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Can a Teen Be Diagnosed 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

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Diagnosing a teen with Borderline Personality Disorder, or BPD, is “tricky,” says Alyson Orcena, LMFT, Executive Clinical Director of Evolve Treatment Centers. That’s because some of its defining features are very common to adolescents in general. Emotional instability, moodiness, identity issues, and sensitivity to rejection are all fairly typical in teens.

Historically, this is why many clinicians have refrained from diagnosing adolescents with BPD. Since borderline personality disorder often co-occurs with depression or anxiety, many mental health professionals simply decide to treat those symptoms rather than risk a “BPD” label on a teen. These clinicians often advise parents to wait until the teen reaches adulthood to see if the symptoms are still persisting.

“The brain’s frontal lobe, responsible for executive function, only reaches maturity at age 25, so many clinicians feel like the symptoms might go away on their own, once the teen gets older,” explains Orcena.

Though some studies indicate that this is indeed the case with some BPD patients, delaying treatment for your struggling teen is never a good idea.

Teens who actually have borderline personality disorder but are not diagnosed with it can suffer from years of inaccurate medication trials, not to mention distress and frustration from feeling helpless or hopeless. Additionally, an inability to manage their severe emotional pain is why so many teens with BPD consider taking their own lives. Evidence shows that 80% of those with BPD attempt suicide. And 10% of them succeed. This suicide rate is 50% higher than the general population.

Early Diagnosis for Borderline Personality Disorder

On the other hand, an early diagnosis means early treatment and intervention, and evidence shows that giving teens coping skills early on improves the long-term prognosis of BPD. So more recently, clinicians are overcoming their hesitation to diagnose adolescents with BPD if the teens’ symptoms match DSM criteria.

What Is the BPD Diagnosis Age?

According to the DSM, borderline personality disorder can be diagnosed in adolescents or even children under age 18 as long as formal criteria are met. Symptoms have to be occurring for more than a year, and they must be “pervasive, persistent and unlikely to be limited to a particular developmental stage.”

Common BPD Symptoms in Teenagers

  1. Fear of abandonment, and need for constant reassurance that someone important (friend, romantic interest, etc.) won’t leave them
  2. A pattern of unstable and intense relationships with others
  3. No coherent sense of self
  4. Problems with extreme impulsivity (e.g. shopping, casual sex, drinking, substance abuse, binge-eating, running away from home)
  5. Recurrent suicidal behavior, gestures or threats, or self-injurious behavior
  6. Intense irritability or anxiety
  7. Chronic feelings of emptiness
  8. Difficulty controlling anger
  9. Feeling like things aren’t real at times; dissociation

Treatment for Teens with BPD

The recommended treatment for borderline personality disorder is Dialectical Behavior Therapy (DBT). DBT teaches adolescents practical skills they can use to manage their highly emotional temperament and self-destructive behaviors. These skills fall into four categories, known as the four core modules of DBT: Emotion Regulation, Distress Tolerance, Mindfulness, and Interpersonal Effectiveness.

In fact, Dr. Marsha Linehan originally developed DBT as a treatment exclusively for her borderline personality disorder patients. To date, DBT is the only evidence-based treatment for BPD.

While Dr. Linehan’s original DBT model was based on treatment in an outpatient setting, DBT has since been adapted for residential treatment. A mental health treatment center for teens usually incorporates individual and family therapy, DBT skills groups, and 24/7 skills-coaching for teens.

“Even for teens who aren’t officially diagnosed with borderline personality disorder, DBT is amazingly helpful,” says Orcena. “Every teen who struggles with intense emotions and relationship issues can benefit from learning the practical skills that DBT offers.”

And unlike medication, DBT has no negative side-effects—just positive, life-changing ones.

What Is the BPD Treatment Success Rate?

Dialectical Behavior Therapy (DBT) is the primary treatment for borderline personality disorder (BPD). Regardless of the BPD diagnosis age, the DBT treatment success rate is significant.  Research indicates that up to two-thirds of people undergoing it see a decrease in their symptoms. 

Research shows that families who use programs for teen DBT experience improved relationships and see decreased suicidal behaviors in the teens. Research indicates that while the effects of treatment may not be permanent, they can last up to two years after the completion of therapy. As such, continued monitoring and follow-up care is recommended for those with BPD. 

Histrionic Personality Disorder vs BPD: Are There Similarities?

Both Histrionic Personality Disorder and Borderline Personality Disorder (BPD) are classified as Cluster B personality disorders.  Generally speaking, individuals with either disorder tend to be emotionally unstable and often have difficulty managing their feelings. They also may struggle with interpersonal relationships due to impulsivity, an inability to self-soothe, suicidal thoughts, and a tendency to manipulate others. 

Despite their similarities, histrionic personality disorder vs BPD are distinctly different disorders.  Histrionic Personality Disorder tends to be more focused on seeking attention from others due to an underlying need for validation and approval. Those with BPD may have an increased risk of engaging in self-destructive behaviors due to the intense emotions they experience. 

In both cases, when a parent notices histrionic personality disorder or BPD symptoms in a teenager, it’s worth considering obtaining inpatient teen depression treatment  and other services that can help the teen learn healthy coping skills.  Good treatment centers will also teach parenting tips and advice and guide families through appropriate treatments.

Is Borderline Personality Disorder the Same as Being Bipolar?

No, Borderline Personality Disorder (BPD) is not the same as being bipolar. Bipolar disorder is a mood disorder characterized by extreme highs and lows in mood, energy levels, and activity. People with this condition tend to experience distinct periods of mania followed by depression. Alternatively, Borderline Personality Disorder is primarily an impulsivity disorder. BPD is characterized by unpredictable emotions, unstable relationships, fear of abandonment, and difficulty regulating one’s own behavior.  If you suspect your child may have one of these disorders, get your teen help with treatment as soon as possible.  

Can Borderline Personality Disorder Be Cured?

Borderline Personality Disorder is considered to be a lifelong condition, and as such, it cannot be “cured” in the traditional sense. However, with proper treatment, individuals can learn to manage their symptoms and lead healthier lives. Dialectical Behavior Therapy (DBT) has been found to be particularly effective in managing the symptoms.

How to Parent a Teenager With Borderline Personality Disorder?

Parenting a teen with Borderline Personality Disorder can be difficult and challenging. It is important to provide your child with understanding and support, while also setting appropriate limits and boundaries. Show compassion as they are learning how to cope with their emotions, while also helping them build problem-solving skills that will help them regulate their behavior. 

Seeking professional help from a mental health specialist is important to improving teen mental health.  Professional therapist can help parents answer questions ranging from “what age does BPD develop,“ “what kind of treatment is appropriate,” and “what should the parents’ role be in treatment.”  With patience and dedication, parents can help their child learn how to manage the symptoms of Borderline Personality Disorder and lead meaningful lives. 

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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