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How To Parent A Teenager With Borderline Personality Disorder

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 >

Borderline personality disorder in teens is marked by a host of symptoms. There’s emotional instability and extreme bouts of moodiness. Identity issues. Chaotic relationships. Self-harming behavior and suicidal ideation.

While many of these issues sound like they’re common in teens, adolescents with borderline personality disorder experience them much more intensely than others.

“Their emotions can take over their body,” explains Alyson Orcena, LMFT, Executive Clinical Director of Evolve Treatment Centers. A teen with BPD, for example, might feel uncontrollable grief when others might just feel sad. He or she can have a panic attack when others are just nervous. Or feel euphoria when others might just be happy. When others feel upset or annoyed at being wronged, a teen with BPD could be shaking with uncontrollable rage.

“Some people cry after a breakup; a teen with BPD could be throwing their partner’s things out of the window,” describes Orcena, who works with adolescents with BPD and their families in California. “When they’re upset, they could become threatening, hysterical, punch someone else, punch a hole in the wall. In a nutshell, they’re highly sensitive, highly reactive, and have a slow return to baseline,” she says.

What does it mean to have a slow return to baseline?

Orcena explains. “Instead of experiencing the emotion and then letting it pass, like many do, they keep reigniting it. The moment they think about it, their distress level peaks back up. The person can’t help let the experience go. So they keep getting emotionally activated.”

How to Control Borderline Personality Disorder?

If you are wondering how to control borderline personality disorder, know that the best thing parents can do is be supportive and guide their kids to seek help for teen BPD.  Parents can help their teens with Borderline Personality Disorder (BPD) by ensuring they get appropriate medical care and treatment. 

It is also important for parents to provide their teen with borderline personality disorder a secure and stable home environment with clear boundaries and expectations. Helping teens feel safe, supported and understood is a proven way of improving teen happiness. Additionally, parents should be aware of their own behavior and attitudes as these can have a significant impact on the teen’s BPD. 

Finally, it is important for parents to encourage positive coping skills in their teens such as physical activity, relaxation techniques or other forms of self-care. With the right support and guidance, such as is taught in DBT programs for teenagers, teens with BPD can learn to better manage their condition and lead healthy and productive lives. 

Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder

This inability to pass through emotions is called emotion dysregulation. It is the primary, overarching symptom of borderline personality disorder. It is also the reason why so many teens with BPD have problematic behaviors – like impulsive substance use, self-harming attempts, and uncontrollable anger.

Additionally, a lot of teens with BPD struggle with being in the moment. “It’s challenging for them to see what is fact, what is judgment, what is real and what isn’t,” says Orcena.

This is why Dialectical Behavior Therapy, created by Dr. Marsha Linehan in the 1980s, is such a highly effective treatment. Dr. Linehan originally developed DBT to treat her patients with BPD when other therapies were not effective. DBT employs a hierarchy of treatment, referred to as the DBT House of Treatment, in which therapists target life-threatening behaviors – e.g. self-harming and suicidal behaviors – before any other issues. To date, Dialectical Behavior Therapy is the only evidence-based treatment for BPD.

Four Core Modules of DBT

DBT teaches four main skills sets: Emotion Regulation, Distress Tolerance, Mindfulness, and Interpersonal Effectiveness. These are the core modules of DBT.

Emotion Regulation skills teach teens a variety of ways to temper their out-of-control emotions. Interpersonal Effectiveness teaches them not to take a black-and-white (i.e. love/hate) approach when it comes to other people. These skills also provide practical ways to bring up issues with friends and family, solve conflicts, converse with others, and approach a situation when they feel that someone else has wronged them. Distress Tolerance skills show them how they can soothe themselves when they’re highly upset, grief-stricken, or panicked—without hurting themselves or others around them. And general Mindfulness exercises help adolescents be more at peace with themselves and more present throughout each day instead of ruminating on the past or jumping to negative conclusions about others too soon.

All of these skills-sets are ones that teens with BPD are lacking.

