Borderline personality disorder (BPD) is a personality disorder defined in DSM-IV and described as a prolonged disturbance of personality function in a person (generally over the age of eighteen years, although it is also found in adolescents), characterized by depth and variability of moods
Many parents have questions about borderline personality in adolescents. Some are worried that their teen is exhibiting the signs of borderline personality disorder (BPD), such as intense and frequent mood swings, impulsive behaviors, self-harm or difficulties in relationships. Others have BPD themselves and are worried that their kids will also have the disorder. The good news is that there has been a major surge in research on borderline personality in adolescents, and there are new discoveries every day that are helping us better understand teens with BPD.
n the most recent (fourth) edition of the DSM, experts have decided to add a provision for the diagnosis of borderline adolescents. Now BPD can be diagnosed in teens when the symptoms of BPD have been present for at least 1 year (as opposed to two years for BPD in adults) and are persistent.
A very important part of this provision is the presence of “persistent” symptoms. Sometimes teenagers go through developmental stages, where they exhibit many symptoms of BPD (e.g., impulsive behavior, mood shifts, intense anger), but these symptoms resolve once the stage is passed. Also, some kids react to specific situations (e.g., a divorce or another stressful event) with symptoms that look like BPD; however, this should only be diagnosed in a teen if the symptoms are unlikely to be part of a developmental stage or a reaction to event. BPD should only be diagnosed if the symptoms are unlikely to change over time or in a different environment.
A Difficult Diagnosis
It is important to note that even an expert clinician can have difficulty making an accurate diagnosis of borderline personality in a teenager. The symptoms of BPD often overlap with other common teen mental health conditions, making it difficult to make a definitive diagnosis before adulthood.
The symptoms of BPD can overlap significantly with the symptoms of oppositional defiant disorder, conduct disorder and attention deficit hyperactivity disorder. These are three of the most common disorders seen by child psychiatrists, so it is not unusual that adolescents with BPD are misdiagnosed with one of these disorders.
It is also the case that many teenagers have both BPD and one of these other disorders, complicating the diagnostic picture even more. This is why it is so important for parents to ask the diagnosing provider about how and why they arrived at the diagnosis. You can also ask whether any of the aforementioned conditions were considered, and if so, why they were or were not ruled out.
Diagnosing Borderline Adolescents
Many clinicians still hesitate to diagnose borderline personality in teenagers. Some still believe that there are too many cases when the symptoms of BPD may be part of a developmental stage and may change. Also, many are concerned with the stigma associated with the disorder and are afraid that “labeling” a teen with BPD will do them more harm than good. Many experts, though, now agree that as long as the teenager has been evaluated very carefully, the accurate diagnosis of BPD may be helpful in making sure that he or she gets the most appropriate treatment.
Borderline Personality Symptoms in Teens Versus Adults
While the symptoms of BPD recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) are no different for teens and adults, several experts have argued that while the underlying symptoms are the same in adults and kids, they may present very differently in teens. Below are some examples of how BPD symptoms may manifest differently in a teen versus an adult.
- Unstable Interpersonal Relationships. A key symptom of BPD in both teens and adults is instability in interpersonal relationships. In adults, this is most often characterized by "black or white" thinking about other people (also called idealization and devaluation), in which another person may at times be viewed as "perfect" or put on a pedestal, while at other times that person may be seen as evil or cruel. Teens with BPD also engage in idealization and devaluation, but they have an additional tendency to distort the nature of relationships (which is not as common in adults with BPD). For example, a teen with BPD might describe a teacher as a "girlfriend."
- Impulsive Behaviors. Both adults and teens with BPD engage in impulsive behaviors, but teens tend to display a different pattern of behaviors than adults. For example, adults with BPD commonly engage in behaviors such as reckless driving and spending. Teens with BPD are more likely to run away from home, engage in sexual acts that are beyond their maturity level, or use drugs or alcohol.
- Identity Disturbance. Both adults and teens with BPD have problems with identity. Adults with BPD tend to describe being unsure about who they really are, or experience swings from feeling good about themselves to feeling they are bad or even evil. Teens, who are less likely to think introspectively about identity, tend to show this identity confusion through their behavior. For example, kids with BPD may demonstrate gender identity confusion by cross-dressing, or may show that they are confused about their place in social hierarchies by engaging in behaviors that seem out of place. A teen with BPD might run for class president despite having no friends, or engage in socially inappropriate behavior and then be confused when he or she is rejected by others because of this behavior.
- Chronic Feelings of Emptiness. Whereas adults with BPD describe feeling chronically empty, teens with BPD are more likely to describe feeling chronically and hopelessly bored. They may also seem unable to invest their time in any activity that might bring them out of that boredom. They may say that they have no interests.
Borderline Personality Disorder in Adolescents: A Complete Guide to Understanding and Coping When Your Adolescent Has BPD
Price: $11.53 & eligible for FREE Super Saver Shipping on orders over $25.
You Save: $5.42 (32%)