The transition to adulthood is naturally a time of insecurity, shifting relationships and intense emotions. But for some people, the intensity never lets up. Hypersensitivity to social interactions leads to a persistent pattern of emotional outbursts, unstable relationships, and harmful behaviors. These are all symptoms of Borderline Personality Disorder (BPD) in teens.
Until recently, experts have recommended waiting until personality stabilizes in adulthood before diagnosing an individual with BPD. But given the toll that BPD takes on individuals and their families, not to mention the high rates of suicide associated with the disorder, that advice is changing. Research demonstrates that BPD can be reliably diagnosed in adolescence, and that early intervention can change the course of the disorder.
With the right treatment approach, teens with borderline personality disorder can successfully learn to regulate their overwhelming emotions, control self-destructive behavior, and lead a healthy life.
Key Takeaways
- Teen Borderline Personality Disorder (BPD) is characterized by hypersensitivity to social interactions, leading to a persistent pattern of emotional outbursts, unstable relationships, and harmful behaviors.
- Research demonstrates that BPD can be reliably diagnosed in adolescence, and that early intervention can change the course of the disorder.
- BPD symptoms sometimes first emerge in childhood, typically increasing with the onset of puberty and worsening with the complex emotional demands of the teenage years.
- Successful treatment for BPD includes a variety of approaches that target different aspects of emotional regulation.
What Is Borderline Personality Disorder in Teens?
BPD is one of 10 personality disorders listed in the Diagnostic and Statistical Manual 5. The term “personality disorder” can be misleading and stigmatizing, as it suggests that someone is broken or inadequate. Rather, a personality disorder refers to a rigid and unhealthy pattern of thinking, functioning, and behaving in response to social and environmental stressors.
People without BPD or other personality disorders may behave in similar ways from time to time. But they have the flexibility to react in different ways. A response pattern is termed “disordered” when it is persistent, inflexible, causes distress, and interferes with a person’s ability to function normally in daily life.
The term “borderline” is also not very descriptive. The condition was named by early researchers who regarded BPD symptoms as on the “borderline” between disorders marked by emotional distress and disorders marked by hallucinations or delusions. Hence, some experts have advocated for renaming the condition. You may also see it called Emotionally Unstable Personality Disorder, Emotional Intensity Disorder, or Borderline Pattern Personality Disorder.
Causes of Teen Borderline Personality Disorder
As with some other mental health disorders, the causes of borderline personality disorder are not fully understood. Without a doubt, there is a definite mix of environmental and genetic factors. Potential BPD causes include the following:
Teen BPD Genetic Factors
No specific BPD gene has yet to be identified. Still, studies in twins reveal a strong hereditary link. Thus, scientists conclude that genetics play a role in borderline personality disorder.
BPD genetic studies are gaining momentum. However, these preliminary findings await replication. Larger sample sizes and more precise methodologies are needed. Still, per recent scientific models, borderline traits concentrate in families. Such a concentration implies a genetic predisposition for the disorder. Indeed, borderline personality disorder is five times more common with a previous BPD diagnosis in the family.
Neurological Factors in BPD
People with BPD lack the neural capacity needed to inhibit negative emotions. Thus, the part of the brain that regulates emotions and controls impulses functions differently, leading to BPD symptoms.
BPD and Teen Trauma
Teens with BPD may have a history of childhood trauma. Often, this trauma includes physical abuse, extreme stress, and/or abandonment. Many people with borderline personality disorder report such traumatic life events during childhood. Early exposure to unstable relationships and hostile conflicts also are potential factors.
73%
of patients with BPD will make 3 or more suicide attempts in their lifetime
1 in 10
people with BPD will die by suicide
50x
The rate of death by suicide for people with BPD is 50 times that of the general population
Signs and Symptoms of Borderline Personality Disorder in Teenagers
Until recently, many mental health providers have been reluctant to diagnose BPD before age 18. The symptoms of BPD have some similarity to normal adolescent behaviors, after all, and personality does not solidify until the mid-20s. Moreover, because BPD used to be considered a difficult disorder to treat, many practitioners tried to avoid a label that could be stigmatizing. Research has consistently shown, however, that unlike other personality disorders, BPD can be reliably diagnosed in adolescents.
Criteria and Symptoms of Teen BPD
According to the DSM-V, a diagnosis of teen BPD requires at least five of the following symptoms to have been present for more than a year. Experts in adolescent BPD recommend treatment when just three or more of those symptoms are present.
