Borderline Personality Disorder in Teens: Meaning, Causes, Effects and Treatment

Borderline Personality Disorder (BPD) in teens refers to a mental illness that severely affects their ability to regulate moods. The condition mostly occurs in adults, but BPD also affects teens. While BPD and Bipolar Disorder (BD) have similar symptoms and are often confused, they are distinct conditions. According to a 2019 study by Patel, R. S., et al, published in the Medicina journal, BP is typified by extreme highs and lows in mood and energy, while Borderline Personality Disorder is characterized by unstable personal relationships and mood swings.

Signs and symptoms of Borderline Personality Disorder in teens include unstable relationships, feelings of emptiness, distorted self-image, impulsivity, acts of self-harm, and fear of abandonment.

Borderline Personality Disorder develops due to a combination of genetic (genes), biological (neurotransmitter imbalance ), and environmental (chaotic and unstable families, childhood trauma ) factors rather than a single cause.

Borderline Personality Disorder in teens affects their emotional well-being, causes problems in relationships, and results in academic impairment.

Treatment for Borderline Personality Disorder in teens typically involves a combination of psychotherapy (DBT, CBT, family therapy),  medication ( antidepressants, mood stabilizers, antipsychotics), and support from family and friends.

What is Borderline Personality Disorder in Teens?

what is borderline personality disorder

Borderline Personality Disorder, commonly known as BPD, is a mental health disorder characterized by a pattern of instability in interpersonal relationships, self-image, and emotions.  The National Institute of Mental Health (NIMH) defines Borderline Personality Disorder as a mental condition that affects a person’s ability to manage their emotions. Individuals with BPD often experience intense, unstable moods, and have difficulty regulating their emotions and behavior. This leads to impulsive actions, unstable relationships, and a distorted self-image.

While the condition is often associated with adults, it’s important to recognize that BPD also affects teenagers. Adolescence is already a period of significant emotional and psychological development, and when BPD is added to the mix, it makes this phase even more tumultuous.

Difference between borderline personality disorder and bipolar disorder

Borderline Personality Disorder (BPD) and Bipolar Disorder (BD) are often confused because they have some overlapping symptoms, but they are distinct mental health conditions. While BPD is characterized by the inability to control emotions, bipolar disorder (BD)involves rapid changes in moods. According to an article published by NewYork-Presbyterian Health Matters on understanding the difference between bipolar and borderline personality disorder, BD is rooted in the biology of the nervous system. At the same time, BPD is a condition on the psychological level.

Borderline Personality Disorder (BPD)

  1. BPD is characterized by instability in mood, behavior, self-image, and interpersonal relationships.
  2. Individuals with BPD often have intense, unstable relationships, fear of abandonment, and a distorted self-image.
  3. External events often trigger mood swings in BPD and shift rapidly, lasting from a few hours to a few days.
  4. They engage in impulsive behaviors such as substance abuse, reckless driving, binge eating, or self-harm.
  5. BPD is typically diagnosed in late adolescence or early adulthood.

Bipolar Disorder (BD)

  1. BD involves significant changes in mood, energy, and activity levels, affecting the ability to carry out day-to-day tasks.
  2. It consists of episodes of mania (elevated mood) and depression, with periods of normal mood in between.
  3. Manic episodes in BD are characterized by elevated mood, increased energy, racing thoughts, and decreased need for sleep.
  4. Depressive episodes involve feelings of sadness, hopelessness, and low energy.
  5. BD typically emerges in late adolescence or early adulthood but sometimes occurs in childhood.

What Are The Signs and Symptoms of BPD in Teens?

signs and symptoms of borderline personality disorder in teens

Signs and symptoms of Borderline Personality Disorder in teens include unstable relationships, suicidal behavior, distorted self-image, impulsivity, and fear of abandonment. According to a 2024 article by the National Institute of Mental Health, people with BPD view things in extremes, act recklessly, and have highly variable moods.

