Until recently clinicians believed they could not diagnose BPD until individuals were at least 18 years old.
The symptoms were typically seen as typical of every adolescent during the tumultuous years of puberty, misdiagnosed as other mental health conditions such as bipolar disorder, anxiety, anorexia, trauma, substance abuse, etc.
Additionally, the profound stigma associated with this disorder led clinicians to avoid giving a client the diagnosis in fear of potentially saddling them with a negative label that would follow them throughout the mental health and school systems.
Without accurate diagnosis, adolescents are without access to treatment, referred to incorrect treatments (i.e., CBT for depression), or over treated with medications that target mood disorders they do not have (i.e., medications designed to treat bipolar disorder, plus additional medications for sleep, anxiety and depression).
Many adolescents I coach are taking multiple medications and consistently report—as do their parents—that there is no improvement.
Without accurate diagnosis, adolescents are without access to treatment, referred to incorrect treatments, or over treated with medications that target mood disorders they do not have.
BPD is a disorder that involves a core problem regulating and stabilizing emotions and behaviors, and often begins to emerge in adolescence.
There is a pattern to the symptoms that involves frequent negative and reactive emotions, interpersonal struggles, an unstable sense of self, and risky and impulsive behavior. It can be differentiated from other more typical adolescence following a detailed diagnostic interview by a licensed professional who will looks for a variety of emotional and behavioral traits.
While not all people who exhibit these traits have BPD, the following traits of BPD emotional sensitivity include:
- Unusually intense experience of emotions
- High degree of reactivity to emotions
- Extremely slow return to baseline after experiencing an emotion
Two criteria used:
- “Are the symptoms persistent for more than a year?” and
- “Does the adolescent demonstrate many more problem behaviors across the board in all environments (school, home, church, etc. ) than other teens?”
Observable behaviors associated with adolescent BPD include:
- Intense depressed mood
- Irritability and anxiety that lasts just a few hours to a few days then shift
- Intense and uncontrollable anger
- Feelings of boredom and emptiness
- Judging themselves as terrible people
- Exhibiting little connection to goals or commitments
- Engaging in risky and casual sexual encounters
- Self-harm
- Drug use and abuse
- Eating disorders
- Suicidal thoughts and/or attempts
- Unstable friendships
- Frantic efforts to avoid abandonment
Sadly, there are few clinicians trained to diagnose and treat BPD in adolescents.
Sadly, there are relatively few clinicians effectively trained to diagnose and treat BPD in adolescents. There are however, excellent resources and psycho-educational trainings available to jump start the process.
The great news is, emotion regulation and distress tolerance can be taught and developed during adolescence and the course of BPD can be halted and even reversed in some cases.
Evidence based treatments (DBT MBT-A) can effectively reduce life threatening behaviors and the need for hospitalization.
For adolescents the first step toward effective treatment is education for the family and the adolescent followed by referral to the best and most effective treatment options available related to cost and geographical location.
Connecting with an intensively trained DBT coach and therapist is recommended. They are best able to help you sort through the therapeutic advertising and insurance mazes to help you create a long term, wrap around team of providers including prescriber, therapists, skills and life coach/case manage to create a treatment team to support and help the adolescent and family progress to recovery.
If you’d like help sorting things out or are interested in a qualified referral, I might be able to help.
