Understanding

Borderline
Personality Disorder
in Teens
The difference between typical teen behaviors and emerging
personality disorders can be hard to recognize. How can you tell
which is which?
Being a teenager is difficult. Teens go through many changes, including social and
educational changes and hormonal mood swings.

Sometimes teens act without thinking if they will get into trouble, with out-of-
character actions, thoughts, and feelings all being part of the typical teen
experience.

Other times, emotions may overpower a teenager, maybe even control their
actions. Some young people may also spend a lot of time being overly worried
about social situations.

It’s important to be able to tell the difference between “typical” teen moodiness
and signs of a mental health condition, such as BPD. Below you can learn more
about the condition to understand what typical teen behavior may be—and what
may be a sign that help is needed.

Understanding Borderline Personality Disorder

Borderline personality disorder (BPD) is a complex mental health condition in
which people often struggle with self-image, mood swings, impulse control, an
intense fear of abandonment, and low feelings of self-worth.

BPD may cause people to have a difficult time controlling their emotional
reactions to certain situations. It’s not unusual for people with BPD to live with
other mental health conditions, such as eating disorders, anxiety, depression, and
substance use disorder.
Borderline personality disorder is more common than many people realize,
affecting an estimated 1.6% of U.S. adults. This number may be higher, however,
because many people with BPD are misdiagnosed with PTSD, ADHD, bipolar
disorder, or depression.

Because the disorder is common—and complex—it’s important to recognize its

signs and symptoms. The sooner BPD is diagnosed, the faster it can be treated.

What Does Emerging BPD Look Like in Teens?

Like with any mental health diagnosis, what’s within a normal range for that
person’s age, culture, and so, is taken into consideration. When mental health
professionals consider a BPD diagnosis, they look for the following key
symptoms:

 An intense fear of abandonment

 Unstable relationships with family members and friends
 An unclear or constantly shifting self-image
 Impulsive or self-destructive behaviors
 A pattern of self-harm
 Extreme emotional swings, particularly in response to seemingly minor
issues
 Chronic feelings of emptiness or loneliness
 Explosive periods of anger
 A feeling of being out of touch with reality

The following are significant symptoms that may indicate borderline personality
disorder in a child or teenager.

Behavioral Dysregulation

This is one of the first signs people may notice, with some teens engaging in self-
harming behavior. They may cut themselves, burn their skin, or punch a wall.
Plenty of other issues may appear as well: the child or teen may use substances or
engage in dangerous sexual behavior.

Relationship Problems

Many kids and teens with emerging BPD have trouble managing relationships.
They may have an intense fear of abandonment or may have trouble controlling
their anger. When very emotionally distressed, some teens may hold irrational or
paranoid beliefs. These fears and beliefs may make it hard to develop friendships
or romantic relationships.

Strong Emotional Reactions

There may be strong emotional reactions to seemingly minor issues, where they
may appear to overreact to everything. Minor issues may feel like the end of the
world.

It is difficult for health care professionals—and parents—to look at these signs and
know whether an adolescent has emerging BPD or if the individual is simply going
through a normal teenage phase.

With this in mind, a teenager who displays any or all of the characteristics
associated with BPD might look around and ask themselves: “Does it seem that
other people can deal with things I can’t deal with?” or “Why aren’t others
struggling like I am?”

A teenager who feels strong emotions for longer periods than others or takes longer
to get back to their emotional baseline may have the condition. Strong reactions to
seemingly small irritations—a sense that minor issues feel like the “end of the
world” and that behaviors like self-harm, drugs, or death seem to be the only way
to make these stop—could be signs of a serious problem.

Teens with these actions and reactions should seek help for their symptoms.

How BPD Differs in Adolescents and Adults

BPD is a personality disorder that has historically been diagnosed in adults. A
significant body of evidence suggests it is possible for children and adolescents to
begin to develop BPD before age 18.

Because teen personalities are still forming, young people may undergo many
changes before they’re considered an adult. Mood swings, instability, and other
symptoms may be a sign of hormonal fluctuations, stress, or anxiety.