  1. Intense and Unstable Relationships: Teenagers with Borderline Personality Disorder usually struggle to maintain stable relationships with friends, family members, and romantic partners. They alternate between idealizing and devaluing others, leading to frequent conflicts and misunderstandings.
  2. Distorted Self-image: Teens with Borderline Personality Disorder often have a distorted and unstable sense of self. They frequently change their goals, values, and career aspirations and struggle to establish a clear identity.
  3. Impulsive Behavior: Impulsivity is a common symptom of BPD in teenagers. They engage in reckless behaviors such as substance abuse, unsafe sex, careless driving, or self-harm without considering the consequences.
  4. Intense and Unstable Emotions: Teenagers with Borderline Personality Disorder often experience intense and rapidly shifting emotions. They feel happy, sad, angry, or anxious within a short period and experience difficulties regulating these emotions.
  5. Chronic Feelings of Emptiness: Many teenagers with Borderline Personality Disorder report feeling empty, bored, or restless, even when they are surrounded by others or engaged in activities.
  6. Fear of Abandonment: Teens with Borderline Personality Disorder often have an intense fear of being abandoned or rejected by others. They are likely to go to extreme lengths to avoid real or imagined abandonment, such as clinging to unhealthy relationships or acting out in an attempt to provoke a response from others.
  7. Self-harm or Suicidal Behavior: Some teenagers with Borderline Personality Disorder engage in self-harming behaviors such as cutting, burning, or hitting themselves as a way to cope with intense emotions or to feel something when they are emotionally numb.

What Are The Causes of Borderline Personality Disorder in Teens?

causes of borderline personality disorder in teens

BPD develops due to a combination of genetic (genes), biological (neurotransmitter imbalance), and environmental (chaotic and unstable families, childhood trauma ) factors rather than a single cause. According to a 2013 study by Larrivée, P., on borderline personality disorder in adolescents, Borderline Personality Disorder risk factors in teens include maternal neglect, inappropriate parental behavior, and maternal rejection.

Genetic and Biological Factors Causing Borderline Personality Disorder in Teens

  1. Genes: Studies show that Borderline Personality Disorder runs in families, indicating a genetic predisposition to the disorder. According to a 2008 study by the University of Missouri-Columbia ‘Possible Genetic Causes Of Borderline Personality Disorder Identified, scientists identified genetic material on chromosome nine was linked to BPD. However, having a family member with BPD does not guarantee that a teenager will develop the disorder.
  1. Biological Factors: Neurotransmitter imbalance in certain neurotransmitters, such as serotonin and dopamine also plays a role in the development of BPD. These neurotransmitters are involved in regulating mood, emotions, and impulse control.

Environmental Influences

  1. Chaotic Homes and Dysfunctional Families: Unstable home environments, inconsistent parenting, and a lack of emotional support increase the risk of developing BPD in teenagers.
  1. Childhood Trauma and Abuse: Many teenagers with Borderline Personality Disorder have a history of traumatic experiences such as physical, emotional, or sexual abuse, neglect, or abandonment. These experiences can have a profound impact on a teenager’s emotional development and may contribute to the development of BPD.

What Are The Effects of Borderline Personality Disorder on Teens?

Borderline Personality Disorder has a significant impact on a teenager’s life, affecting their relationships, academic performance, and overall well-being. A 2012 study by Stepp, S. D., published in the Journal of Abnormal Child Psychology, shows that adolescents with BPD face social stigma and poor social and occupational outcomes.

Impact on Emotional Well-being

  1. Low self-esteem: Teens with BPD often have a poor self-image and feel worthless, unlovable, or undeserving of happiness and success.
  1. Self-harm and suicidal behavior: Self-harm behaviors such as cutting, burning, or hitting oneself are common among teenagers with BPD. They use self-harm as a way to cope with emotional pain or to feel something when they are emotionally numb. In severe cases, BPD leads to suicidal thoughts and behaviors.
  1. Substance abuse: Many teenagers with Borderline Personality Disorder turn to drugs or alcohol as a way to cope with their intense emotions and alleviate their symptoms. However, substance abuse worsens their symptoms and creates more problems.

Effects on Relationships

  1. Problems in relationships: BPD makes it difficult for teens to form and maintain healthy relationships with friends, family members, and romantic partners. They may experience frequent conflicts, misunderstandings, and breakups as a result of their intense emotions and impulsive behavior.

