Borderline personality disorder (BPD) is defined by a pervasive pattern of instability in moods, self-image, and behaviors, alongside difficulties in emotional regulation. This instability often centers on the inability to manage emotions effectively, leading to distress and disruption in a person’s life. While BPD is associated with adults, its characteristic features frequently emerge during adolescence, prompting caregivers to seek understanding of these traits in a younger person.
Why Formal Diagnosis is Restricted by Age
The criteria for diagnosing BPD are outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), which indicates that personality disorders are not formally diagnosed in individuals under the age of 18. This restriction is based on the understanding that personality is still forming and stabilizing throughout childhood and adolescence. Many emotional and behavioral patterns that appear concerning in a teenager might be transient, reflecting normal developmental flux rather than an entrenched, pervasive disorder.
However, the DSM-5 does allow for a diagnosis of BPD in those under 18 if the symptoms are significant, persistent, and have been present for at least one year. The diagnosis requires assessment to ensure the pattern is not merely a temporary phase or limited to a specific developmental stage. Clinicians are cautious because many adolescents exhibit heightened emotional instability and sensitivity that do not ultimately progress to a full personality disorder. Early identification of BPD-like traits, sometimes referred to as “emerging BPD,” is crucial because it allows for early intervention, which can significantly improve long-term outcomes.
Identifying Core Features of Severe Emotion Dysregulation
In youth, BPD-like traits manifest primarily as severe emotion dysregulation, meaning the person struggles intensely to manage their feelings. This often presents as extreme emotional reactivity, where moods shift rapidly and intensely, sometimes lasting only a few hours. For example, a minor setback, like a low grade or a minor peer conflict, can trigger an episode of intense sadness, irritability, or rage that is disproportionate to the event.
Fear of Abandonment and Unstable Relationships
A profound and persistent fear of abandonment is a hallmark feature, often driving intense and unstable relationships. A young person might exhibit frantic efforts to prevent a parent or friend from leaving, becoming clingy, or lashing out in anger when plans are canceled. These relationships are often characterized by quickly alternating between extremes of idealization and devaluation, sometimes referred to as “splitting,” where a person is seen as either entirely good or entirely bad.
Identity Disturbance
Identity disturbance is another core feature, presenting as an unstable sense of self. The young person may have frequent, sudden changes in their goals, values, or friend groups, struggling with a chronic feeling of emptiness or boredom. They may adopt the identity, style, or interests of a person they admire, only to discard it quickly, indicating a lack of a cohesive self-image.
Impulsive and Self-Damaging Behaviors
Impulsive behaviors are common and potentially self-damaging, often serving as maladaptive attempts to cope with overwhelming emotions. Recurrent self-harming behaviors, such as cutting or burning, or suicidal gestures and threats are frequently observed, reflecting an attempt to manage emotional pain or numbness. This can include:
- Reckless driving
- Substance abuse
- Binge eating
- Reckless spending
Distinguishing BPD-Like Traits from Typical Adolescent Behavior
Differentiating BPD-like traits from normal adolescent moodiness is a significant challenge for clinicians and families. Typical teenage mood swings are situational, transient, and less severe, while the features associated with emerging BPD are pervasive, enduring, and highly intense. The key difference lies in the severity and persistence of the symptoms across multiple settings—home, school, and social life.
When a trait is BPD-like, the emotional reaction is hyperbolic, meaning it is extreme, highly sensitive, and disproportionately reactive to the trigger. This extreme reactivity causes significant functional impairment, leading to repeated difficulties in maintaining friendships or performing consistently in school. Mental health professionals focus on the function of the behavior, noting if the young person is engaging in impulsive or self-harm behaviors primarily to regulate intense, intolerable emotions. The persistence of these patterns is a major cause for concern.
Therapeutic Approaches for Youth
When a young person exhibits persistent and impairing BPD-like traits, evidence-based psychotherapy is the recommended course of action. Dialectical Behavior Therapy (DBT) is the most studied treatment for youth with severe emotion regulation difficulties. DBT for adolescents (DBT-A) is an adaptation of the adult model that includes the caregivers.
DBT-A is a skills-based therapy that teaches four core skill modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. The therapy aims to balance acceptance of the young person’s intense emotional experience with the need for change in their behavioral patterns. Family involvement is a central component, with parents and caregivers often participating in skills training to help them reinforce positive behaviors and manage the emotional intensity at home. Early intervention with DBT-A has been shown to reduce self-harm, suicidal ideation, and the overall severity of BPD symptoms.