What You Need to Know About Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a mental health diagnosis that has a core symptom of the inability to effectively manage emotions. The typical manifestation of BPD usually begins during adolescent years or early adulthood. Difficulties with regulating one’s thoughts and emotions, impulsiveness or reckless behaviors, and unstable personal relationships are some of the prominent symptoms of people who are diagnosed with BPD.

Historically, BPD has been often misunderstood and highly stigmatized. In addition, many people diagnosed with BPD often have a co-occurring mental health diagnosis, such as anxiety and depression, making the diagnosis even more difficult. However, an accurate, early diagnosis of BPD is instrumental in the treatment to decrease and manage its symptoms.

Causes of Borderline Personality Disorders

While research for BPD is still in its early stages, many agree genetics and childhood environments play a significant role in the development of BPD. Emotional, physical or sexual abuse experienced as a child may also contribute to the causes of BPD, as well as childhood loss, neglect or bullying. However, people are more likely to develop BPD due to biology and genetics — painful childhood experiences only increase the overall risk.

Top Signs of Borderline Personality Disorder

In addition to a pattern of unstable relationships and a poor self-image, those with BPD usually exhibit at least five or more of these symptoms, as well:

• Fear of abandonment
• Unstable or changing relationships
• Unstable self-image or a struggle with identity
• Impulsive behavior like excess spending habits, unsafe sex, substance abuse, reckless driving or binge eating
• Self-injury habits or suicidal behavior
• Varied, random mood swings
• Constant feelings of sadness or worthlessness
• A difficulty managing anger, like a frequent loss of temper or physical fights
• Stress-related paranoia or loss of contact with reality

Common BPD Triggers

You may have noticed your child’s mood swings and behavior are worse at certain times. There are a variety of BPD triggers that can precipitate and increase the intensity of symptoms, including:

• Unexpectedly being left alone
• Having a fight with a friend
• Visiting the site of a negative experience
• Being reminded of a traumatic event
• Being rejected for any reason

Any event or discussion that could lead to the child feeling abandoned can be a powerful trigger. Even something like not getting a text back soon enough can trigger a cascade of BPD symptoms. Learning to identify your child’s triggers can help you prepare for the emotional impact of the resulting episode.

Age Range for BPD Diagnoses

Mental health professionals usually hesitate to diagnose anyone under the age of 18 with a personality disorder for several reasons, including the continuous development of the brain and the strong stigma that comes with a personality disorder diagnosis.

Teen Borderline Personality Disorder

In the case of BPD, diagnosis in teens is even more complex because many of the borderline personality disorder symptoms, such as an unstable self-image and impulsivity, can be mistaken for common adolescent behaviors — even when they are much more severe than typical teen behavior. Professionals will often note the symptoms as “borderline personality traits” instead of giving a full BPD diagnosis.

In the past few years, there has been some movement in the professional community advocating for earlier diagnoses of BPD in adolescents due to the benefits of early engagement in treatment. A mental health professional experienced in the diagnosis and treatment of mental illness can detect signs of BPD through individual interaction and evaluation of a client. The psychosocial history and information given by family members or loved ones can also be helpful in providing an accurate diagnosis.

Common Borderline Personality Relationship Patterns and Cycles

Unstable relationships are a hallmark of BPD. Although the behavior and reactions of a child with BPD can appear erratic, a pattern or cycle in your relationship will typically emerge over time. Adolescent borderline personality disorder relationship cycles often look like:

• Experiencing hurt: The behavior pattern is usually triggered by an experience that causes the teen emotional pain. You or other members of the family may feel confused by the intensity of the pain the teen experiences, and feel that it is an overreaction.
• Feeling fear: In reaction to your confusion, the teen may be overwhelmed by fear of abandonment.
• Lashing out: Their intense fear may result in losing their temper and impulsively lashing out at you or others close to them.
• Dissociation or self-harm: Your teen may also turn their intense emotions inward and experience extreme feelings of worthlessness, leading to dissociation and self-injurious behavior.

This borderline personality disorder relationship pattern may repeat at any point where the child’s emotional dysregulation leads to extreme feelings of anger, emptiness, shame or abandonment. After the child stops lashing out or dissociating, it can seem like everything is fine for a while until the next triggering event occurs. This can lead to a chronic feeling of instability in your relationship with your child, which needs to be addressed as part of treatment for borderline personality disorder.

Parenting a Child With Borderline Personality Disorder

One of the most difficult aspects of BPD for parents to handle is the creation of a “love-hate” relationship. Your child may attempt to manipulate you by being pleasant and loving in order to get what they want and push you away when you don’t give in to their demands or try to make them do something they don’t want to do.

This tendency can be exhausting, as it seems your teen’s mood and perception of you can change at any time. One moment, your child may seem perfectly fine with your conversation, but immediately begin raising their voice and actively attempting to cause emotional harm if they are triggered by something you say.

A significant element of parenting a child with BPD is learning how to achieve emotional independence. Intense bouts of anger can cause you to feel highly distressed and more likely to express it negatively, harming your relationship even further. Learning how to identify emotions and self-soothe is one of the most important things parents can do to help their child with BPD.

