Borderline Personality Disorder in Children and Teenagers

Borderline personality disorder (BPD) also known as emotionally unstable personality disorder (EUPD) is a complex mental illness characterized by a painful mix of emotional turmoil, unstable relationships and self-image, and self-destructive impulsivity. Those with BPD are volatile, very difficult with those close to them and are quick to feel abandoned or betrayed (Child Mind Institute, 2019). It is said that living with BPD is like being on a rollercoaster.

It was once thought that children and teenagers could not have BPD, however, research now indicates that the disorder can occur in kids under the age of 18 years and treating the symptoms as early as possible leads to better long-term outcomes. Admittedly, it is difficult to diagnose BPD accurately in children, but it can be readily diagnosed in teenagers and young adults. However, as BPD presents with similar signs and symptoms to other mental disorders more common in children/teenagers such as anxiety disorders, major depressive disorder, bipolar disorder and CPTSD, a thorough assessment and very detailed medical/psychiatric history is required. To further complicate things, BPD is rarely diagnosed on its own, and commonly co-occurs with other mental disorders including eating disorders, depression, bipolar disorder, substance use disorder and anxiety disorder.

Experts call BPD a biosocial disorder because it is the result of two distinct factors: biological and social. The biological factor is a highly emotive and reactive temperament, whilst the social factor considers the child/teenager’s environment e.g. neglect, abuse, or parents that do not respond appropriately to extreme behaviours/emotions. Consequently, the child will not develop effective skills in regulation of emotions and may resort to unhealthy ways of coping with feelings.

Specific risk factors which increase the likelihood of a child/teenager developing BPD are:

  • Family history of BPD
  • Traumatic childhood (up to 70percent of those with BPD were sexually abused in childhood)
  • ACEs

In BPD it feels like one’s brain is on high alert all the time, and everything appears scarier, more stressful; consequently, the flight/fight/fright switch is easily tripped and once this happens, it hijacks the rational brain triggering primitive survival instincts that are usually inappropriate. For a diagnosis of BPD, five or more signs and symptoms must be present before the age of 20 years.

Specific signs and symptoms of BPD are:

  • Volatile and unstable relationships: idealizing to devaluing another person
  • Extremely emotionally reactive and easily overwhelmed by the intense emotions
  • Engage in self-destructive behaviours: drugs, alcohol, unsafe sex
  • Experience chronic periods of emptiness and worthlessness
  • Profound negative self image resulting in self harm, suicidal ideation
  • Explosive anger which is difficult to control
  • Rapid mood cycling: joy, irritability, fear, despair
  • Intense fear of abandonment, being left alone (real or perceived)
  • Paranoid thinking or dissociative symptoms

In children, the common signs and symptoms that may indicate BPD and require further assessment are:

  • Hyper-reactive emotions and severe temper outbursts
  • Poor impulse control: violence towards self or others
  • Significantly impaired thinking and reasoning skills for age
  • Marked disturbance in relationships with parents, siblings, family

Treatment Options

  • Healing requires intensive therapy designed to break the dysfunctional patterns of thinking, feeling and behaviours that cause emotional distress. Therapies that have been found to be successful in the treatment of BPD:
  • Schema Therapy: uncover and understand schemas (unhelpful patterns that a child/teenager develop if emotional needs are not met)
  • Talk Therapy: education about BPD, awareness of emotions and responses, day to day functioning
  • Dialectical Behaviour Therapy (DBT): teaches coping skills to deal with unhealthy emotions/behaviours and improve relationships and encourages the practice of mindfulness
  • Other therapy: family support, social skills training, individual counselling
  • There are no medications officially approved for the treatment of BPD, however, some medications that have been found helpful include antidepressants, antipsychotics, mood-stabilizing drugs

How To Help A Child/Teenager With BPD

  • Be patient
  • Try to promote a calm home environment
  • Employ strategies (from therapy) to help control impulsivity, improve interpersonal skills
  • Encourage and participate with child/teenager in mindfulness: meditation, deep breathing, relaxation, yoga
  • Demonstrate and show love and support
  • Be aware of warning signs of suicide: up to 70 percent of teenagers and young adults with BPD will make at least one suicide attempt, 10 percent will die by suicide
  • Follow a daily routine
  • Encourage healthy lifestyle: exercise, rest, diet
  • Follow up with medical appointments, therapy
  • Ensure medications are taken (if prescribed) and monitor for potential side effects
  • Meet with teacher, school counsellor and discuss strategies to help deal with emotions and behaviour
  • Talk with siblings, other family members, friends. Explain how best to support and empower child/teenager
  • If child/teenager has a pre-existing mental disorder, health ailment, learning disability, continue to monitor, treat and observe for any changes
  • Be alert to sudden changes in friends, style of dress, behaviour, routine.
  • Children/teenagers with BPD have an increased risk of using alcohol and drugs, engaging in risky behaviours, and/or may self-harm, can become the victim of a bully and/or become a bully

In my next blog #22, I will discuss mental illness and suicide in
American Indians and Alaskan Natives children and teenagers

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