struggle with self-image, mood swings, impulse control, an intense fear of abandonment, and low feelings of self-worth.

BPD may cause people to have a difficult time controlling their emotional reactions to certain situations. It’s not unusual for people with BPD to live with other mental health conditions, such as eating disorders, anxiety, depression, and substance use disorder.

BPD is more common than many people realize, affecting between 0.9% to 3% of those younger than 18. This number may be higher, however, because many people with BPD are misdiagnosed with PTSD, ADHD, bipolar disorder, or depression.

An estimated 10% of psychiatric outpatients, 20% of psychiatric inpatients, and 6% of people visiting their primary health care provider have BPD.

Because the disorder is common—and complex—it’s important to recognize its signs and symptoms. The sooner BPD is diagnosed, the faster it can be treated.

What Does Emerging BPD Look Like in Teens?

Like with any mental health diagnosis, what’s within a normal range for that person’s age, culture, and so on, is taken into consideration. When mental health professionals consider a BPD diagnosis, they look for the following key symptoms:

• An intense fear of abandonment
• Unstable relationships with family members and friends
• An unclear or constantly shifting self-image
• Impulsive or self-destructive behaviors
• A pattern of self-harm
• Extreme emotional swings, particularly in response to seemingly minor issues
• Chronic feelings of emptiness or loneliness
• Explosive periods of anger
• A feeling of being out of touch with reality

The following are significant symptoms that may indicate borderline personality disorder in a child or teenager.

Behavioral Dysregulation

This is one of the first signs people may notice, with some teens engaging in self-harming behavior. They may cut themselves, burn their skin, or punch a wall. Plenty of other issues may appear as well: the child or teen may use substances or engage in dangerous sexual behavior.

Relationship Problems

Many kids and teens with emerging BPD have trouble managing relationships. They may have an intense fear of abandonment or may have trouble controlling their anger. When very emotionally distressed, some teens may hold irrational or paranoid beliefs. These fears and beliefs may make it hard to develop friendships or romantic relationships.

Strong Emotional Reactions

There may be strong emotional reactions to seemingly minor issues, where they may appear to overreact to everything. Minor issues may feel like the end of the world.

It is difficult for health care professionals—and parents—to look at these signs and know whether an adolescent has emerging BPD or if the individual is simply going through a normal teenage phase.

With this in mind, a teenager who displays any or all of the characteristics associated with BPD might look around and ask themselves: “Does it seem that other people can deal with things I can’t deal with?” or “Why aren’t others struggling like I am?”

A teenager who feels strong emotions for longer periods than others or takes longer to get back to their emotional baseline may have the condition. Strong reactions to seemingly small irritations—a sense that minor issues feel like the “end of the world” and that behaviors like self-harm, drugs, or death seem to be the only way to make these stop—could be signs of a serious problem.

Teens with these actions and reactions should seek help for their symptoms.

How BPD Differs in Adolescents and Adults

BPD is a personality disorder that has historically been diagnosed in adults. However, despite the common misconception that BPD does not occur in those younger than 18, a significant body of evidence suggests it is possible for children and adolescents to begin to develop BPD before age 18.

Neither the current Diagnostic and Statistical Manual of Mental Disorders (DSM) nor the older versions of the DSM prohibit the diagnosis of BPD in young people.

According to BPD expert Blaise Aguirre, MD, “It is outrageous to think a clinician would not diagnose BPD when a person is seventeen years and 364 days old and then diagnose it the next day when the teen turns eighteen.”

Because teen personalities are still forming, young people may undergo many changes before they’re considered an adult. Mood swings, instability, and other symptoms may be a sign of hormonal fluctuations, stress, or anxiety.

Those who are experiencing symptoms of borderline personality disorder need help—don’t wait to seek care in the hopes that a behavior is “just a phase” or “they’ll grow out of it.”

The importance of early diagnosis cannot be stressed enough. The sooner BPD symptoms are diagnosed, the faster treatment can begin and the better the chance to live a successful, meaningful life.

How Does BPD Develop in Children and Teens?

Just like adults, kids react to situations with their own unique responses. If you were to touch the arm of a very ticklish child and touch the arm of one who isn’t, they would react very differently.

The same holds true when it comes to the reactions of people with borderline personality disorder versus those without it.

When children grow up in a social or family environment that does not match their temperament, they may develop poor self-esteem and a lack of self-confidence. They may have a hard time trusting others and have issues with their own identity.

When these children become teens, they can feel lost and engage in high-risk behaviors. They may look for ways to deal with feelings of emptiness—this is when symptoms of BPD can emerge.

Teens can begin to experience periods of depression, which can easily progress into self-harming behavior or thoughts of suicide. These issues require immediate attention and the introduction of effective treatment.

Any thoughts, feelings, or signs of self-harm must be addressed as quickly as possible.

How BPD Symptoms Are Diagnosed in Young People

BPD requires a licensed health care professional to properly assess symptoms and rule out other potential causes. A trained mental health professional diagnoses BPD by talking with the patient and examining the functioning and reasoning behind each of the teen’s behaviors.

To understand BPD, it’s important to learn why a person may be engaging in a certain manner. Why are they taking risks? Why do they appear to be acting irrationally?

For example, many teens experiment with drinking. Many young people drink to fit in, bond with friends, or experience something new. Just because a teen starts drinking doesn’t mean they have BPD.