Those who are experiencing symptoms of borderline personality disorder need

help—don’t wait to seek care in the hopes that a behavior is “just a phase” or
“they’ll grow out of it.”

The importance of early diagnosis cannot be stressed enough. The sooner BPD
symptoms are diagnosed, the faster treatment can begin and the better the chance to
live a successful, meaningful life.

The Myth of BPD and Gender

It’s estimated that over 14 million Americans have BPD. Once more commonly
diagnosed in women, the largest study done on psychiatric disorders shows that it
occurs equally often in women and men.
One explanation behind it appearing to affect more women is that women are more
likely to seek mental health care than men. Since research on BPD is often
conducted in psychiatric settings, it was previously less likely for men with
borderline personality disorder to be included in these research efforts.

Another explanation is that BPD is often misdiagnosed in men. Many men with the
condition are often diagnosed with depression or PTSD.

Or perhaps the issue is that for years, the general public and many in the
psychiatric community have viewed mental illness in boys and mental illness in
girls in very different ways.

The Bias of Behavior

To illustrate this gender bias, psychologist Alan E. Fruzzetti, PhD, offers a simple
test.

“If I told you that a student in a classroom was pounding on a desk and being
disruptive, would the image of a boy or a girl enter your mind?” he asks. “Or, if I
told you that a student in a classroom was upset and incessantly tapping on a desk,
would you think it was a boy or a girl?”

Most of us would imagine the “pounding” student was a boy and the “tapping”
student was a girl. And, when observing essentially the same behaviors, many
people would describe them and react to them very differently, according to the
gender of the person displaying the behavior.

There are various factors as to why we view boys and girls through different
lenses.

Different behaviors are deemed acceptable or troubling depending on one’s gender,

leading to different social responses for boys and girls.

In general, a girl who is angry, depressed, or displaying other signs of distress has
a better chance of being treated with compassion and understanding—and being
referred to counseling and treatment—than a boy.

In contrast, boys who show similar behaviors are often punished or ignored
completely.

“The problem is that both boys and girls display ‘non-normative’ behaviors, and
our misunderstanding of these behaviors has produced serious consequences for
their mental health,” Fruzzetti explains.

Gender Gap in BPD Diagnosis

This gap between boys and girls is particularly present in the diagnosis and
treatment of BPD.

BPD affects approximately the same number of men and women, but the condition
is likely slightly over-diagnosed in women and significantly under-diagnosed in
men.

Many studies have explored the differences between men and women who meet
the criteria for BPD, finding that more men with substance use disorders are
diagnosed with BPD than women, while more females with eating disorders or
PTSD are diagnosed with BPD.

“When boys don’t fit social and emotional norms, their behavior can be
misinterpreted,” Fruzzetti says. “Bias around gender may have a lot to do with
these different diagnoses.”

For example, when men display anger, it is more often seen as a sign of antisocial
behavior than it is in women, even though women with BPD show more
aggression than non-BPD women, and men with BPD show less aggression than
non-BPD men.

Also, established stereotypes about the nature of masculinity can lead to BPD
being misdiagnosed or missed altogether.

Fruzzetti states that boys generally possess fewer social and emotional skills
compared to girls, which is often misunderstood and incorrectly attributed to a lack
of motivation or flaws in character.

Challenges of BPD in Boys and Men

Because of misdiagnosis and underdiagnosis, many boys with BPD do not receive
any treatment, receive the wrong treatment, or worse, end up in prison.

About 20% of males in the criminal justice system actually have BPD.

According to Fruzzetti, overall, our health care system is not set up to help men
with BPD. In particular, the prison system does not provide proper treatment.

In prison, biases and stigma about mental illness are intensified. Boys and men
who struggle with BPD are more likely to be punished rather than treated.

“The solution isn’t to be less compassionate towards women; it’s to be more

compassionate towards men,” Fruzzetti says.

How Does BPD Develop in Children and Teens?

Just like adults, kids react to situations with their own unique responses. If you
were to touch the arm of a very ticklish child and touch the arm of one who isn’t,
they would react very differently.

The same holds true when it comes to the reactions of people with borderline
personality disorder versus those without it.

