How To Treat A Teen With Borderline Personality Disorder

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 Elise Guthmann, Clinical Program Director at Evolve Residential Treatment Center in Ojai, California. 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 Guthmann, 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?

Guthman 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.”

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 Guthmann.

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 Teens With BPD

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

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 Guthmann. “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 Guthmann. “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.