Understanding Borderline Personality Disorder (BPD) in Teens

Experts have long debated whether it’s appropriate to make a BPD diagnosis in teens. But research suggests early detection and treatment of BPD in teens is both possible and important for a positive outcome.

Borderline personality disorder (BPD) is a psychological condition involving a persistent pattern of unstable moods, a fear of abandonment, and an unclear sense of self.

While BPD has historically been diagnosed in adults only, it’s now widely recognized that it can be detected well before adulthood. Diagnosis in teens requires a careful evaluation by a mental health professional, and the process may take some time.

Yes, teens can be diagnosed with BPD. In fact, BPD is estimated to affect about 3% of adolescents in the general population.

But it’s important to note that diagnosing personality disorders in teens is a complex issue that’s been debated among experts for many years.

Some experts argue that the symptoms of BPD can mimic typical adolescent behavior, which can lead to a premature or inappropriate diagnosis. Others assert that early identification and treatment are necessary and can lead to better outcomes for young people.

Today, it’s generally accepted that the evidence for BPD in teens is strong enough to justify its diagnosis. Research suggests that teens as young as 11 can receive a reliable diagnosis. Keep in mind, however, that BPD is one of the most commonly misdiagnosed mental health conditions, according to the National Alliance on Mental Illness. It’s often mistaken for bipolar.

Many clinicians will give an unofficial diagnosis of “emerging personality disorder” to a teen who’s showing BPD-like symptoms. If symptoms still persist after some time, they often make a diagnosis of BPD.

While the diagnosis of a personality disorder typically requires a long-term pattern of symptoms, there may be some early signs that could indicate a higher likelihood of developing a personality disorder later in life.

Some of these early signs may include:

• social isolation or difficulty forming close relationships
• impulsivity or behavior that may have harmful effects
• intense mood changes or emotional instability
• persistent feelings of emptiness or loneliness
• chronic feelings of anger or irritability
• difficulty regulating emotions or coping with stress
• suspiciousness or paranoia
• persistent feelings of worthlessness or inadequacy

Potential symptoms of BPD in teens include:

• Intense emotions: Teens with BPD may have periods where they experience intense and highly fluctuating emotions, such as rage, sadness, or anxiety. These periods can last for hours or days.
• Lack of self-worth: Teens with BPD may have a distorted view of themselves and experience low self-worth or carry a sense of self-loathing.
• Chronic feelings of emptiness: Teens with BPD may feel a persistent sense of emptiness and have difficulty finding meaning or purpose in their lives.
• Impulsive behavior: Teens with BPD may engage in dangerous or impulsive behaviors, such as substance use or reckless driving.
• Unstable relationships: They may struggle to maintain stable relationships with friends and family members. They may also have a fear of abandonment and go to great lengths to avoid it.
• Self-harm or suicidal thoughts: Teens with BPD may engage in self-harming behaviors, such as cutting or burning, or have frequent thoughts of suicide.

It’s important to note that these behaviors alone do not necessarily indicate BPD, and a professional evaluation is necessary for an accurate diagnosis. In addition, these symptoms would need to be more intense and frequent than what’s seen in typical teen behavior.

Interestingly, research shows that a commonly seen symptom in adults with BPD — thinking that neutral or ambiguous facial expressions are actually expressing negative emotion — is not seen in teens.

The authors state that this symptom might occur later on in the disorder or may only be seen in more severe forms of BPD.

When diagnosing teens with BPD, clinicians use the same criteria used for adults in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

BPD in teens is defined as a year-long pattern of immature personality development with concerns in at least five of the following areas:

• efforts to avoid abandonment
• unstable interpersonal relationships
• identity disturbance
• inappropriate intense anger
• impulsivity
• suicidal and self-harming behaviors
• emotional instability
• chronic feelings of emptiness
• stress-related paranoid ideation

The first-line treatment for teens with BPD is psychotherapy.

This may include:

• Dialectic-behavioral therapy (DBT):DBT uses elements of cognitive behavioral therapy and is specifically designed to treat individuals with BPD. In DPT, the therapist will help you learn mindfulness strategies and build skills to manage intense emotions, improve interpersonal relationships, and cope with stress.
• Cognitive analytic therapy (CAT): CAT is a brief, structured intervention designed to help you gain insight into your patterns of thinking and behavior. You can learn new coping strategies and develop more effective ways of managing your emotions and relationships.
• Mentalization-based therapy (MBT):MBT is a form of psychotherapy that focuses on enhancing your ability to “mentalize,” or think about your own and others’ thoughts, feelings, and motivations. By improving these skills, you can develop more stable and satisfying relationships and reduce impulsive or self-destructive behaviors.
• Family-focused therapy (FFT):FFT is a type of family therapy that works to reduce family stress and improve communication among family members. It aims to help families better understand and support their teen’s treatment.

Medications, including second-generation antipsychotics, may be helpful for some people with BPD. A clinician will take a variety of factors into consideration to determine whether medication would be helpful.

BPD is a common personality disorder with symptoms such as intense mood shifts, abandonment fears, and lack of self-esteem. While previously only diagnosed in adults, BPD is now widely recognized as being diagnosable in adolescence.

If you believe you or your teen may have BPD, consider reaching out to a healthcare professional. A comprehensive evaluation by a doctor is important to ensure an accurate diagnosis and appropriate treatment.

Last medically reviewed on April 11, 2023

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