When children grow up in a social or family environment that does not match their
temperament, they may develop poor self-esteem and a lack of self-confidence.
They may have a hard time trusting others and have issues with their own identity.

When these children become teens, they can feel lost and engage in high-risk
behaviors. They may look for ways to deal with feelings of emptiness—this is
when symptoms of BPD can emerge.

Teens can begin to experience periods of depression, which can easily progress
into self-harming behavior or thoughts of suicide. These issues require immediate
attention and the introduction of effective treatment.

Any thoughts, feelings, or signs of self-harm must be addressed as quickly as

possible.

How Borderline Personality Disorder Symptoms Are

Diagnosed in Young People
BPD requires a licensed health care professional to properly assess symptoms and
rule out other potential causes. A trained mental health professional diagnoses
BPD by talking with the patient and examining the functioning and reasoning
behind each of the teen’s behaviors.

To understand BPD, it’s important to learn why a person may be engaging in a

certain manner. Why are they taking risks? Why do they appear to be acting
irrationally?

For example, many teens experiment with drinking. Many young people drink to
fit in, bond with friends, or experience something new. Just because a teen starts
drinking doesn’t mean they have BPD.

On the other hand, if someone is drinking in order to change the way they feel
fundamentally, it could be a sign of the condition. Someone with an underlying
mental health condition may start to drink to avoid problems.

Other, less dangerous behavior could indicate an issue as well. For example, many
teens with BPD lock themselves in a room and study for hours on end. This is an
effort to avoid dealing with more serious problems.
Even though this may not seem like risky behavior, it could be a sign they’re
having issues managing their emotions. When a teen patient meets with a therapist,
they will discuss such situations and learn the skills needed to successfully manage
their illness.

How Is Emerging BPD Treated in Teens?

It’s important to know that BPD is treatable. It is possible for teens and their
families to find relief after an accurate diagnosis has been made and the patient is
engaged in evidence-based treatment.

There are two therapies proven to be helpful for young people living with
borderline personality disorder: dialectical behavior therapy (DBT) and general
psychiatric management (GPM).

Dialectical Behavior Therapy

DBT is a popular treatment option for BPD. This highly effective therapy targets
self-harm and suicidal behavior. It addresses destructive behavior, such as
substance misuse.

During sessions, therapists work with teens to break down behaviors. Then, they
give teens the skills they need to handle difficult situations and emotional
circumstances.

Dialectical behavior therapy emphasizes four separate skills sets:

 Mindfulness
 Emotion regulation
 Interpersonal effectiveness
 Distress tolerance

DBT is often combined with cognitive behavior therapy (CBT) to help teens
maximize each treatment session. Teens can better control their emotions, stop
self-destructive behaviors, and have an easier time managing their feelings.

In DBT sessions, teens learn how to:

 Be non-judgmental about their own experiences and those of others

 Increase positive experiences
 Manage overwhelming emotions that prevent them from taking control of
their lives
 Communicate effectively with others
 Accept situations they have no control over
 General Psychiatric Management
 GPM combines key components of other treatment types to provide care to
patients even if specialized or more resource-intensive treatments are not
available. Studies have shown that GPM can be as effective as DBT in
treating BPD.
 GPM for adolescents (GPM-A) is the same treatment method but adapted
for young people. It focuses on providing young patients with the life-
building skills needed to understand and effectively manage their condition.
 These skills help patients focus on the idea that they aren’t just a patient, but
instead, are still living a full life outside of treatment.
 Kids and teens with BPD who engage in GPM-A treatment can develop
non-reactive critical thinking skills, discover what they are good at, and
learn how to view their experiences in a healthier manner.
 Even though DBT and GPM can be highly effective, they are not
appropriate for every patient. In addition, neither of these treatments are
more effective than the other. Your mental health care provider can help you
decide which method of treatment is right for you.
 Your treatment team may suggest other forms of therapy that they believe
may be most effective in relieving symptoms and helping that patient lead a
better life.
 It is always important to do your own research and ensure that the type of
therapy suggested is backed by research and performed by a licensed mental
health professional.