Borderline personality disorder (BPD) is one of ten recognized and categorized personality disorders in the Diagnostics and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), characterized largely by instability in two major aspects of life: self-image and interpersonal relationships. Other common characteristics include impulsivity, maladaptive or inappropriate behavior in different personal and social situations, and chronic feelings of emptiness.
While borderline personality disorder is a recognized and treatable condition in adults, its exact diagnostic criteria – specifically whether it can or should be diagnosed in children – remained up to debate for years. The International Statistical Classification of Diseases and Related Health Problems, 11th Revision (ICD-11) and DSM-V provide clear outlines for defining these conditions. There are various ways to diagnose and treat them.
However, some experts continue to argue that teens should generally not be diagnosed with BPD at all. In contrast, others find that there are cases where it is useful to identify and begin early treatment of BPD, especially if that treatment can help the teen learn to adjust and improve their long-term behavior. Either way, research suggests that teens exhibit symptoms of BDP differently from adults. Understanding how and why borderline personality disorder in adolescents develops can help parents provide better care and support.
A Primer on Personality Disorders
Personality disorders are misunderstood and contentious. Rather than stigmatizing individual differences and temperaments, these disorders serve to identify rigid or inflexible maladaptive patterns in behavior and thinking, leading to self-destructive and hurtful behavior.
These disorders disrupt patients’ lives and those around them, sometimes to a disastrous degree, and can be affected through targeted therapies and treatments. Personality disorders are diagnosed when a person’s thoughts and behaviors actively cause problems at home and work. Treating personality disorders can be tricky.
Teens and adults diagnosed with a personality disorder will rarely agree that they need treatment and will often find ways to blame others for their problems. Because paranoia and trust problems often feature so heavily in personality disorders, treatment suggestions may be intrusive or offensive to some.
Personality disorders often co-occur alongside other mental health problems, most notably substance use. This can further complicate treatment and require more intensive residential care. While there are ten recognized personality disorders in the international psychiatric community, these are usually categorized into three major clusters:
- Eccentric disorders (Cluster A)
- Dramatic disorders (Cluster B)
- Anxious disorders (Cluster C)
Borderline personality disorder is characterized as a dramatic disorder.
Borderline Personality Disorder in Teenagers vs. Adults
One of the greatest challenges behind accurately diagnosing a personality disorder in teens is that instability and a flexible self-image are common in adolescent mental development. This makes it harder to separate problematic or disordered behavior and thinking from what might be considered a normal part of growing up. Statistics also indicate that teens are more likely to have a personality disorder than adults, meaning that some do grow out of it without professional intervention.
Other considerations include the fact that teens are likely to shift in and out of meeting the diagnostic criteria for borderline personality disorder and often display subclinical symptoms (i.e., not severe enough to require treatment), escalate, and then fall back down. Worries around pathologizing normal developmental behavior and avoiding stigmatizing the patient can also affect how and when a teen is treated. To that end, the DSM states that adolescents can and should be diagnosed with BPD, provided specific criteria are met.
These include pervasive and unusual maladaptive behavior, lasting at least a year and unlikely to be tied to the teen’s emotional or mental development. This generally means that the criteria for diagnosing BPD in teens are stricter than in adults, as psychiatrists must go through great lengths to ensure that a teen’s actions and thoughts are consistently disruptive over a period of at least a year.
Providing early treatment in the form of talk therapy, developing a support system, and healthy coping mechanisms can drastically help teens reduce the effects of their diagnosis, as the disorder is addressed at the onset. This can also help reduce reliance on medication in the long-term and may improve outcomes.
Identifying Borderline Personality Disorder in Teenagers
The symptoms of borderline personality disorder can be different for teens than adults. In general, borderline personality disorder can include symptoms such as:
- Feelings of emptiness.
- Mood swings and lashing out.
- Self-harm or signs of depression.
- Self-destructive and risk-taking behavior.
- Struggling to manage and control emotions.
- Misinterpreting social cues (often exaggerating their meaning).
- Severe interpersonal trouble (arguments and rifts caused by emotional turmoil).
Individuals with BPD are often characterized by feeling intensely confused by their emotions and thoughts and lash out or seek validation to soothe their pain. This can feel manipulative and deliberately damaging towards others. Still, it is important to understand that these issues arise from constant inner turmoil and a lack of healthy emotional regulation skills.
How Are Personality Disorders Diagnosed?
Like any mental health disorder, a professional diagnosis is critical before beginning treatment. A qualified psychiatrist will discuss a teen’s thoughts and behaviors to gauge their emotions and responses and utilize various tests to rule out potential physical causes and alternate explanations for different symptoms.
A better understanding of a teen’s family life and family/medical history is also crucial for the diagnostic process. Certain areas of a teen’s life are specifically investigated for signs and symptoms of a borderline personality disorder, including:
- Their own self-image.
- Their relationships with others.
- Impulse control and risk-taking.
- Their grasp and awareness of self and reality.
- Their ability to regulate thoughts and emotions.
Treating Teenagers With Borderline Personality Disorder
Treatment for teen borderline personality disorder involves rigorous and repeated talk therapy to identify and address maladaptive coping mechanisms, thoughts, and behaviors. Central to many BPD cases is a warped sense of self and trouble with emotions and co-occurring disorders such as depression and substance use disorder.
An individualized treatment approach utilizing different talk therapies and emotional regulation training can help teens address their problems closer to the disorder’s onset before they become much harder to treat. Individualized treatment can also help address multiple disorders concurrently, including a dual diagnosis, through residential or outpatient programs.
If you or your loved one struggles with BPD symptoms, do not hesitate to seek professional help. An early diagnosis can drastically improve quality of life in the long-term.