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BPD Awareness Month: How Can I Tell if my Teen has Borderline Personality Disorder (BPD)?

If you’re the parent of a teen with mental health issues, but you’re not a mental health professional, you may not know the signs and symptoms borderline personality disorder (BPD). That’s not at all unusual, because it’s relatively difficult to understand – and the symptoms may be confusing – and a little bit frightening, too.

The first thing we need to tell you – and we have data for this below – is that the long-term prognosis for people with borderline personality disorder is encouraging. In fact, a 16-year study on close to three hundred patients with BPD showed the following:

  • 2 years: 35% remission
  • 10 years: 91% remission
  • 16 years: 99% remission

That doesn’t mean the early stages of BPD are easy for the teen or the family, which brings us to the core issue that patients with personality disorders experience. This is a general quality to watch for in your teen, if you think they have symptoms associated with BPD:

People with BPD have an unstable sense of self, which doesn’t always match reality and impairs their understanding of how their behavior affects others.

That’s what makes BPD difficult for families. The symptoms of BPD – for someone with a typical, stable sense of their personality and who they are – can lead to unpredictable and sometimes volatile behavior that seems completely irrational and disconnected from reality. And while the long-term prognosis for people with BPD shows most enter remission over time, it’s critical to understand that BPD and other personality disorders rarely resolved without professional support and care.

In this article, our goal is to help you understand BPD, identify the factors that increase risk of BPD, learn the symptoms of BPD, the consequences of untreated BPD, and the evidence-based treatments that can help teens with BPD manage the disorder and live full and productive lives.

Hope and Optimism Make a Difference

We completely understand that if you’re reading this article, you’ve likely seen behavior in your teen that’s concerning or upsetting. Whether your teen has borderline personality disorder or not, our hope for you is that after reading this article, you’ll understand that with professional treatment and support, your teen and your family can meet and overcome the challenges presented by mental health issues like BPD and others. For you and your family, it’s important to remember that essential elements of any healing process are hope and optimism: hope based and the belief that evidence-based treatment is effective, and optimism derived from the fact that many individuals and families have learned to live a full and fulfilling life when a loved one has BPD.

What is Borderline Personality Disorder (BPD)?

National Institute of Mental Health (NIMH) offers the following definition of BPD:

“Borderline personality disorder is a mental illness that severely impacts a person’s ability to regulate their emotions. This loss of emotional control can increase impulsivity, affect how a person feels about themselves, and negatively impact their relationships with others.”

That part of the definition explains how BPD can begin to impact family life. However, the components of BPD that cause the most disruption are related to this aspect of BPD, also described by the NIMH:

 “People with borderline personality disorder may experience intense mood swings and feel uncertainty about how they see themselves. Their feelings for others can change quickly, and swing from extreme closeness to extreme dislike.”

This type of behavior is often what disturbs parents, siblings, and other family members the most. The teen they know and love can be loving and happy in one moment, and the opposite in the next. The NIMH further explains this aspect of BPD:

“These changing feelings can lead to unstable relationships and emotional pain. People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their interests and values can change quickly, and they may act impulsively or recklessly.”

Clearly these types of symptoms and associated behavior can upset balance and harmony in family life. One of the most important things for parents and family members to learn is to not take the behavior personally – far easier said than done – and to understand that at the root of borderline personality disorder is an intense, powerful fear of abandonment.

Parents: Early Signs to Watch for in Your Teen

A paper published recently examined over a dozen studies conducted over the past 40 years on BPD and the factors present during childhood associated with elevated risk of developing BPD as an adolescent. This research can help parents put any symptoms they observe in early adolescence in the context of behavior they observed earlier in childhood.

