Borderline Personality Disorder in Teens

Borderline personality disorder symptoms are confusing, frustrating, and hard for loved ones to understand. This is particularly the case for parents or caregivers dealing with teens who have borderline personality disorder (BPD).

While we know a great deal about how borderline personality symptoms look in adults, we know much less about how the disorder presents in teens. In fact, there is still controversy over whether it is appropriate to diagnose teens with BPD. Many experts argue that teens can have BPD, and adolescent BPD is now recognized as an official diagnosis.

What Is Borderline Personality Disorder?

Borderline personality disorder is a serious mental health condition. It is characterized by instability in relationships, moods, self-image, and behaviors.

Many experts have argued that borderline personality should not be diagnosed in anyone younger than 18 since, technically, their personality is not yet fully formed. In the most recent edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), though, there is a provision that allows for the diagnosis of borderline personality before the age of 18.

Symptoms of BPD in Teenagers

While the symptoms of BPD as listed in the official DSM-5 diagnostic criteria are no different for teens and adults, some experts have suggested that there are differences in adolescent BPD symptoms.

Symptoms of borderline personality disorder include:

• Depression
• Frequent and intense changes in mood
• Fear of abandonment or rejection
• Difficulty maintaining relationships
• Impulsive and risky behavior
• Paranoia
• Self-harm
• Suicidal thoughts and behaviors

Symptoms, such as instability in interpersonal relationships, impulsive behavior, chronic emptiness, and unstable sense of self, may look different in teens. It may also sometimes be difficult to distinguish between symptoms of BPD and normal teenage challenges.

Diagnosis of BPD in Teenagers

In order to diagnose BPD in teens, doctors and psychiatrists will look not just at the individual's behavior but also their motivations for those behaviors. For example, engaging in substance use is not necessarily a sign that a person has BPD. However, if they engage in such behavior in order to avoid problems or feelings, or to manage emotions, that might be considered a sign of the condition.

Prognosis of BPD in Teenagers

For adults with BPD, the symptoms of the condition typically gradually decline with age, particularly past the age of 40. The progression and outlook for teens with the condition are less clear, although appropriate treatment can significantly improve the management of symptoms.

According to a review published in 2015, the remission rate for adolescents could range from 50% to 65%. However, it's also possible that some symptoms could remain even though some teens no longer met the diagnostic criteria for BPD.

Prevalence of BPD in Teenagers

A study published in 2014 suggested that rates of borderline personality in teens are slightly higher than in adults. This may be related to the fact that some teenagers display BPD in reaction to stressful events, but many are more likely to recover.

According to the National Institute of Mental Health (NIMH), 1.4% of adults over the age of 18 are affected by borderline personality disorder.

Prevalence rates are higher in psychiatric populations. Research has found that 11% of adolescents receiving treatment in outpatient clinics have BPD. This number climbs to 78% of teens admitted to the ER for suicidal behavior or attempts.

Risk Factors of BPD in Teenagers

The risk factors for borderline personality in adolescents are very similar to the risk factors in adults. In fact, many of the environmental risk factors for BPD occur during childhood. Some of the factors that may increase the risk of BPD include:

• Brain differences: Research has found that people who have BPD often have changes in areas of the brain that are associated with the regulation of emotions and impulses. 
• Environmental factors: Childhood abuse and neglect, as well as parental separation or loss, have been linked to borderline personality in adults and teens.
• Family history: Kids whose parents have serious mental health conditions (such as depression, substance abuse, or antisocial personality) are at greater risk for BPD.
• Genetic influences: In addition, there are likely biological risk factors for BPD, such as a genetic component of the disorder that is inherited.

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Prevention of BPD in Teenagers

If you are worried that your adolescent may be at risk for developing BPD based on either environmental risk factors (e.g., trauma exposure) or biological risk factors (e.g., a first-degree relative with the disorder), some experts believe that there are ways to modify the course of the condition.

Kids who experience externalizing disorders such as oppositional defiant disorder (ODD) and attention-deficit hyperactivity disorder (ADHD) appear to be more likely to develop BPD symptoms in adolescence. The presence of depression in adolescence appears to predict BPD during adulthood.

Treatment for BPD

While BPD is a serious and complex condition, there are effective treatments available that can help manage and reduce symptoms. Getting an accurate diagnosis and the use of appropriate treatments is important.

Psychotherapy

Several types of psychotherapy including cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) may be effective with teens with borderline personality.

• CBT can be useful for helping people learn to recognize and change negative thoughts that contribute to symptoms of the condition.
• DBT helps people address destructive behaviors, learn new skills, and find ways of tolerating distress and difficult emotions.

DBT has also been adapted for use specifically with adolescents. Dialectical-behavioral therapy for adolescents (DBT-A) involves individual psychotherapy and family skills training.

Medications

While there are no FDA-approved medications for BPD, there are medications that have been shown to reduce some of the symptoms.

• Second-generation antipsychotics, also known as atypical antipsychotics, can be useful for managing suicide risk when used in conjunction with psychotherapy.
• Anti-anxiety medications may also be prescribed on a short-term basis to help manage some symptoms. However, benzodiazepines should never be prescribed to treat BPD.
• Other medications, such as Ritalin (methylphenidate) and selective serotonin reuptake inhibitors (SSRIs), may also be prescribed to treat co-occurring ADHD and depression.
• Melatonin may also be useful for treating insomnia, which is often present with BPD.

Keep in Mind

Finding good treatment for an adult with BPD is hard, but given some of the controversial issues in diagnosing borderline personality in adolescents, finding a therapist for a teen with BPD is even harder. Fortunately, more and more therapists are being trained to treat teens with borderline personality. With treatment, remission and relief from symptoms is possible.