- Frantic efforts to avoid real or imagined abandonment
- Pattern of unstable and intense interpersonal relationships characterized by extreme shifts between idealization and devaluation (also known as “splitting”)
- An unstable self-image or sense of self
- Impulsive harmful behavior in at least two areas (e.g., spending, sex, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behavior, gestures, or threats, or self-harming behavior
- Emotional instability in reaction to day-to-day events (e.g., sadness, irritability, or anxiety)
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger
- Temporary, stress-related paranoid ideation or severe dissociative symptoms.
Behavioral Signs of BPD in Teens
BPD symptoms sometimes first emerge in childhood. They typically increase with the onset of puberty and worsen with the complex emotional demands of the teenage years.
With early treatment, those symptoms may wane by early adulthood before they lead to a cascade of other mental health issues and functional impairment. Therefore, many experts recommend proactive treatment even when symptoms do not meet the requirements for a full-blown diagnosis.
Signs of emerging BPD in teens include:
- A tendency to see people or situations as black or white
- Dangerous impulsivity, especially in stressful situations
- Prone to misreading other people’s emotions
- Confusion over which thoughts, impressions, fear, and desires are their own and which are someone else’s
- Angry outbursts that are out of proportion to external circumstances
- Extreme difficulty talking about their feelings
- History of conflicts with parents, friends, and siblings
The Link Between Borderline Personality Disorder and Suicide
When it comes to the signs of BPD in teens, there is a prominent threat of self-harm and suicide. In fact, borderline personality disorder includes suicidal or self-injurious behavior among its diagnostic criteria. Furthermore, it is the only personality disorder type that includes such criteria.
About 75 percent of people with borderline personality disorder will make at least one suicide attempt. Even worse, close to 10 percent of people with BPD will die by suicide. Consequently, this rate of death by suicide is 50 times the rate of suicide in the general population. Therefore, it’s critical to ensure the safety of the environment for teens suffering from BPD.
Questions to Help Identify Borderline Personality Disorder in Teens
Are you a parent who suspects that your teen might be suffering from teenage borderline personality disorder? There are questions to consider that may help illuminate the situation.
- Does your teen see things as black and white to the extreme? Do they define people as all good or all bad?
- Is your teen dangerously impulsive? Do they take senseless risks on a regular basis?
- Does your teen lack a firm sense of identity? Do they change all the time, almost cycling through personality types?
- Does your teen seem incapable of reading emotions?
- Does your teen feel crushed when a person leaves? Is their fear of abandonment not reflective of the emotional reality of a situation?
- Does the mood of your teen change for no apparent reason? Do these mood shifts seem extreme?
- Does your teen exhaust and lose relationships? Are their connections to other people more volatile than expected?
- Are your teen’s angry outbursts out of proportion to external circumstances? Is it hard to talk them down?
Many teens without borderline personality disorder can fit these descriptions. This is important to recognize. Yet, answering yes to most these questions is a red flag. Such answers indicate that proactive steps should be taken toward a professional assessment.
If a sensitive teen is struggling with a borderline personality disorder, they are not alone. Borderline personality disorder affects close to 14 million Americans.
How to Parent a Teenager with BPD
Families are a critical part of treatment for an adolescent with BPD. Difficulty with interpersonal relationships is at the heart of BPD, and family members are likely to be the primary relationships in an adolescent’s life. At the same time, adolescence is naturally a time of tension between the competing demands of independence and connection to one’s family.
The experience can be especially turbulent for a person with heightened interpersonal sensitivity. Any sense of abandonment, rejection, or criticism (real or perceived) can trigger self-loathing or extreme anger at others. The more family members understand about the disorder, the better they will be able to manage their own reactions to the inevitable distress and confusion.
4 Tips for Families to Support Teens with BPD
The Handbook of Good Psychiatric Management for Adolescents, edited by Lois W. Choi-Kain and Carla Sharp, offers the following suggestions for families:
Reduce stress.
Three characteristics of BPD—difficulty regulating intense emotion, black-and-white thinking, and fear of abandonment—impair a person’s ability to manage stress. Family members can help by managing their own stress levels to keep the home environment as calm and stable as possible.
Take small steps.
Long-term goals, even if they seem age-appropriate and reasonable given a person’s abilities, can trigger a stress response that derails progress. Mistakes that are a natural part of the learning process can seem catastrophic. That’s because of the BPD tendency towards black-and-white thinking and difficulty regulating emotion.
Go slowly.