Here are factors the researchers identified:

  • Intense, powerful emotions
  • Extremely active/impulsive
  • Limited ability to interact successfully/socialize with other kids
  • Persistent low mood
  • Defiance/opposition
  • Hyperactivity

Additional evidence from the review article showed that the presence of the following mental health disorders during childhood increase risk of developing BPD during adolescence:

  • Oppositional defiant disorder (ODD)
  • Major depressive disorder (MDD)
  • Anxiety (GAD)
  • Attention deficit hyperactivity disorder (ADHD)

Finally, the research indicated that the presence of alcohol use disorder (AUD) or substance use disorder (SUD) during adolescence also increased risk of BPD. Based on this data, the researchers developed a list of childhood and early adolescent factors associated with risk of adolescent BPD:

  • Challenging behaviors associated with extreme emotions
  • Diagnosis of ODD, MDD, GAD, and/or ADHD
  • Experiencing bullying from peers
  • Witnessing interpersonal violence in the family
  • History of physical, sexual, or emotional abuse

If you’re the parent of a teen who showed these behaviors or experienced these circumstances during childhood, we need to offer this disclaimer: this article cannot diagnose your teen. Only a mental health professional experienced working with adolescents can do that. Therefore, when you read the list of symptoms we provide below, please try to avoid jumping to conclusions. This article can help you understand the behavior you see and inform your decisions moving forward.

Diagnosing BPD: Clinical Criteria

We’ll continue the disclaimer here: if your child meets the criteria above and also meets the diagnostic criteria below, your first step should be arranging a full psychiatric assessment administered by a mental health professional with extensive experience diagnosing mental health disorders – particularly BPD – in teens and young adults.

With that said, let’s look at how professionals diagnose BPD. The National Institutes of Health (NIH) provides the following list of symptoms. To receive a BPD diagnosis, and individual must show at least five of the following:

  • Frantic efforts to avoid abandonment
  • Extreme instability in relationships, characterized by alternating between extremes
  • Unstable, inconsistent sense of self
  • Two areas of potentially dangerous impulsivity, not including suicidal ideation
    • Alcohol and substance use
    • Dangerous driving
    • Unsafe sexual behavior
    • Binge eating
  • Extreme mood swings/mood instability with intense negative moods that can last more than several hours and, in come cases, several days
  • Pervasive, chronic sense of emptiness
  • Extreme, inappropriate anger
  • Anger management issues:
    • Tantrums
    • Chronic anger
    • Fighting
  • Paranoia
  • Dissociation

Those are the primary symptoms of BPD. Again, if you see these in your teen, professional support is your next best step. The consequences of untreated borderline personality disorder include:

  • Suicidality
  • Non-suicidal self-injury
  • Alcohol and drug use
  • Risky behavior
  • Impaired academic achievement
  • Inability to find and maintain employment
  • Problems forming stable relationships

Those are serious consequences, which makes treatment for BPD essential. It’s also relevant to remind you that patients with BPD – despite the extreme symptoms and volatility – can learn to manage the disorder, and the ongoing support and commitment of the family is one of the keys to successful treatment.

We’ll review the current standards of care for BPD now.

Treatment for Teen Borderline Personality Disorder

Evidence shows that for a teen, the most effective approach to treating borderline personality disorder includes a combination of therapy and medication.

Psychotherapeutic approaches include:

  • Dialectical behavior therapy (DBT)
  • Systems training for emotional predictability and problem solving (STEPPS)
  • Psychodynamic approaches:
    • Mentalization based psychotherapy
    • Transference-focused psychotherapy
    • Schema-focused psychotherapy
  • Supportive psychotherapy
  • Medication:
    • Mood stabilizers
    • Second generation antipsychotics
    • Antidepressants

With the right therapists and family involvement, healing is possible. In the study on long-term outcomes we mention in the introduction to this article, we mention that the long-term outcomes for people with BPD indicates a majority, over time, enter remission. However, they propose that a contributing factor to remission of symptoms could be associated with a decrease in social contact, and reduced participation in activities with others where symptoms would be noticeable and cause disruption – but that’s their informed speculation, rather than a conclusion based on experimental data.

Protective Factors Associated With BPD Remission

While the exact reasons BPD often enters full remission in the years following diagnosis are unknown, we do know the treatment approach we describe above helps patients manage acute symptoms and make progress in the short-term. In addition, researchers identified other factors – aside from evidence-based treatment – associated with remission: no additional mental health disorders, no history of sexual abuse, and no history of alcohol or substance use disorder in the family.

These are known as protective factors, and their presence – i.e. the absence of additional disorders and abuse – increases the likelihood of successful treatment.

That’s why we focus on hope and optimism: despite the fact the BPD is a complex mental health disorder, healing is possible, and within reach.

How to Find Support for Teen Borderline Personality Disorder: Online Resources for Families