Borderline personality disorder (BPD) is one of the most misunderstood and misdiagnosed mental health conditions, and teens with BPD are particularly vulnerable to the effects of being stigmatized. This leads to delayed diagnosis, delayed care, and delayed recovery. And because early intervention and treatment are critical to the successful treatment of borderline personality disorder in teens, it’s essential that we reduce the stigma around this disorder so young people can get the care that they need.
What Is Borderline Personality Disorder in Teens?
Borderline personality disorder is a mental health condition that affects how you see yourself, how you see your relationships with others, and how you behave. Those who have been diagnosed with borderline personality disorder struggle to regulate their emotions, maintain stable personal relationships, and control impulsive behavior.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders criteria for diagnosing borderline personality disorder in teens and adults includes displaying at least five of the following symptoms:
- Extreme fear of being abandoned and intense efforts to avoid being rejected, whether these fears are real or imagined
- A pattern of unstable interpersonal relationships, alternating between intense feelings that someone is perfect and feelings that someone is uncaring and mean
- Engaging in impulsive, self-destructive behaviors such as drug abuse, self-harm, or unsafe sex
- A distorted and often negative sense of self that frequently changes
- Extreme mood swings and emotional responses, especially around seemingly minor things
- Constantly feeling empty or lonely
- Frequent explosive outbursts of anger
- Paranoia that comes on during times of stress
- Suicidal thoughts and threats
Borderline personality disorder can be diagnosed in children as young as 11 years old after at least a year-long pattern of the symptoms listed above.
What Causes Borderline Personality Disorder in Teens?
There isn’t one single cause of borderline personality disorder in teens. Although 70% of teens struggling with BPD have experienced abuse, researchers believe that the development of BPD has a variety of influences, including hereditary and environmental factors as well as early life experiences.
Why It’s Important to Know the Difference Between BPD and Bipolar Disorder
While both borderline personality disorder and bipolar disorder are characterized by mood swings and impulsive behavior, they are two different disorders and require different treatment approaches. The mood swings and strong emotions associated with borderline personality disorder are abrupt, triggered by stress and conflict, and last only hours or even minutes. Bipolar disorder mood swings are not externally triggered and can last for days, weeks, and even months. Treatment for bipolar disorder in teens typically includes medication and therapy. Borderline personality disorder is mainly treated with certain types of therapy that help patients learn to manage their emotions. Currently, there are no medications approved specifically for the treatment of borderline personality disorder.
The two disorders are often confused, even by clinicians. One study found that 40% of people with borderline personality disorder were misdiagnosed as having bipolar disorder. Because these disorders are treated very differently, this confusion can cause delays in appropriate diagnosis and therapy, a very serious consequence since early diagnosis is critical to the successful treatment of borderline personality disorder in teens.
Why Are Teens with BPD Diagnosis Stigmatized?
Borderline personality disorder is one of the most stigmatized mental health conditions, which means teens with BPD face stigma not only from their peers and communities, but also from mental health professionals. People with BPD are often seen as manipulative, difficult, attention-seeking, angry, and dramatic. Because their symptoms are viewed as just being “emotional,” people with BPD are often judged by their peers and others for not being able to control their feelings.
Mental health professionals sometimes feel as if BPD patients put outsized demands on their time and capacities. There is also an outdated yet persistent misconception within the mental health community that BPD is untreatable. In addition, many therapists and other mental health caregivers treating people with BPD experience negative countertransference reactions, leading them to lose objectivity or become overly critical of their patients.
BPD Myths & Misconceptions
- BPD is the same as bipolar disorder
- People with BPD are manipulative and demanding
- Those with BPD can’t control their emotions
- BPD is untreatable
What Is the Impact of Stigma against Teens with BPD?
Teens with BPD pick up on these negative feelings from peers and caregivers. Socially, teens with BPD may be overdisciplined at school and avoided or even bullied by their peers. This can lead to feelings of shame, self-loathing, isolation, and alienation. This stigmatization can lead teens with BPD to engage in impulsive and dangerous behaviors as they look for ways to cope with their feelings.
Many family members of teens with BDP face obstacles, condescension, and even discrimination when they try to find appropriate care. The problem is compounded when those with BPD receive negative feedback from mental health providers. In addition to the emotional damage done to the individual in need of help, this can result in delays seeking treatment. This leads mental health providers to perceive teens with BPD as being resistant to treatment, creating a vicious cycle of misperception and misunderstanding.
How to Reduce Stigma for Teens with BPD
Education is the key to reducing stigma experienced by teens with borderline personality disorder. Learning about BPD helps people better understand and support people who struggle with mental health issues and their families. The more understanding that people with BPD experience, the more likely they’ll be to ask for and receive the help they need. Education around BPD is particularly important for mental health professionals. Research has shown that teaching mental health clinicians about BPD improves their attitudes towards patients as well as the care they provide.
How to Support Teens with BPD Diagnosis
The lack of education around BPD means families and friends of teens dealing with the disorder often don’t know how to support their loved one.
Here are a three ways to be there for your teen with BPD:
- Healthy Communication Strategies
The ups and downs of BPD can make it hard to communicate with your teen. And indeed, there are certain topics you may not want to bring up when someone is having an episode. But consistently using healthy communication strategies enables you to support your teen while also taking care of yourself. Listening to and validating the feelings of a teen with BPD can be hugely helpful. Validation doesn’t mean that you agree with how your teen is feeling, it just means that you’re acknowledging your teen’s feelings and how real those feelings are to them.
- Setting Boundaries
Setting and enforcing boundaries are important for any teen, but especially teens with BPD. Healthy boundaries are also crucial to maintaining your own well-being. The main thing to remember is that teens with BPD often hear “no” as a rejection or an abandonment. While you have every right to decide what your boundaries are, using “I” statements instead of “you” statements can be helpful when expressing them.
- Maintaining a Supportive and Stable Home Environment
Borderline personality disorder in teens causes a rollercoaster of emotions and experiences. But the more consistent and calm you can make your home environment, the better. Stick to your family’s normal routines as much as possible. Maintain your friendships and other family relationships. Try to keep conversations calm and even keeled.
Try Not to Take It Personally
If you’re parenting a teen with BPD, you know they can have major reactions to what seem like minor situations. When you’re on the receiving end of one of these reactions, it’s normal to feel defensive. But taking their reaction personally can make things worse. Try to stay calm and neutral in the face of big emotions. By recognizing and acknowledging your teen’s feelings, you can help create the supportive environment they need.
Take Care of Yourself
Constantly being on high alert for your child can lead to neglecting your own well-being. But it’s very important that you take care of your own mental, physical, and spiritual health during this time. If you haven’t done so already, you may consider entering therapy yourself. Keeping in touch with friends, maintaining hobbies, and staying active — these are all great ways to bring calm and joy into your life at what can be a chaotic time. Taking time for self-care not only models good coping skills and healthy habits for your child but also helps you to be fully present with them.
BPD Support Groups for Families
Connecting with other families who are going through an experience similar to yours can be a great source of support, comfort, and education. Your local National Alliance of Mental Illness (NAMI) Chapter may offer a support group for parents of children with BPD. You can also find support groups for BPD families online.
Parenting a teen with BPD can be challenging, but there is help and hope at Evolve. We believe that every child deserves to get the help they need. Our team of compassionate professionals specializes in adolescent mental health care and understands the unique challenges of treating borderline personality disorder in teens. We offer a full range of proven therapies for BPD, including Dialectical Behavior Therapy (DBT), Mentalization-Based Therapy (MBT), and Cognitive Behavioral Therapy (CBT). Contact us today to learn more about finding the right mental health treatment for your teen.
