Teens with Borderline Personality Disorder at Risk of Being Perpetrators and Victims of Teen Dating Violence

Borderline personality disorder (BPD) is one of the most confounding mental disorders we know about. It’s a serious mental illness. For family members, loved ones, and friends of people with BPD, the symptoms and behaviors associated with BPD can be hard to understand. The up-and-down, volatile nature of the symptoms and behaviors can be confusing, heartbreaking, and at times, scary.

It’s difficult for most people to grasp the extremes of emotion people with BPD feel. It’s even more difficult to understand how those extreme emotions manifest in the types of behavior common in people with BPD.

Here’s how the National Institute of Mental Health (NIMH) defines BPD:

“A mental illness marked by a pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships. People with BPD may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.”

The disorder is characterized by symptoms that are distressing and disruptive for everyone involved. What’s confusing to most people is the core issue behind BPD – according to our latest understanding – is an intense fear of abandonment by friends, family, and loved ones. The emotions derived from this intense fear often manifest in the following ways:

• Extreme efforts to avoid the abandonment they fear
• Volatile relationships that swing between love/affection and hate/anger – often paired closely in time
• Dangerous, risky behavior
• An unstable sense of self
• A distorted self-image
• Extreme mood swings
• Dissociation
• Uncontrollable rage and anger
• Suicidal behavior

The intense and volatile nature of the disorder is also complicated by these two facts:

1. Two years after an initial diagnosis, almost 50% of people diagnosed with BPD no longer meet diagnostic criteria
2. Ten years after an initial diagnosis, almost 90% of people diagnosed with BPD no longer meet diagnostic criteria

We’ll leave those facts aside for the moment, because while a person with full BPD shows active BPD symptoms and behaviors, those symptoms and behaviors create significant risks and challenges. In fact, recent research shows that teens diagnosed with BPD are at increased risk of being both perpetrators and victims of interpersonal dating violence.

Borderline Personality Disorder and Dating Violence in Teens

To date, there are very few studies that examine the relationship between BPD and dating violence in teens. However, several studies show the connection between BPD and interpersonal violence (IPV) among adults, in general. We’ll start with the most recent study on adults in order to demonstrate our current understanding of the relationship between BPD and IPV.

A study published in 2020 – Elucidating the Relationship Between Borderline Personality Disorder and Intimate Partner Violence – showed the following:

• BPD correlates significantly with IPV
• BPD correlates significantly with:
  • Psychological IPV
  • Physical IPV
  • Sexual IPV
• BPD correlated most significantly with physical IPV
• The most significant predictors of IPV among people with BPD were risk taking and suspiciousness

That last bullet point aligns with two things we know about BPD, which we list above: fear of abandonment and suspiciousness. Suspiciousness is related to fear of abandonment, and risk taking is related to dissociation and a distorted/unstable view of the self. When these two things combine, researchers found that they drastically increase the risk of violence between intimate partners.

Another study – The Relation Between Borderline Personality Disorder Features and Teen Dating Violence – begins with a discussion of the relationship between BPD and violence in adults as well. In that study, samples of adult men show strong associations between the presence of BPD and various types of violence and dangerous relationship behavior.

Study: BPD and Adult Men

Compared to men without BPD, adult men with BPD show increased rates of:

• Perpetration of severe physical and sexual violence
• Domestic battery
• Chronic anger
• Jealousy
• Verbal and physical aggression

Those results also align with what we know about BPD. The extreme states of emotion can lead to volatile, violent behavior, especially towards those with whom a person with BPD is intimate. The vacillation between love and hate creates dangerous behavior and emotional and physical levels.

The researchers also analyzed the mental health records of women, in order to determine whether gender differences in the relationship between BPD and IPV.

Study: BPD and Adult Women

Compared to women without BPD, adult women with BPD show:

• Increased likelihood of being a victim of physical and/or sexual assault overall
• Increased likelihood of being a victim of intimate partner violence, both physical and sexual
• Higher rates of arrest as perpetrators of domestic violence

The study authors began with the data on adults because that’s what they had to work with: there was almost no data on the relationship between BPD and dating violence among teens. We’ll now look at the adolescent section of their research.

