Adolescent Borderline Personality Disorder

Borderline personality symptoms are confusing, frustrating, and difficult for loved ones to understand. This is especially true for parents or caregivers who deal with adolescents with borderline personality disorder (BPD).

Although we know a lot about borderline personality symptoms in adults, we know very little about how this disease manifests in adolescents. In fact, there is still controversy as to whether it is appropriate to diagnose adolescents with BPD.

Many experts believe that adolescents may have BPD, and that adolescent BPD is now recognized as an official diagnosis.

Parents often have questions about the marginal personality of adolescents. Some people worry that their adolescents show signs of borderline personality disorder (BPD), such as strong and frequent mood swings, impulsive behavior, self-harm, or relationship difficulties.Others have BPD themselves and worry that their children will also have the disease.


Borderline personality disorder is a serious mental health condition. It is characterized by the instability of interpersonal relationships, emotions, self-image and behavior.

Many experts believe that borderline personality should not be diagnosed in anyone under the age of 18, because technically, their personality is not yet fully formed. However, in the latest version of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), there is a provision that allows the diagnosis of borderline personality before the age of 18.

Although this provision technically allows the diagnosis of BPD in children under 13 years of age, this situation is very rare.


Although the BPD symptoms listed in the official DSM-5 diagnostic criteria are no different for adolescents and adults, some experts suggest that there are differences in BPD symptoms for adolescents.

Symptoms of borderline personality disorder include:

  • Frustrated
  • Frequent and dramatic changes in mood
  • Fear of being abandoned or rejected
  • Difficult to maintain a relationship
  • Impulsive and dangerous behavior
  • Paranoid
  • Self-harm
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Symptoms such as unstable interpersonal relationships, impulsive behavior, long-term emptiness, and unstable self-awareness may vary among adolescents. Sometimes it may be difficult to distinguish BPD symptoms from normal teenage challenges.


In order to diagnose BPD in adolescents, doctors and psychiatrists will not only pay attention to individual behaviors, but also their motivations for these behaviors. For example, the substance used is not necessarily a sign that a person has BPD. However, if they engage in such behaviors to avoid problems, as well as how they feel or manage emotions, it may be seen as a sign of illness.

Studies have shown that children as young as 11 years old can describe their behavior and motivation enough to make an accurate diagnosis.


For adults with BPD, the symptoms of the disease usually gradually decrease with age, especially after the age of 40. The progress and prospects of adolescents with this condition are less clear, although proper treatment can significantly improve symptom management.

According to a review published in 2015, the remission rate of adolescents may be between 50% and 65%, but even if some adolescents no longer meet the diagnostic criteria for BPD, certain symptoms may persist.


A study published in 2014 showed that the marginal personality rate of adolescents is slightly higher than that of adults. This may be related to the fact that some teenagers show BPD in response to stressful events, but many are more likely to recover.

According to the National Institute of Mental Health (NIMH), 1.4% of adults over the age of 18 are affected by borderline personality disorder.

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Some studies have shown that the prevalence of adolescents is about 3%.

Risk factors

The risk factors of adolescent borderline personality are very similar to those of adults. In fact, many environmental risk factors of BPD occur in childhood. Some factors that may increase the risk of BPD include:

  • Brain differences: Studies have also found that people with BPD usually have changes in the brain regions, which are related to the regulation of emotions and impulses.
  • Environmental factors: Childhood abuse and neglect, as well as separation or loss of parents, are all related to the marginal personality of adults and adolescents.
  • Family history: Studies have also found that children whose parents have severe mental health conditions (such as depression, drug abuse, or antisocial personality) are also at greater risk of BPD.
  • Genetic influence: In addition, there may be biological risk factors for BPD, such as the genetic component of genetic diseases.


If you are concerned that your teen may be at risk of BPD due to environmental risk factors (for example, trauma exposure) or biological risk factors (for example, first-degree relatives with the disease), some experts believe that there are ways to change the condition process.

Children who have experienced externalization disorders, such as oppositional defiant disorder (ODD) and attention deficit hyperactivity disorder (ADHD), seem to be more likely to develop BPD symptoms during adolescence.

The presence of depression in adolescence seems to predict BPD in adulthood. This suggests that early detection and use of specific therapeutic interventions to address these symptoms may help change the course of the disease.


Although BPD is a serious and complex disease, there are some effective treatments that can help control and reduce symptoms. It is important to obtain an accurate diagnosis and use the appropriate treatment methods.


Several psychotherapies, including cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT), may be effective for adolescents with borderline personality.

  • CBT can be used to help people learn to recognize and change the negative thoughts that cause disease symptoms.
  • DBT helps people solve destructive behaviors, learn new skills, and find ways to endure pain and difficult emotions.

DBT is also specifically used for young people. Youth Dialectical Behavior Therapy (DBT-A) involves individual psychotherapy and family skills training.

A randomized controlled trial comparing DBT-A with psychodynamic therapy and CBT found that, compared with other treatments, DBT-A was associated with a reduction in depressive symptoms, borderline symptoms, self-harm behavior, and suicidal ideation.


Although there are no FDA-approved drugs for the treatment of BPD, some drugs have been shown to relieve some symptoms.

  • Studies have shown that when combined with psychotherapy, second-generation antipsychotics can be used to manage suicide risk.
  • Anti-anxiety medications can also be prescribed for a short period of time to help control certain symptoms, but benzodiazepines should never be prescribed to treat BPD.
  • Drugs such as Ritalin (methylphenidate) and selective serotonin reuptake inhibitors (SSRIs) can also be used to treat concurrent ADHD and depression.
  • Melatonin can also be used to treat insomnia, which is usually accompanied by BPD.

Very good sentence

It is difficult to find a good treatment for adults with BPD, but considering that there are some controversial issues in diagnosing borderline personality in adolescents, it is even more difficult to find a therapist for adolescents with BPD. Fortunately, more and more therapists are being trained to treat adolescents with marginal personality.