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For Teens With Borderline Personality Disorder, This One Symptom Is Very Common

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

One of the main symptoms of borderline personality disorder (BPD) is splitting. Splitting is the unconscious division of people, situations or events as “all good” or “all bad.” For example, a teen with BPD can decide a friend is either “the most loyal person in the world” or “evil.” An event is either “amazing” or “terrible.” A situation either “worked out perfectly” or turned “disastrously”. Splitting occurs as a defensive response when a teen with BPD becomes annoyed or upset at another person, event, or themselves. They automatically revert to black-and-white, all-or-nothing thinking.

There is no in-between. There is no gray area.

Teens with BPD often put others on a pedestal—when they like them. If you’re in the good graces of a teen with borderline personality disorder, you will be adored and looked up to. However, once you make any sort of mistake, the same teen may be highly disappointed. In the eyes of a teen with BPD, you went from hero to zero. They cannot integrate your mistake with their former positive, idealized version of you. 

Splitting: Repeated and Unpredictable

Splitting can happen repeatedly. In the eyes of a teen with BPD, people can go from zero to hero, or hero to zero, based on their actions. Do something nice for a teen with BPD, and you will seem – to them – the greatest friend or parent in the world. But if you do something they consider insensitive or rude, they may perceive you as the worst, most uncaring person in the world. Teens with BPD have a very difficult time forgiving others for mistakes and integrating alleged transgressions into the whole entire picture they have of a person.

That’s why splitting is often draining. It’s mentally exhausting for the teen with BPD to go through their day-to-day life like that. They constantly shift their perspective of a person or situation from one extreme to the next. It’s equally draining for the friends and family members, who ride the love-hate rollercoaster along with the teen with BPD.

Therapists Who Treat BPD Teens

Teens with BPD often have a hard time in therapy, too, because they will often “split” their therapists.

When therapy is going well, the therapist can be “the best” in the world. A teen may thank them and give them rave reviews. But if something goes wrong during a session, all that praise might go out the window. Maybe the therapist arrives late or cancels a session for some reason. Or perhaps a teen forgets about a session, and their parents have to pay full price for the session, per standard policy. After any one of these incidents, the teen with BPD might do a hundred-eighty degree turn. They start thinking their therapist is the “worst” or the “least professional” therapist in the world. Then they consider stopping therapy and choosing a different therapist. Or they might be tempted to lash out at the therapist, give them the silent treatment, or threaten them.

All-or-Nothing Thinking

Family and friends don’t often understand the behavior of a teen with BPD. They’re often confused at the teen’s hot-and-cold behavior. They don’t understand what terrible transgression they made to go from being loved to being hated so fast and so often.

To help parents and friends of a teen with BPD, we’ll ry to shed some light on what happens inside the brain of a teen with BPD.

Teens with BPD are extremely sensitive and reactive, so even minor mistakes can hurt as if they were serious blows. From the perspective of a teen with BPD, a single uncaring action or insensitive remark can “contaminate” the entire relationship. It’s extremely difficult for them to consider something as having both positive and negative aspects – whether it’s a person, event, situation, or even themselves. This is why friendships are often unstable, and can go up and down like a rollercoaster. The same goes for relationships with their parents and romantic interests. This elevated state of sensitivity and reactivity is why a teenwith BPD can swing between loving someone to hating them in the span of a day.

Mental Health Treatment for Teens With BPD

People who engage in splitting behavior often have borderline personality disorder. BPD is treatable, however. Mental health treatment for teens with BPD can include treatment at an intensive outpatient or partial hospitalization program (IOP or PHP). If a teen also engages in self-harm or displays suicidal tendencies or behavior – both common in individuals with BPD – they will most likely require treatment at a teen residential treatment center (RTC).

Please note that only a mental health professional diagnose BPD and determine what level of treatment, supervision, or care they require.

With that said, a residential treatment program for adolescents will provide 24/7 monitoring and round-the-clock treatment, which can help a teen with BPD understand their disorder nad manage their symptoms. When searching for adolescent treatment centers for borderline personality disorder, look for an RTC, PHP or IOP that specializes in Dialectical Behavior Therapy (DBT).

[NOTE: Only a mental health professional diagnose BPD or determine what level of treatment they require]

Why Therapists Recommend DBT for Teens With BPD

Dialectical Behavior Therapy is the ideal treatment for teens with BPD. In fact, to date, DBT is the only evidence-based treatment for BPD.

The main goal of DBT is to reduce and eliminate the all-or-nothing thinking characteristic of BPD. In fact, the word “dialectical” means “holding two opposing things at the same time.” DBT teaches teens how to look at the entire picture and think of it in terms of gray, rather than the black-and-white kind of reaction that eventually results in splitting. Teens learn, in DBT, that people are not, usually, “all-good” or “all-bad”. Oftentimes, they are somewhere in between. Teens with BPD learn how to integrate positive and negative aspects of a person into one whole, instead of rushing towards extreme, polarizing reactions.

Dialectical Behavior Therapy for Teens: How it Works

So, let’s take a peek of how DBT works in practice. Perhaps a teen feels sad because her best friend isn’t picking up the phone, or isn’t able to make plans over the weekend. In the situation, DBT discourages statements like “My friend is always terrible and uncaring. I hate her.” Or even the opposite: “My best friend is usually the most loyal and caring person in the world. How could she do this to me?”

Instead, DBT encourages a more truthful, integrated statement such as My friend is caring and loyal, and she isn’t able to go out with me over the weekend this time. Note that DBT discourages the use of the conjunction “but”, since the word “but” implies negation of the first half of the sentence. This is a prime example of how DBT works: therapists seek to eliminate polarizing, extreme thoughts and statements, that often include words like “always”, “never,” “hate,”  or “love,” and instead take a more dialectical, middle-path approach.

Which is usually the most truthful and realistic, anyway – and that’s why it works.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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