Borderline Personality Disorder And The Adolescent
Giving a diagnosis of borderline personality disorder (BPD) to an adolescent is problematic. However, given the emotional problems I had at that stage in my life, I wish, in retrospect, there had been professional intervention – for one thing, I was deeply depressed, and, in my teens, would cry with a regularity more commonly associated with toddlers (including even bursting into tears in lessons at secondary school). How I would have responded to the idea of such professional intervention at the time, however, is another matter.
Most professionals are reluctant to give an adolescent a diagnosis of borderline personality disorder (BPD) due largely to the fact that during teenage years personality traits such as rebelliousness, uncertainty regarding identity, fluctuating emotions, changeable relationships, poor decision making, anger and impulsiveness, are, to a degree, a normal part of the developmental stage the young person is at. ; this complicates and confuses the diagnostic process in relation to BPD.
Also, if the diagnosis is wrong, the adolescent may become unnecessarily stigmatized. Furthermore, young people often resent professional intervention in connection with such a sensitive issue as mental health and may regard such intervention as another stressor/problem. Indeed, if professional intervention is mishandled, it can do yet further substantial damage to the young person’s already rock-bottom self-esteem
How do we know if these the traits referred to above are just symptoms of being an adolescent or whether, instead, they are a sign of something more serious? In order to attempt to resolve this question, clinicians will usually focus on the following three factors :
1) PERSISTENCE OF SYMPTOMS eg are there long-standing emotional instability and chronic relationship problems which show no sign of abating or of being resolved?
2) SEVERITY OF SYMPTOMS eg is suicidal behavior/ideation present? Is self-harming/self-mutilating behavior present? Is anger so extreme that it puts the adolescent, or others, in danger? Is impulsiveness so extreme that it puts the adolescent, or others, in danger?
3) AMOUNT OF DISTRESS CAUSED BY THE SYMPTOMS eg is the adolescent in obvious significant emotional pain (perhaps due to loneliness, depression or anxiety)? This is likely to be the most important consideration of all.
Because of the problems entailed in diagnosing a young person with BPD, clinicians tend much to prefer making a diagnosis of the adolescent having ‘borderline personality traits.’ This means that the young person shows some behaviors similar to those found in adults with BPD (which go beyond the normal range of behaviors one typically finds in teenagers/young people), but it is too early to make a definite diagnosis of BPD.
WHAT ARE THE POSITIVE ASPECTS OF RECEIVING A DIAGNOSIS ?
It is important to point out that, despite the problems noted above, receiving professional intervention and a diagnosis can bring potentially tremendous, even life-saving ( ten per cent of BPD sufferers end up killing themselves), benefits.
There is strong evidence that making an early diagnosis reduces the risk of the development of full-blown BPD as an adult, as well as reducing the risk of the development of co-morbidities such as addictions and self-harm.
In short, then, early intervention can save the adolescent from an adulthood of profound emotional pain, despair and loss.
WHAT KIND OF SYMPTOMS NEED TO BE LOOKED OUT FOR IN THE ADOLESCENT ?
The symptoms to look out for are similar to the symptoms that an adult sufferer of BPD would display (click here to view a video on BPD). However, in adolescents the fluctuations in mood may be even more extreme and dramatic than those of an adult with BPD. Because of this, adolescents who are later diagnosed as having BPD have not infrequently initially been misdiagnosed as having bipolar disorder.
Click on image below to enlarge.
The connection between BPD and brain abnormalities
CLICK HERE TO READ MY POST ON HOW CHILDHOOD TRAUMA CAN CREATE BRAIN ABNORMALITIES WHICH GIVE RISE TO BPD.
At present dialectical behavior therapy, or DBT (click here to read my article on DBT) is the main treatment provided to adolescents, though it is a form of DBT that has been specially adapted for young people.
The treatment given to adolescents with BPD traits differs from that given to adults with BPD. FAMILY INVOLVEMENT WITH THE TREATMENT IS CRUCIAL as adolescents are, in general, more psychologically enmeshed with their families than are adults. Also, the family may be the main source of the young person’s stress, or, indeed, paradoxically, his/her main source of support as well.
Furthermore, the social context in which an adolescent finds him/herself (friends, acquaintances, peers etc) is a vital part of his/her life and goes a long way towards molding the young person’s sense of his/her own identity. It is again crucial, therefore, that clinicians gain a good understanding of how this may be affecting the adolescent.
Another way in which DBT for young people differs from DBT given to adults is that, whilst adults are encouraged to take ‘full ownership’ of their illness, most adolescents will not realize that one of the main causes of their own problems is likely to stem from their more extreme behavior ; this can be because they have not yet had enough adverse as evidence for the connection (whereas an adult, for example, may have lost his/her home, family, job, friends etc as a consequence of his/her BPD).
Instead of seeing the link between their behaviors and their predicament, adolescents are far more likely to EXTERNALIZE their problems (eg blame them on others – although, of course, this may be partly or pretty much wholly correct in some circumstances).
It follows from the above that the adolescent should not be blamed for his/her behaviour as, for one thing, this is likely to have the effect of yet further diminishing his/her self-esteem which will, in turn, almost inevitably increase the level of problem behaviors. Instead, the focus should be on trying to understand the root causes of the problem behaviors and rectifying, as far as possible, these.
Parents need to attend the DBT sessions along with their child where they, too, will be informed and educated about BPD as well as trained in the skills that the young person is trained in to manage BPD symptoms.
It is important for the adolescent to understand that, if he/she is diagnosed with having BPD traits that its symptoms have, hitherto, been out of his/her control. It also needs to be acknowledged that it is the young person’s deeply painful and distressing emotions which lie behind his/her behavior, not malice.
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David Hosier BSc Hons; MSc; PGDE(FAHE).