How to Handle Someone With Borderline Personality Disorder

The way you interact with your adolescent can improve their behavior over time. It’s important to look past the BPD label and learn more about your child as a person if you want to help them manage their condition. When dealing with someone with BPD, try to:

1. Focus on Emotions

It’s easy to give too much focus to the harmful or manipulative things your child says when the real issue is the underlying feelings of worthlessness, emptiness or abandonment. When you focus on what the child says and does, they often feel like you are not hearing them fully. When you see your teen having a hard time, try to help them identify their emotions by asking exploratory questions like “It seems like you’re feeling hurt. Is that correct?”

2. Provide Validation

If your child shares feelings of worthlessness with you, don’t try to insist those feelings are wrong. Instead, acknowledge the emotion the child is feeling and try to re-frame the conversation toward processing the emotion or simply acknowledging it and not acting on their impulses.

3. Hold Boundaries

Boundaries and consistency can help improve emotional safety in adolescents with BPD. Boundaries should be developed with the input of both you and your child, as well as anyone else in the home, and should be based on shared values. Start slowly by introducing a single boundary and evaluating it together after a week or two.

How to Discipline a Child With BPD

Disciplining teens with BPD can feel like a losing battle, but there are two things you can do to help change your child’s behavior: Eliminate empty threats and establish consistent consequences for certain behaviors.

Many parents fall prey to empty threats as their children grow up. For example, you might tell your child that if they don’t finish their vegetables, they won’t get to eat dessert — only to give it to them anyway. Likewise, you may tell a teen that if they are caught texting in class again, they won’t be able to go to a certain social event, and then let them go despite the threat.

Establishing consistent consequences and following through provides a stable base for improved behavior. Consequences can be discussed at the same time as boundaries and should be clear as well as logical. It’s important to establish a set of positive consequences as well as negative ones. Invite your child’s input on both sets, and don’t shield them from negative consequences once you have agreed on what they should be.

A significant element of discipline is handling verbal abuse directed at you. Let your child know you will not tolerate yelling or other abusive behavior. Provide options for acceptable reactions that will be protective for both of you. For example, you can inform your child that if they begin yelling, you will simply walk away until they can re-engage safely. Your child should also know they have options when they begin feeling out of control, including going to their room for a while until they feel more in control.

Borderline Personality Disorder Support Groups for Families

The symptoms of BPD can cause emotional burnout for all members of the family. Aside from family therapy, one way to reduce the stress of parenting a child with BPD is to join a support group. Spending some time each week or month with people who understand your experience can provide stress relief and give you an opportunity to process events and emotions in a healthy manner.

How to Treat Borderline Personality Disorder

Psychotherapy with a mental health counselor is the starting point for treating BPD. The therapeutic process may look different for each client — however, effective therapy is predicated upon a well-developed trust and therapeutic relationship between the client and the therapist. Studies have shown treatment can be highly effective in decreasing suicide attempts and self-harm, as well as increasing functioning and social adjustments.

At Hillside, we utilize the following options for the treatment of BPD:

• Dialectical Behavior Therapy (DBT): Originally developed to treat BPD, Dialectical Behavior Therapy teaches clients how to increase awareness of and manage their emotions in more effective ways. DBT has been successful in helping clients reduce self-destructive behavior and improve their interpersonal relationships. At Hillside, we offer the adherent and comprehensive DBT treatment protocol, which includes individual DBT therapy, DBT skills training for client and family, skills coaching calls between sessions as needed, and therapist consultation team. DBT is the most studied BPD treatment, as well as the most effective.
• Psychiatric Medication Management: You can’t cure BPD with medicine, but prescriptions can help with other conditions that often co-occur with BPD, like depression, anxiety and impulsiveness. A combination of medication and psychotherapy is more effective in the treatment of mental illness than medication alone.
• Self-Care Activities: By taking part in good practices like regular exercise, good sleep, a nutritious diet and healthy stress management, patients can reduce the instances of mood changes, impulsive behavior and irritation commonly found in BPD.

Choosing the Best Therapist for You

Engaging in psychotherapy with a mental health professional is the first step in treating BPD. However, finding the right therapist is essential for effective treatment. Look for a licensed professional who has specific training and experience in treating clients with BPD. Ask the potential therapist about the treatment approach and ask yourself if the therapist is someone with whom you are willing to develop a trusting and therapeutic working relationship.

Trust Hillside for Your Child’s Borderline Personality Disorder Treatment Plan

Since 2005, Hillside has been utilizing DBT in the treatment of adolescents who struggle with emotion dysregulation, making Hillside the first residential treatment programs to implement DBT with the adolescent population in the Southeast.

All of Hillside’s clinicians have been intensively trained in Dialectical Behavior Therapy and have experience working with clients who have BPD or Borderline Personality traits. Our treatment team includes the first clinician in Georgia to be certified by the Linehan Board of Certification. We are also proud to be the first residential treatment facility in the state to offer comprehensive, immersive DBT services. We’re excited to offer outpatient DBT services to non-residential treatment clients in Atlanta, as well.

Learn more about our services today by completing our online contact form or calling 404-846-5118 to speak to one of our specialists.