Advice for Parents of Adolescents With BPD

If you’re a parent of a teen with BPD, you probably have a difficult relationship with your child.

What Are the Biggest Signs of BPD?

The most common signs of Borderline Personality Disorder (BPD) include intense mood swings, feelings of emptiness and inappropriate anger, difficulty controlling impulses, fear of abandonment, and difficulty with relationships.

Teens with borderline personality disorder experience intense emotions that cause them to behave in a way that others might find hard to tolerate. “Whether it’s their angry outbursts or their self-destructive behaviors, the BPD teen often drains others around them,” says Orcena. “They can also go from loving a person to hating them very quickly, which causes issues with their friends, parents, romantic interests, and even therapists.”

“But what people around them have to remember – parents especially – is that these teens are in so much distress and pain,” explains Orcena. “It is too easy to get frustrated with them and forget the level of pain they’re in, or have compassion with what they’re experiencing.”

Residential Treatment for Teens with Borderline Personality Disorder

Unfortunately, their severe levels of emotional pain is why teens with BPD frequently self-harm and consider suicide. Studies show that 80% of those with BPD attempt suicide. And 10% of them die from these attempts. This relatively high rate of mortality – 50% more than the general population – is the number-one reason it is vital to seek treatment for a teen with BPD.

Residential treatment at a teen mental health treatment center is what many clinicians recommend for teens with BPD. An adolescent RTC that specializes in BPD should offer DBT as well as 24/7, full-time monitoring onsite. This is necessary if a teen struggles with self-harming and suicidal tendencies. Also, certain mental health treatment centers are Fully Comprehensive DBT Residential Treatment Centers. This means they integrate all four DBT requirements of Dr. Linehan: individual and family therapy, skills-training groups, skills-coaching, and therapists’ consultation team.

After completing residential treatment at a teen mental health treatment center, a teen might step down to a partial hospitalization program (PHP) or an intensive outpatient program (IOP) for adolescents with borderline personality disorder. Alternatively, an adolescent might also start treatment at a PHP or IOP if his or her symptoms are not yet severe enough to warrant full-time residential treatment.

How Is Teen Histrionic Personality Disorder Similar to Borderline Personality Disorder (BPD)?

Teen histrionic personality disorder (HPD) is similar to BPD in several ways. Both disorders involve an intense fear of abandonment, unstable relationships, and excessive emotions that can change rapidly and without explanation. Additionally, an HPD or a BPD BPD teenager may exhibit impulsive behaviors such as self-harming, reckless spending, substance abuse, or risky sexual behavior. Furthermore, both teens with HPD and BPD may have difficulty controlling their emotions, leading to frequent outbursts of anger or sadness. Furthermore, individuals with either disorder often engage in manipulative behaviors as a means of gaining attention or sympathy from others.

Can Borderline Personality Disorder Be Diagnosed in Adolescence?

The answer is yes. Borderline Personality Disorder (BPD) can be accurately diagnosed in adolescents by highly specialized professions.  Adolescent borderline personality disorder usually begins around the age of 14 or 15. 

In order to diagnose BPD in adolescence, a mental health professional will evaluate the teen’s symptoms and behavior over an extended period of time, typically six months or more. During this evaluation process, the mental health professional will look for patterns of unstable relationships, intense emotions and impulsivity. They may also assess whether the teen’s symptoms are severe enough to cause significant distress or impairment in functioning. Parents who  seek help for teen BPD after a diagnosis will be given an appropriate diagnosis and treatment plan.

How Can I Help a Teen With Borderline Personality Disorder?

As a parent, it can be difficult to watch your teen struggle with Borderline Personality Disorder (BPD). However, there are many ways that you can help. The most important thing is to provide emotional support and understanding. 

Encourage them to seek professional help and talk openly about their feelings. Teens experiencing symptoms associated with BPD may benefit from focused therapies such as inpatient teen depression treatment and  teen drug rehab programs.  Parents should always know that they are not alone and that help is available.  The process of learning coping skills and positive parenting techniques may take time, but with support and understanding, your teen can have a more positive outlook.

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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