Borderline Personality Disorder in Teens

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Borderline personality 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. Still, many experts argue that teens can have BPD, and adolescent BPD is now recognized as an official diagnosis.

Many parents have questions about borderline personality in adolescents. Some are worried that their teen is exhibiting the signs of borderline personality disorder (BPD), such as intense and frequent mood swings, impulsive behaviors, self-harm or difficulties in relationships. Others have BPD themselves and are worried that their kids will also have the disorder.

Overview

This is a hotly debated question; 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. Technically, this provision also allows for the diagnosis of BPD in children under 13, but this is very rare.

Symptoms

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, such as instability in interpersonal relationships, impulsive behavior, chronic emptiness and unstable sense of self, may look different in teens.

Prognosis

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

According to a study published in 2014, 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.

Risk Factors

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. For example, childhood abuse and neglect, as well as parental separation or loss, have been linked to borderline personality in adults and teens. Research has also found that kids whose parents have serious mental health conditions (e.g., depression, substance abuse or antisocial personality) are also at greater risk for BPD. In addition, there are likely biological risk factors for BPD, such as a genetic component of the disorder that is inherited.

Prevention

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), you will be happy to know that experts believe that for some teens there are ways to prevent the disorder.

Treatments

Several types of psychotherapy, including dialectical behavior therapy and cognitive-behavioral therapy, may be effective with teens with borderline personality. In addition, while there are no FDA-approved medications for BPD, there are medications that have been shown to reduce some of the symptoms.

Resources

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.

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Article Sources

  1. Kaess M, Brunner R, Chanen A. Borderline personality disorder in adolescence. Pediatrics. 2014;134(4):782-93. doi:10.1542/peds.2013-3677

  2. Biskin RS. The Lifetime Course of Borderline Personality DisorderCan J Psychiatry. 2015;60(7):303–308. doi:10.1177/070674371506000702

  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington D.C.: 2013.

  4. Guilé JM, Boissel L, Alaux-Cantin S, de La Rivière SG. Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategiesAdolesc Health Med Ther. 2018;9:199–210. Published 2018 Nov 23. doi:10.2147/AHMT.S156565