If you have a teen, you want to help them navigate the ups and downs of life, and when you have a teen who shows symptoms associated with borderline personality disorder (BPD) – and they’ve received a full psychiatric assessment – you want to do your best to help them manage the symptoms of this challenging mental health disorder.
If you, your teen, and your family have already been through the assessment and diagnostic process, then you understand that clinicians cannot officially diagnose personality disorders before a patient is 18 years old. However, recent research shows that in teens who display borderline psychopathologies, the course of those pathologies follow a similar pattern to BPD diagnoses in young adults. In addition, the symptoms – the borderline psychopathologies – respond to the same type of treatments that help young adults and adults manage BPD.
If you and your family haven’t been through this assessment and diagnosis process, then you may need to learn more about BPD overall. To learn more – thereby helping – please navigate our website to our blog and read this article:
BPD Awareness Month: How Can I Tell if my Teen has Borderline Personality Disorder (BPD)?
That article includes a clinical definition of BPD, the primary symptoms of BPD, risk and protective factors associated with BPD, and the latest evidence-based approaches for BPD treatment. We recommend that article for you and any family member: the more you know, the more you can help your teen in the here and now.
And it’s important to know that treatment for BPD can work.
Help for a Teen With Borderline Personality Disorder
The lead scientist on the research effort we mention above, Dr. Carla Sharpe, describes the contemporary approach to BPD:
“Like adult BPD, adolescent BPD appears to be not as intractable and treatment resistant as previously thought. That means we should not shy away from identifying BPD in adolescents and we shouldn’t shy away from treating it.”
She continues, with a message for clinicians reluctant to engage with or treat patients under age 18 that show BPD symptoms:
“Don’t put your head in the sand! If the pathology is there, diagnose it and treat it with your best evidence-based treatment.”
This advice to face early BPD head-on rather than shy away from treating symptoms of BPD in teens is based not only on her research, but on previous studies. Evidence shows 35 percent of patients diagnosed with BPD enter remission after 2 years, 91 percent entered remission after 3 years, and 99 percent entered remission after 16 years. In that study, researchers defined remission as no longer meeting criteria for BPD diagnosis.
As the parent of a teen with BPD, you know that BPD often co-occurs with major depressive disorder, bipolar disorder, anxiety disorders, eating disorders, and alcohol and or substance use disorders. You may also be aware that while most people think BPD is extremely rare, close to 14 million people have BPD. That’s more people than bipolar disorder and schizophrenia combined. What that means is that you, your family, and your teen are not alone, and that millions of people nationwide can relate to what you’re going through.
Treatment for Your Teen: What Works for BPD?
If your teen already has a diagnosis for borderline personality disorder and/or borderline-type pathologies or symptoms, it’s likely you also know that evidence-based treatment for BPD includes family participation in the treatment process, and a combination of psychotherapy and medication. Psychotherapeutic approaches may include:
- Dialectical Behavior therapy (DBT)
- Systems training for emotional predictability and problem solving (STEPPS)
- Supportive psychotherapy
- Various psychodynamic techniques
Medication for BPD may include:
- Mood stabilizers
- Antipsychotics (second generation)
- Antidepressants
While the exact combination of treatment approaches vary by the individual and the treatment team, on thing almost all clinicians agree in is that personality disorders are far more likely to resolve or enter remission with professional, specialized support.
What You Can do to Help Your Teen
The most important steps are to get a full psychiatric assessment, ensure your teen has an accurate diagnosis, and find and initiate professional support delivered by experienced clinicians who understand how to work with adolescent BPOD symptoms. If the clinicians ask you to participate in family therapy or workshops with your teen, it’s important to engage in that process.
Beyond getting an accurate diagnosis, finding professional treatment, and following the advice or the treatment team, we’ve compiled a list of ten things you need to know or do in order to help your teen as they learn to manage the symptoms of BPD.
Help Your Teen With Borderline Personality Disorder: Ten Tips
1. Common approaches to parenting aren’t likely to work.
Most parents establish basic rules with clear consequences. However, this can alienate a teen and increase their mistrust, and may result in the escalation of challenging behavior.
2. Feelings are primary.
It’s important to understand that acting out and problem behaviors most often stem from fear of abandonment. When a child is afraid or in a fearful state, logical debate or argumentation is ineffective. What they need most is emotional support, compassion, and the kind of genuine empathy that makes them feel safe and understood.
3. Resist being directive or terse.
When problematic behavior occurs, engage them with empathetic statements and leading questions, such as, “This situation must be upsetting. How do you plan to figure things out?” Help them formulate a solution that comes from them that will work for them.
4. Create a calm, consistent, safe, and peaceful home environment.
Your stability, and the consistency of the surroundings you create, can help act as an anchor when they’re lost at sea.
5. Lying and memory problems are part of BPD.
Dissociation, a common symptom BPD, involves temporarily detaching from current reality in order to protect oneself from painful emotions or experiences. In teens with BPD, dissociation can lead to issues with lying and memory that seem intentional. However, most often, lying and saying things like “I don’t remember yelling at you,” when they did, in fact, yell at you are consequences of dissociation, rather than lying with malice.
6. Self-harm is about emotions.
With regards to non-suicidal self-injury (NSSI), which includes self-harming behaviors like cutting, burning, hitting, scratching, or unhealthy restrictive eating, it’s important to address the underlying emotions that led to the behavior. Again, this is a case of using compassion rather than logic. Explaining why self-harm is dangerous and non-productive probably won’t help, because the behaviors are most often an indication of intense emotional pain your teen has no idea how to talk about or talk about.
7. Expect temper tantrums and volatile emotions.
While outgrowing temper tantrums is a sign of typical child development and most often occurs by age 5 or 6, around the time a child moves from kindergarten to first grade, people with BPD may still throw violent, scary temper tantrums during adolescence and early adulthood. Don’t take them personally. Understand the extreme displays of emotion are rooted in a sense of isolation, not feeling heard or understood, and a fear of abandonment.
8. When they act out, do your best to stay tranquilo.
The situations can be tense, frightening, and difficult. Avoid adding fuel to the fire by responding emotionally, being reactive, or getting in a power struggle. Remember: if you get in a power struggle with a teen, you already lost. Stay calm, and model the healthy processing of emotion.
9. Never ignore suicidality.
Suicidal ideation and suicide attempts are part of the diagnostic criteria for BPD. That means you can expect this type of behavior. It’s important to take each instance of suicidality seriously, and enlist the support of your professional treatment team right away.
10. Lead with love, empathy, and compassion.
The primary emotion that drives the problematic behaviors associated with BPD is fear. Your teen fears you may leave them alone, never loved them, and never will love them. They need to feel a sincere sense of attachment, which you reciprocate. They need your constant reassurance you love them unconditionally. And they need to know you’re there for them through the tough times, and you’re committed to helping them learn to manage their emotions and find balance in their lives.
Resources for Families
The National Education Alliance for Borderline Personality Disorder (NEABPD) is an excellent clearinghouse for helpful information for people with BPD and their families. They describe the following resources as “accurate and honest”:
- The National Alliance on Mental Illness (NAMI) page on BPD
- McLean Hospital page on BPD
- The National institute of Mental Health page on BPD
- The Mental Health America BPD fact page
In addition, you can download this fact sheet from the NEABPD for a quick overview of BPD facts. The big picture takeaway for parents is that although BPD can be frightening, treatment can work. Your family can rediscover balance. Most importantly, though, please understand that with the right support, you can help your teen can learn to manage borderline personality disorder: your family can heal, and your teen can live a full and fulfilling life.
