Borderline personality disorder in teens is marked by a more intense experience of typical teenage feelings, as well as unstable relationships, an unclear sense of self, intense mood swings, and explosive anger. Experiences during adolescents influence how we feel, act, and relate to others, making it especially difficult for a teen struggling with BPD.
Borderline Personality Disorder Workbook
Our workbook helps you better understand and manage challenges of Borderline Personality Disorder (BPD), including triggers, emotions, and self-care.
What Is Borderline Personality Disorder in Teens?
Borderline personality disorder (BPD) is a mental health condition that involves mood swings, abandonment concerns, low self-esteem, low self-worth, poor boundaries, and impulse issues. In general, teenagers have a reputation for being moody and full of angst; however, personality disorders in teens present with much more extreme emotional reactions.
Is BPD in Teens Different From Adult BPD?
BPD in teens is not significantly different from adult BPD. No matter the age, borderline personality disorder has the same set of signs and symptoms. Teens may find differences in the intensity or frequency of their thoughts, feelings, and behaviors, but overall, the personality disorder is the same.
When Does BPD Typically Develop?
Commonly, experts view BPD as a condition that begins in early adulthood, but new understandings of the condition show that children as young as 12 can meet the full criteria.7 Professionals may refer to this as “early onset” BPD. In other cases, some signs and symptoms may be present in teens, and as the condition develops over time, they can receive the diagnosis.
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Signs & Symptoms of BPD in Teens
For the most part, people with BPD will experience many of the same symptoms, regardless of their age. They will note periods of extreme happiness and elation, sometimes called BPD euphoria, and other times, they will report extreme anger, sadness, and emotional instability.7
Symptoms of borderline personality disorder in adolescents are:
- Unstable relationships
- Extreme mood swings
- Low self-esteem and self-worth
- Anger and/or extreme rage
- Self-harm behaviors and thoughts
- Impulsive and risky behavior
- Severe depression
- Fear of abandonment
- Fear of rejection
- Anxiety
- Self-destructive behavior
- Paranoia
- Feelings of emptiness
Identifying Self-Harm Behavior in Teens With BPD
Self-harm behaviors and suicidal ideation are major indicators of BPD in teens. Note that self-harm can manifest in many different behaviors, so as a parent, teacher, or caregiver, it’s important to be on the lookout for lesser-known or more concealed forms of teen suicidal behaviors and self-harm.
Forms of self-harm include:1
- Cutting
- Punching walls or other hard, inanimate objects
- Using drugs or alcohol
- Talking about harming themselves with a plan
- Playing with fire or sharp objects
- Engaging in unsafe sexual behavior
- Burning their skin, nails, or hair
Risk Factors of BPD In Teenagers
There are many risk factors and causes of borderline personality disorder in adolescents, including abuse, sexual trauma, and mental health conditions like anxiety, depression, and antisocial personality disorder (ASPD).
Here are seven risk factors and causes of BPD in teens:
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- Early childhood abuse or neglect: Abuse and neglect can have lasting impacts on anyone. For some, these acts will trigger BPD.
- Sexual trauma: Like with other types of abuse, sexual abuse and other forms of sexual trauma are highly linked to BPD.
- Pre-existing mental health conditions: BPD is also linked to other mental health conditions. Children with depression, anxiety, or PTSD may develop BPD.
- Unstable home environment: Chaotic home life and inconsistent reinforcement at home can increase the chances for BPD to emerge.
- Family history of mental health disorders: When a family member has any type of mental health condition, it will increase the teen’s risk of BPD.
- Brain abnormalities: If someone has damage or deficits in the parts of their brain that influences emotions, they could have an increased risk of BPD.
- Genetic factors: Having a family member with borderline personality disorder increases a person’s chance of having BPD by five times.7
How Is BPD In Teens Diagnosed?
Although BPD is more commonly diagnosed in young adults, symptoms of BPD may be present in preteens and teenagers. No matter the age, professionals will gather information about the individual and compare their experience with the criteria for BPD as outlined by the American Psychiatric Association. If the person reports enough symptoms to have BPD, they will receive the diagnosis regardless of their age.7
Can BPD in Teens Be Prevented?
It’s unknown if BPD can be prevented, but there are numerous interventions families and professionals can use to manage symptoms. By being consistent, loving, and supportive, people with BPD symptoms can learn limits of their behaviors and prevent symptoms from worsening.
Would Your Teenager Benefit From Therapy?
Therapy can help teenagers develop self-esteem and feel less overwhelmed by their emotions. Teen Counseling specializes in serving teens, and parents of teenagers. The services start at $65. Complete a brief questionnaire and a therapist will be suggested based on your answers.
Treatments For BPD in Teens
There are a number of ways to treat borderline personality disorder in adolescents, including dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), mentalization-based therapy (MBT), and different forms of medication.