Academic and Social Impairment

  1. Difficulty in school: Teenagers with BPD normally struggle academically due to their emotional instability, impulsivity, and difficulty focusing on tasks.
  1. Isolation and loneliness: Due to their difficulty in forming and maintaining relationships, teens with BPD become isolated and lonely, further exacerbating their symptoms and reducing their quality of life.

What Are The Treatment Options for Borderline Personality Disorder in Teens?

treatment options for borderline personality disorder in teens

Treatment for BPD in teens typically involves a combination of psychotherapy (DBT, CBT, family therapy),  medication ( antidepressants, mood stabilizers, antipsychotics), and support from family and friends. The goal of treatment is to help teens manage their symptoms, improve their quality of life, and develop healthier ways of thinking and behaving.

The 2013 study by Larrivée, P., on borderline personality disorder in adolescents, published in Dialogues in Clinical Neuroscience journal indicates that dialectical behavior therapy (DBT) is ideal for treating BPD.

Psychotherapy

  1. Dialectical Behavior Therapy (DBT): DBT is the most well-researched and effective treatment for BPD in teens. It focuses on teaching teens coping skills to manage their emotions, improve their relationships, and reduce impulsive behavior. DBT typically involves individual therapy, group skills training, and phone coaching.
  1. Cognitive-Behavioral Therapy (CBT): CBT helps teens identify and change negative thought patterns and behaviors. It is especially helpful for teens with BPD who also have co-occurring conditions such as depression or anxiety.
  1. Schema-Focused Therapy: This therapy focuses on identifying and changing negative core beliefs and maladaptive coping strategies that contribute to BPD symptoms.
  1. Family Therapy: Family therapy helps improve communication and reduce conflict within the family. It also assists family members better understand BPD and learn how to support their teen.

Medication

  1. Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and other antidepressants are prescribed to help manage symptoms of depression and anxiety.
  1. Mood Stabilizers: Mood stabilizers such as lithium or lamotrigine are prescribed to help stabilize mood and reduce impulsive behavior.
  1. Antipsychotic Medications: Antipsychotic medications such as flupenthixol help to manage symptoms such as paranoia, dissociation, or severe mood swings. According to a 2013 study by Biskin, R. S., on the treatment of borderline personality disorder in youth, published in the Journal of the Canadian Academy of Child and Adolescent Psychiatry, flupenthixol at a dose of 3mg daily is beneficial.

Support Systems

  1. Case Management: Case managers help teens with BPD navigate the mental health system, access treatment and support services, and coordinate care between providers.
  1. Peer Support Groups: Peer support groups provide teens with BPD the opportunity to connect with others who are going through similar experiences. These groups provide validation, support, and encouragement.
  1. School Support: Teens with BPD benefit from accommodations at school, such as extra time on tests, a quieter environment for studying, or a reduced course load.

Tips to support parents with teens who have BPD

Supporting a teenager with Borderline Personality Disorder (BPD) is challenging, but there are several strategies to help parents navigate this difficult terrain:

  1. Educate Yourself: Learn about BPD to understand your teen’s challenges and behaviors better.
  1. Communicate Effectively: Keep communication channels open, listen actively, and validate their feelings even if you don’t agree with their actions.
  1. Set Clear Boundaries: Establish consistent, clear boundaries to provide structure and stability.
  1. Practice Self-Care: Take care of your own physical and mental health to better support your teen.
  1. Seek Professional Help: Consider therapy for your teen and family therapy to learn effective coping strategies and communication techniques.
  1. Encourage Healthy Habits: Promote regular exercise, a balanced diet, and sufficient sleep to support your teen’s overall well-being.
  1. Celebrate Progress: Acknowledge and celebrate even small achievements, fostering a positive environment.
  1. Patience and Understanding: Understand that recovery takes time, and setbacks are normal. Show patience, love, and understanding throughout the journey.

Can Borderline Personality Disorder in Teens Lead to Other Mental Health Problems?

