Borderline Personality Disorder in Adolescence

The Importance of Early Diagnosis

Posted Apr 02, 2017

Until recent years many clinicians avoided offering the diagnosis of Borderline Personality Disorder (BPD) for adolescents.  Since BPD is considered a more pervasive and persistent diagnosis, it seemed premature to label teenagers with a potentially stigmatizing personality disorder, since their personalities are still forming.  Additionally, the characteristics of BPD are similar to those of typical adolescent struggles--unstable sense of identity, moodiness, impulsivity, strained interpersonal relationships, etc.  Therefore, many therapists hesitated to distinguish borderline traits from normality.  But distinctions can be made.  An angry teen may yell and slam doors.  A borderline teen will throw a lamp through the window, cut on himself, and run away.  After a romantic break-up,a typical adolescent will grieve the loss, and turn to friends for consoling.  A borderline teenager may isolate with feelings of hopelessness and act on suicidal feelings.

Many child therapists recognize distinctive dimensions of BPD in childhood and adolescence.  One study of young adults1 indicated that BPD symptoms were most severe and consistent from ages 14 to 17, then declining over the years into the mid-20's.  Unfortunately, psychiatric symptoms in adolescents may be minimized or camouflaged by other, more blatant problems, such as depression, anxiety, or substance abuse.  When BPD complicates another illness, as is frequently the case, prognosis becomes more guarded.  In all medical illnesses, and especially in psychiatric disorders, early intervention is important.  Several psychotherapeutic models have been adapted for utilization with teenagers, including, most prominently, Dialectical Behavioral Therapy and Mentalization Based Therapy.  Medications have not usually proven helpful, except for treatment of collateral illnesses, such as depression.

Research suggests that BPD symptoms in adolescence are less anchored and may respond more robustly to intervention.2    In later years, borderline features may be more ingrained.  Thus, this is a critical period in which to initiate treatment. 

References

1. Bornovalova, M.A., et al. Stability, Change, and Heritability of Borderline Personality Disorder Traits from Adolescence to Adulthood: A Longitudinal Twin Study. Development and Psychopathology.(2009); 21 (4): 1335-1353.

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2. Chanen, A.M., McCutcheon, L. Prevention and Early Intervention for Borderline Personality Disorder: Current Status and Recent Evidence. British Journal of Psychiatry. (2013); 202 (s54): s 24-29.