Therapy for Teens With BPD
- Dialectical behavioral therapy (DBT): DBT for BPD helps to reduce self-harm behaviors, including suicide. These sessions focus on mindfulness, distress tolerance, regulation of emotions, and interpersonal skills. Teens learn how to accept themselves without judgment, acknowledge their emotions, learn how to better manage those emotions, improve communication, recognize when they have no power, and manage that situation accordingly.4
- Cognitive behavioral therapy (CBT): CBT for BPD can be helpful in conjunction with DBT or as a stand-alone modality. It aims to help teens identify patterns of negative thoughts and recognize how thoughts lead to actions. The goal is to challenge them to identify their thoughts and feelings and replace negative ones with positive ones in order to heal and move forward.5
- Mentalization-Based Therapy (MBT): MBT helps people with BPD improve their understanding of themselves and others, which can be helpful in forming or maintaining their relationships with others.
Medication
While there is no known medication to treat BPD, there are medications that can help treat certain symptoms. Because some symptoms of BPD overlap with depression, anxiety, psychosis, and bipolar disorder, it’s common to take medications related to those diagnoses. It’s considered best practice to use pharmacological intervention in conjunction with talk therapy like DBT or CBT.6
Parenting a Teenager With Borderline Personality Disorder
To support a teen with BPD, parents should provide consistency and stability and avoid shaming. Due to their own fears and anxieties about what BPD is and what the future holds, it’s common for parents to struggle. That means they should prioritize self-care and have their own support system and/or therapist as well.
Be Consistent With Boundaries
Consistent boundaries and consequences are critical for teens. Adhering strictly to the boundaries and guidelines set in place makes it clear that they won’t get “special treatment” or be able to bend the rules. This kind of consistency is also important for their healing.
Consider Family Therapy & Individual Therapy for Siblings
If your teen has siblings, consider therapy for them, too, and pay attention to how they’re coping. Siblings with a good relationship may want to try and fix the problem, which could backfire. Siblings who don’t get along may struggle to understand or show compassion. Family counseling provides a collective outlet, a means to connect, and an opportunity to get on the same page.
Help Your Teen Build a Strong Support System
It’s important for teens to have a strong support system in place, especially if they’re struggling with BPD. BPD treatment can be challenging, so they’re encouraged to include family and close friends to help them throughout their journey. Teens who have involved parents/caregivers are more optimistic and tend to have better outcomes as well as better family cohesion.
Attend Your Own Therapy Sessions
Attending therapy sessions can also help parents/caregivers learn how to be better supports for their teen. When the family is involved with the teen’s care plan, the overall prognosis improves greatly.
How to Find a Therapist
Find a therapist for your teen or for yourself by searching an online therapist directory and reviewing providers based on your preferences and insurance. Start by researching clinician profiles online and selecting a few to contact for initial conversations. Many therapists offer a free phone consultation to give families an opportunity to evaluate whether they’re the right fit.
Cost typically depends on your insurance and length of treatment. Therapy can last anywhere from 12-15 weekly sessions. Each one-hour session can range from approximately $60-$200 depending on your insurance, co-pays, and whether your provider is “in-network.”
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Final Thoughts
What you’re struggling with may be unique to you, but you’re not alone. Talking to a therapist or reaching out to a trusted friend or family member can make a big difference in how you feel.
BPD in Teens Infographics
ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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Paris, J. (2019). Suicidality in borderline personality disorder. Medicina. 55(6), 223. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6632023/
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Chanen, A. M., Nicol, K., Betts, J. K., & Thompson, K. N. (2020). Diagnosis and treatment of borderline personality disorder in young people. Current psychiatry reports. 22(5), 1-8. https://pubmed.ncbi.nlm.nih.gov/32335771/
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Bozzatello, P., Bellino, S., Bosia, M., & Rocca, P. (2019). Early detection and outcome in borderline personality disorder. Frontiers in psychiatry. 10, 710. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794381/
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Prada, P., Perroud, N., Rüfenacht, E., & Nicastro, R. (2018). Strategies to deal with suicide and non-suicidal self-injury in borderline personality disorder, the case of DBT. Frontiers in psychology, 9, 2595. https://www.frontiersin.org/articl.s/10.3389/fpsyg.2018.02595/full
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Kredlow, M. A., Szuhany, K. L., Lo, S., Xie, H., Gottlieb, J. D., Rosenberg, S. D., & Mueser, K. T. (2017). Cognitive behavioral therapy for posttraumatic stress disorder in individuals with severe mental illness and borderline personality disorder. Psychiatry research. 249, 86-93. https://pubmed.ncbi.nlm.nih.gov/28086181/
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Bozzatello, P., Rocca, P., De Rosa, M. L., & Bellino, S. (2020). Current and emerging medications for borderline personality disorder: is pharmacotherapy alone enough?. Expert opinion on pharmacotherapy. 21(1), 47-61. https://pubmed.ncbi.nlm.nih.gov/31693423/
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American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.
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Primary Changes: Added BPD Workbook with four worksheets.
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Primary Changes: Updated for readability and clarity. Reviewed and added relevant resources. Added “Is BPD in Teens Different From Adult BPD?”, “When Does BPD Typically Develop?”, “Risk Factors of BPD In Teenagers”, “How Is BPD In Teens Diagnosed?”, and “Can BPD in Teens Be Prevented?”. New material written by Eric Patterson, LPC and reviewed by Kristen Fuller, MD.
Author: Silvi Saxena, MBA, MSW, LSW, CCTP, OSW-C
Reviewer: Rajy Abulhosn, MD
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