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.
Does Borderline Personality Exist in Teenagers?
This is a controversial topic. Many experts have argued that borderline personality should not be diagnosed in anyone younger than 18, since technically, their personality is not yet fully formed. In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), though, there is a provision that allows for the diagnosis of borderline personality before the age of 18. Technically, this provision also allows for the diagnosis of BPD in children under 13, but this is rare.
Symptoms of Borderline Personality in Adolescents
While the symptoms of BPD as listed in the official DSM-IV diagnostic criteria are no different for teens and adults, some experts have suggested that there are differences in adolescent BPD symptoms. Symptoms, such as instability in interpersonal relationships, impulsive behavior, chronic emptiness and unstable sense of self, may look different in teens.
Prognosis for Borderline Personality Adolescents
At one time, BPD was considered a life-long disorder; if you had BPD, experts believed you would have it for your entire life and that treatment would be unlikely to lead to recovery. Research has shown, however, that these experts were way off the mark: In adults, about 35% of people with BPD will no longer meet criteria for the disorder in two years. In adolescents, the remission rates are even higher; studies estimate that between 66 and 85% of adolescents with BPD will no longer meet diagnostic criteria in two years.
Prevalence of Borderline Personality in Adolescents
There is some evidence to suggest that there are higher rates of borderline personality in teens than in adults. This may be related to the fact that some teenagers display BPD in reaction to stressful events, but many are more likely to recover.
For example, studies of patients in inpatient psychiatric hospitals have shown that about 20% of adult patients meet diagnostic criteria for BPD, while 43 to 53% of teenage patients meet BPD criteria. In the general population, rates of borderline personality in adolescents are much lower than they are in inpatient populations. Studies have estimated general community rates of BPD in teens from 3 to 14%. This is still somewhat higher than the estimated general community rates of BPD in adults (estimated at about 1.4%).
Risk Factors for Borderline Personality in Adolescents
The risk factors for borderline personality in adolescents are very similar to the risk factors in adults. In fact, many of the environmental risk factors for BPD occur during childhood. For example, childhood abuse and neglect, as well as parental separation or loss, have been linked to borderline personality in adults and teens. Research has also found that kids whose parents have serious mental health conditions (e.g., depression, substance abuse or antisocial personality) are also at greater risk for BPD. In addition, there are likely biological risk factors for BPD, such as a genetic component of the disorder that is inherited.
Preventing Borderline Personality in Adolescents
If you are worried that your adolescent may be at risk for developing BPD based on either environmental risk factors (e.g., trauma exposure) or biological risk factors (e.g., a first-degree relative with the disorder), you will be happy to know that experts believe that for some teens there are ways to prevent the disorder.
Treatment for Borderline Personality Adolescents
Unfortunately, there is much less research on the effectiveness of different treatments for adolescents with BPD. We are now making strides, however, in understanding how to effectively treat kids with BPD. Several types of psychotherapy, including dialectical behavior therapy, may be effective with teens with borderline personality. In addition, while there are no FDA-approved medications for BPD, there are medications that have been shown to reduce some of the symptoms.
Getting Help for an Adolescent with Borderline Personality
Finding good treatment for an adult with BPD is hard, but given some of the controversial issues in diagnosing borderline personality in adolescents, finding a therapist for a teen with BPD is even harder. Fortunately, more and more therapists are being trained to treat teens with borderline personality.
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.
Sharp C, & Romero C. "Borderline Personality Disorder: A Comparison Between Children And Adults." Bulletin of the Menninger Clinic. 71:85-114, 2007.