Borderline personality disorder

Personality disorders in children and adolescents are hard to define. They are known as ‘personality’ disorders because they are enduring and pervasive in nature – so we tend to think of them as being part of a person’s ‘personality’ rather than a set of symptoms.

What are personality disorders?

Our personalities are still developing when we are teenagers, which is why the diagnosis of BPD hasn’t been without its contentions. Some experts say it isn’t helpful to ‘label’ a child when their personality isn’t fully developed, whilst other experts would say that a diagnosis allows for the correct treatment and interventions to be put in place.

There are several ‘clusters’ of personality disorders, which are categorised based on their defining characteristics. The most common personality disorder is borderline personality disorder – which falls in Cluster B.

What is Emerging borderline personality disorder?

Emerging borderline personality disorder is a concept designed to convey the fact that BPD should only be diagnosed in children and adolescents in those rare and relatively unusual cases where the features of BPD are pervasive, persistent and unlikely to be limited to a particular phase of the young person’s life.
It also conveys the idea that the features of BPD may often not persist into adult life. Where present, EBPD is a severe mental health condition, that usually starts developing around mid-teens. Someone who has EBPD will have difficulties in the following areas of their life:

• Interpersonal relationships
• Impulsive behaviour
• Self-identity

EBPD often becomes apparent in how the individual relates to others, it may be that your teen has ‘fiery’ friendships that are ‘all or nothing’. They may find disappointment very hard to bear and it’s common for those with emerging borderline personality disorders to self-harm or even make attempts on their lives.

Symptoms of emerging borderline personality disorder

The symptoms used to diagnose EBPD in teenagers are the same as those used for adults and include:

• Frantic efforts to avoid real, or imagined, abandonment by others
• Intense relationships with others – shifting from idealising to detesting.
• Unstable sense of self
• Impulsive behaviour (overspending, promiscuity, binge eating, reckless driving)
• Self-harming / suicide attempts or threats
• Intense moods – anxiety, depression or irritability
• Feeling empty and worthless
• Intense and inappropriate anger and outbursts
• Brief episodes of paranoid thoughts and dissociation
  
  

Causes of emerging borderline personality disorder research has shown that personality disorders aren’t caused by one factor in particular; like most mental health issues they are a result of genetic predispositions, environmental and social factors. Studies have shown that those with a personality disorder are more likely to have another mental health disorder as well. For instance, someone with a personality disorder is 5 times as likely to have an eating disorder.
Martinussen, M., et al (2009)

Diagnosing emerging borderline personality disorder

Regardless of the reason why your child or teenager may be behaving the way they are, if your child is harming themselves, acting dangerously or recklessly and suffers from anxiety, depression or low self-esteem, it is important to get some help for them as early as possible.

Only a Psychiatrist who has experience of working with personality disorders will be able to diagnose and recommend the most effective treatment options for your child. They will also look to ascertain whether your child has another mental health conditions like depression or anxiety which could explain their symptoms.

Treating emerging borderline personality disorder

Adolescence is a time of developmental transitions – learning more about yourself, how to build and maintain relationships and building a sense of who you are as a person. These factors, teamed with ‘meltdowns’ or strong emotions are frequently dismissed as being due to hormones, teenagers who have a personality disorder often go untreated.

Treatment options for EBPD include primarily talking therapies.

Medication can be useful for some disorders that frequently accompany BPD, such as anxiety and depressive disorders.

Talking therapies like MBT-A and DBT-A are usually recommended. These therapies have added benefits, not only in dealing with the immediate issues but also supporting your child or teenager to develop a healthier and fuller sense of self. They will also learn invaluable coping mechanisms and skills that will last a lifetime.

Many psychiatrists shy away from diagnosing BPD in adolescents for fear of labelling teens unfairly. This could indeed be a problem if, once recorded, the diagnosis of BPD is never reviewed. In reality, of course, many young people will no longer meet the diagnostic criteria for BPD in adulthood. By giving a diagnosis during adolescence, the child is able to access treatment programmes for BPD.

Dr Dennis Ougrin

MBBS, MRCPsych, PGDip (Oxon), CCT, PhD

Consultant Child Psychiatrist

London

Dr Ougrin is a psychiatrist with nearly 10 years of clinical and academic experience specialising in child and adolescent psychiatry. He also has undertaken much research in the area of self-harm and has developed an effective intervention for...