Diagnosing a teen with Borderline Personality Disorder, or BPD, is “tricky,” says Elise Guthmann, LMFT, Clinical Program Director at Evolve Residential Treatment Center in Ojai, California. 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 Guthmann.
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.
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.”
Below are common symptoms of borderline personality disorder:
- Fear of abandonment, and need for constant reassurance that someone important (friend, romantic interest, etc.) won’t leave them
- A pattern of unstable and intense relationships with others
- No coherent sense of self
- Problems with extreme impulsivity (e.g. shopping, casual sex, drinking, substance abuse, binge-eating, running away from home)
- Recurrent suicidal behavior, gestures or threats, or self-injurious behavior
- Intense irritability or anxiety
- Chronic feelings of emptiness
- Difficulty controlling anger
- 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 Guthmann. “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.