BPD and Teen Dating Violence: The Data

The researchers formulated three hypotheses with regards to BPD and TDV among adolescents:

1. BPD features would correlate positively with TDV perpetration and victimization, including severe TDV
2. The presence of BPD would outweigh potentially confounding variables, such as alcohol use and exposure to violence between parents, with regards to TDV perpetration and victimization
3. Females with BPD would show greater levels of TDV victimization than males

Here’s what they found for each hypothesis.

Hypothesis 1:

• BPD features correlated strongly with all forms and measures of TDV:
  • Perpetration
  • Victimization
  • Severe TDV

Hypothesis 2:

• BPD features outweighed all potentially confounding variables, including:
  • Alcohol use
  • Exposure to violence between parents
  • Gender

Hypothesis 3:

• Females with BPD showed greater levels of TDV victimization than males.

In other words, their research confirmed all three of their hypotheses. Based on their observations, they concluded that teens with BPD are indeed at greater risk of being both perpetrators and victims of TDV.

Here’s a summary of their findings.

In adolescents, the evidence suggests:

• BPD manifests in different ways for males and females, which may have implications for TDV perpetration and victimization.
• For males, BPD manifests more often as externalizing problems such as anger and violence
• For females, BPD symptoms manifest more often as internalizing problems, such as emotional dysregulation

The data we present is relatively straightforward: the evidence shows that teens with BPD are at increased risk of experiencing teen dating violence both as victims and as perpetrators. In addition to all of the challenges and difficulties BPD causes, this adds another challenge to the list. It’s something parents should know about. More importantly, anyone involved in an intimate relationship with someone with BPD should also understand their elevated level of risk.

With all of that said, recent research on BPD treatment shows promising results. We discuss this research at length in another article, but we’ll summarize that information here.

Promising Results for Treating Adolescent BPD

The new study found that, after a course of treatment at an inpatient treatment center, teens with BPD showed:

• Significant reductions in externalizing symptoms, i.e. behavior
• Significant reductions in internalizing symptoms, i.e. mood and emotion
• These reductions appeared at the following times:
  • Upon discharge from treatment
  • 6 months after discharge from treatment
  • 12 months after discharge from treatment
  • 18 months after discharge from treatment

In their own words, the study authors observed:

“This is the first study to show that adolescent borderline pathology follows a similar course after discharge from inpatient treatment previously demonstrated for adults.”

That’s positive news for anyone involved in the life of someone with BPD. It’s good news for parents of teens with BPD specifically, because it’s hard to find positive data on BPD and it’s rare to find anything hopeful about BPD in the scientific literature. Combined with the observation we share at the beginning of this article – that symptoms of BPD appear to decrease with age – this information can offer parents confidence that if they find the right treatment, and provide that treatment to their teen as soon as possible, they have a real chance at learning to manage the symptoms of the disorder and living a full and productive life.

Here are the approaches to treatment evidence shows effective in treating BPD, which parents of teens with BPD should both know about and look for when seeking support for their teen:

• Psychotherapy, including:
  • Dialectical behavior therapy (DBT)
  • Cognitive behavioral therapy (CBT)
  • Mentalization-based therapy (MBT)
• Medication, including:
  • Mood stabilizers
  • Antipsychotics
  • Antidepressants
  • Anxiolytics (anti-anxiety medication)
• Peer and Family Support:
  • Friends and family who participate in treatment and show compassion, patience, and acceptance help improve treatment outcomes

With an accurate diagnosis and early intervention, teens with BPD can heal and grow. It will take work, and compassion, and commitment from the entire family, but the evidence is in – and it clearly states that treatment for teen BPD can and does work.

Finding Help: Resources

If you’re seeking treatment for your teen with BPD, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.