Ironically, praise for achievements can produce fears in someone suffering from BPD that they will get less support. And this can evoke feelings of abandonment. The Handbook suggests a more guarded message, such as, “Your progress shows real effort. You’ve worked hard. I’m pleased that you were able to do it, but I’m worried that this is all too stressful for you.”
Listen without getting defensive.
You can acknowledge the strength of your child’s feelings without agreeing with them. “It must be really hard to feel like I don’t love you! Tell me more about that.” Remember that strong emotions will pass more quickly if you do not resist them. Feeling heard will help counteract BPD feelings of abandonment.
BPD can be confusing to address and to recognize, even for mental health professionals. The National Education Alliance for Borderline Personality Disorder offers extensive resources and support for patients, families, and professionals.
Treatment for Borderline Personality Disorder in Teens
Successful treatment for BPD includes a variety of approaches that target different aspects of emotional regulation. These modalities help heighten awareness of a full range of emotions (positive as well as negative). They also help teens with BPD learn strategies for emotional regulation and coping with stress. Successful treatment options include:
- Psychoeducation: The more a patient and their family knows about the neurological underpinnings of BPD and the role stress plays in the disorder, the better they can “make sense” of distressing feelings and behaviors and take steps to manage difficult emotions.
- Cognitive Behavioral Therapy (CBT) – CBT brings clarity and valuable insight to a teen in crisis. CBT identifies the emotions that often result in a sense of isolation. It helps with the self-defeating thoughts and assumptions that make life more difficult.
- Dialectical Behavior Therapy (DBT): Developed by psychologist Marsha Linehan to manage her own BPD, DBT targets skills in four areas. These are mindfulness, distress tolerance, emotions regulation, and interpersonal effectiveness.
- Attachment-Based Family Therapy: BPD can make connection feel challenging. Therefore, supportive family relationships are so important for an adolescent learning to navigate life with BPD. Attachment-Based Family Therapy helps restore empathy and authentic connection.
- Stress-Reduction Techniques: Every teen (and their adults) can benefit from learning ways to soothe the body’s response to stress. But stress reduction is absolutely essential for a teen with BPD symptoms.
Mental Health Treatment at Newport Academy for Teens with BPD
If your adolescent is struggling with symptoms of BPD or another mental health condition, Newport Academy can help. Our outcomes-driven care helps young people learn to manage intense thoughts and feelings with healthy coping mechanisms.
Early treatment of BPD has been proven to improve quality of life in adulthood. Contact us today to learn more about our clinical model and start making a positive difference in your teen’s mental health and your family’s well-being.
“At Newport Academy, we can use unique and cutting-edge treatment approaches that would take the state years to employ…. we have the ability and flexibility to tailor programs that best suit the needs of our residents.”
Helene D’Jay, LPC, Newport Academy Executive Director
What Makes Our Residential Treatment Program Different?
Personalized Treatment
Our priority is to offer the most effective personalized treatment available. We incorporate evidence-based clinical and experiential therapeutic modalities. In addition, we tailor an integrated and comprehensive care plan. Thus the goal of the plan is to meet each teen’s needs, strengths, and challenges.
Upon admission, residents are assigned a treatment team. This team develops a customized program to promote growth and sustainable healing.
Our Philosophy Is Love
We help teens by providing a safe, accepting, and nurturing environment. We pride ourselves on providing unconditional love and support every adolescent who comes through our doors. Thus, teens feel safe enough to explore and resolve underlying issues.
The Newport Academy staff’s clinical expertise is matched only by their compassion. Hence, we provide the care that supports each teen’s self-worth and self-acceptance.
We Achieve Results
We have achieved an unparalleled success rate since our founding and aim to treat every teen that enters our facilities with the best care possible. We are open 24 hours a day, seven days a week, contact us today to find out how we can help your teen. If Newport Academy is not the right fit, then we will help you find a solution that works for you.
Frequently Asked Questions
Can a 15-year-old have borderline personality disorder?
What are the symptoms of BPD in a teenage girl or boy?
What are tips on how to parent a teenager with borderline personality disorder?
Is there a cure for borderline personality disorder?
Sources
JAMA Psych. 2021; 78(2): 187–194.
Curr Psychiatry Rep. 2020 Apr; 22(5): 25.
Am J Psychiatry. 2009 May; 166(5): 530–9.
Choi-Kain, L. and Sharp, C., ed. Handbook of Good Psychiatric Management for Adolescents with Borderline Personality Disorder. American Psychiatric Association Publishing, 2021.