Yes, Borderline Personality Disorder in teens is often associated with other mental health problems, including depression, anxiety, substance abuse, eating disorders, and post-traumatic stress disorder (PTSD). Teens with BPD need to receive comprehensive treatment that addresses all of their symptoms and problems. According to an article by the National Insititute of Mental Health, Borderline personality disorder in teens leads to other mental health problems, BPD usually occurs alongside other mental illnesses such as depression, eating disorders, and anxiety disorder.

What Challenges Do Boys Face in Diagnosing and Treating BPD?

Boys with BPD often face unique challenges due to societal stereotypes and biases. Symptoms of BPD in boys can be misinterpreted as antisocial behavior rather than emotional dysregulation. This misdiagnosis can lead to inappropriate treatment or lack of treatment. Boys may also be less likely to be diagnosed with BPD due to gender biases in understanding emotional and behavioral norms​. According to Alan E. Fruzzetti, a psychologist, “When boys don’t fit social and emotional norms, their behavior is misinterpreted, the bias around gender may have a lot to do with these different diagnoses.”

How Common is BPD in Teenagers?

According to a 2014 review by Michael K., on borderline personality disorder in adolescents and published in the American Academy of Pediatrics website, BPD affects more teens compared to adults. A 2018 study by Guilé JM., et al, on borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies, published in the Adolescent Health, Medicine and Therapeutics, shows that about 3% of adolescents suffer from BPD.

How do adolescent phobias contribute to the development of Borderline Personality Disorder (BPD) in teens?

Adolescent phobias can contribute to the development of Borderline Personality Disorder (BPD) in teens by exacerbating feelings of anxiety, fear, and emotional instability. Teens with intense phobias may experience heightened stress and social withdrawal, which can impact their emotional regulation and interpersonal relationships. This chronic stress and inability to manage emotions effectively are key components in the development of BPD. Addressing phobias through therapeutic interventions, such as cognitive-behavioral therapy (CBT) and exposure therapy, can help reduce anxiety and improve emotional stability, potentially mitigating the risk of developing BPD.

How can parents and educators recognize early signs of suicidal thoughts in teens with Borderline Personality Disorder (BPD)?

Parents and educators can recognize early signs of suicidal thoughts in teens with Borderline Personality Disorder (BPD) by being vigilant for specific behaviors and emotional cues. Warning signs include frequent mood swings, expressions of hopelessness or worthlessness, withdrawal from social activities, and self-harming behaviors. Teens with BPD may also exhibit impulsive actions and intense reactions to perceived rejection or abandonment. Early intervention is crucial; encouraging open communication, seeking professional help, and providing emotional support can help prevent the escalation of suicidal thoughts and promote mental health stability in teens with BPD.

What is the Prognosis for Teens with BPD?

With appropriate treatment, many teens learn to manage their symptoms effectively. Long-term outcomes are significantly improved with early intervention, comprehensive treatment plans, and strong support systems. Research indicates that many adolescents with BPD achieve remission, though some continue to experience symptoms to varying degrees into adulthood. According to a 2015 study by Biskin, R. S., on the lifetime course of borderline personality disorder and published in The Canadian Journal of Psychiatry, BPD symptoms reduce over time, especially with treatment.

How Can Parents Support a Teen with BPD?

According to the Handbook of Good Psychiatric Management for Adolescents by Lois W. C., et al, parents and families with a BPD teen can help by listening with an open mind and regulating their stress to keep the home environment stable and calm. 

Author: Shantel Sullivan Ed.D., LCSW
Dr. Shantel Sullivan, Ed.D., LCSW, serves as the CEO of Bright Path with a rich background in residential adolescent treatment, adult outpatient services, and academia, leveraging over a decade of licensed social work experience in New York and North Carolina. Her academic credentials include a BA in Sociology, an MSW and a graduate certificate in addictions counseling from the University of New England, culminating in a doctoral degree in Educational Leadership focused on transformational leadership. Beyond her clinical expertise, Dr. Sullivan contributes to the field as a national speaker, educator, and editor of the Bright Path Teen Mental Health Blog, committed to enhancing access to evidence-based mental health care for adolescents and their families.
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