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Diagnosing Borderline Adolescents

What You Need to Know About the Diagnosis of Borderline Personality in Teens

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Updated October 01, 2008

Are there borderline adolescents? For many years, the answer was no. When experts first recognized borderline personality disorder as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM), they believed that it was impossible to diagnose BPD in teens, because by definition, a person’s personality had to be fully formed in order for a personality disorder to be present. More recent research, however, suggests that borderline personality does exist in adolescents, and the diagnostic system has changed to reflect this.

DSM-IV Criteria for Borderline Adolescents

In 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.

Borderline Adolescents — 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 — The Bottom Line

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.

Sources:

Aguirre BA. Borderline Personality Disorder in Adolescents: A Complete Guide to Understanding and Coping When Your Adolescent Has BPD. Fair Winds Press; 2007.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition. American Psychiatric Association, 2000.

Friedel RO. Borderline Personality Disorder Demystified: An Essential Guide for Understanding and Living with BPD. Da Capo Press; 2004.

Goldman SJ, D'Angelo EJ, DeMaso DR, & Mezzacappa E. “Physical and Sexual Abuse Histories Among Children With Borderline Personality Disorder.” American Journal of Psychiatry. 149:1723-1726, 1992.

Sharp C, & Romero C. “Borderline Personality Disorder: A Comparison Between Children And Adults.” Bulletin of the Menninger Clinic. 71:85-114, 2007.

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