On the other hand, if someone is drinking in order to change the way they feel fundamentally, it could be a sign of the condition. Someone with an underlying mental health condition may start to drink to avoid problems.

Other, less dangerous behavior could indicate an issue as well. For example, many teens with BPD lock themselves in a room and study for hours on end. This is an effort to avoid dealing with more serious problems.

Even though this may not seem like risky behavior, it could be a sign they’re having issues managing their emotions. When a teen patient meets with a therapist, they will discuss such situations and learn the skills needed to successfully manage their condition.

How Is Emerging BPD Treated in Teens?

It’s important to know that BPD is treatable. It is possible for teens and their families to find relief after an accurate diagnosis has been made and the patient is engaged in evidence-based treatment.

There are two therapies proven to be helpful for young people living with borderline personality disorder: dialectical behavior therapy (DBT) and general psychiatric management (GPM).

Dialectical Behavior Therapy

DBT is a popular treatment option for BPD. This highly effective therapy targets self-harm and suicidal behavior. It addresses destructive behavior, such as substance misuse.

During sessions, therapists work with teens to break down behaviors. Then, they give teens the skills they need to handle difficult situations and emotional circumstances.

Dialectical behavior therapy emphasizes four separate skills sets:

• Mindfulness
• Emotion regulation
• Interpersonal effectiveness
• Distress tolerance

DBT is often combined with cognitive behavior therapy (CBT) to help teens maximize each treatment session. Teens can better control their emotions, stop self-destructive behaviors, and have an easier time managing their feelings.

In DBT sessions, teens learn how to:

• Be non-judgmental about their own experiences and those of others
• Increase positive experiences
• Manage overwhelming emotions that prevent them from taking control of their lives
• Communicate effectively with others
• Accept situations they have no control over

General Psychiatric Management

General, or good, psychiatric management (GPM) combines key components of other treatment types to provide care to patients even if specialized or more resource-intensive treatments are not available. Studies have shown that GPM can be as effective as DBT in treating BPD.

GPM for adolescents (GPM-A) is the same treatment method but adapted for young people. It focuses on providing young patients with the life-building skills needed to understand and effectively manage their condition.

These skills help patients focus on the idea that they aren’t just a patient, but instead, are still living a full life outside of treatment.

Kids and teens with BPD who engage in GPM-A treatment can develop non-reactive critical thinking skills, discover what they are good at, and learn how to view their experiences in a healthier manner.

Even though DBT and GPM can be highly effective, they are not appropriate for every patient. In addition, neither of these treatments are more effective than the other. Your mental health care provider can help you decide which method of treatment is right for you.

Your treatment team may suggest other forms of therapy that they believe may be most effective in relieving symptoms and helping you lead a better life.

It is always important to do your own research and ensure that the type of therapy suggested is backed by research and performed by a licensed mental health professional.

Finding the Right BPD Therapist

Every person is different, and it’s important to customize a treatment plan to meet the needs of the individual. Teens and their families need to find the right therapist. A qualified, licensed professional can make a great difference in someone’s recovery.

Therapy is a safe space where teens can start to work through their relationship and trust issues. They can also experiment with coping techniques.

Before families decide on a therapist, it’s important to sit down with them first. Many teens find it helpful to interview the therapist to make sure they communicate well with one another.

A therapist could be highly qualified, but may still not be the best fit. Ultimately, in addition to a therapist’s qualifications, the relationship between a therapist and patient is incredibly important.

Can Medication Be Used to Treat BPD?

Even though some patients with borderline personality disorder take medication to help with symptom management, the FDA has not approved any medications specifically for the treatment of BPD.

It is common for people who have BPD to take medication to help reduce their symptoms or to help manage other disorders or symptoms, including depression, anxiety, bipolar disorder, or psychosis.

While medication can be helpful, individual and group therapy using DBT or GPM is the most effective treatment option for those who have been diagnosed with BPD.

Family Involvement in BPD Treatment

Teens need a strong emotional support structure as they go through treatment. Family members are encouraged to be involved during the treatment process.

Parental involvement can lead to improved outcomes, including better family functioning overall, which helps increase family participation in treatment. When parents and siblings are a part of treatment, everyone can benefit.

When teens feel their family members are supportive of them, they may be more open about seeking treatment or being active in treatment.

Many families struggle to understand the behaviors and symptoms of loved ones who have been diagnosed with BPD.

Some families find it difficult to acknowledge that teens are experiencing an actual mental health condition. When someone has BPD, it can affect how the family functions. Furthermore, unhealthy family dynamics can worsen a person’s BPD symptoms.

Family therapy can help everyone better understand this condition and learn how to cope with it. It teaches family members to identify cycles of negative reinforcement or difficulty with managing diagnoses and how to break from them.

This can improve the prognosis of the person who has been diagnosed with BPD.

Help Is Available!

Borderline personality disorder is a serious condition that can impact children and teens. It’s important for anyone who has been diagnosed with BPD to understand they are not alone.

If you think you or someone you care about may have BPD, it’s important to seek help as quickly as possible.

With access to the right treatment method and a trained therapist, people with BPD can have satisfying relationships, a strong sense of self-worth, and lead meaningful lives.

Contributors

Alan E. Fruzzetti, PhD