More than Moody: Teenage Borderline Personality Disorder

Teen experiences often mean intense fluctuations in mood and relationships, but how do you know when it’s “more than moody?” This article will help you learn when extreme moods could mean borderline personality disorder (BPD).

We cover the most asked questions about adolescents and BPD, including what a personality disorder is; how to tell the difference between borderline personality disorder, bipolar disorder, ADHD, and other mental health disorders; and what to do if you think your teen might have symptoms of BPD.

Definition of Borderline Personality Disorder

BPD is one type of personality disorder, which is more broadly defined as enduring patterns of inner experiences and behavior that differ significantly from expectations from one’s culture. These deviations are inflexible, pervasive and cause significant distress and impairment. For borderline personality disorder, the most prominent problematic patterns are:

  • Instability and intense distress within relationships
  • Instability in self-image (rapid changes in identity)
  • Extreme mood changes
  • Impulsivity

When does Borderline Personality Disorder Develop?

Personality disorders are typically not diagnosed until adulthood (18+) since they are significant diagnoses that carry a fair amount of stigma and require specialized treatment. Teens rarely present with this many symptoms in a stable way over time. 

Many symptoms of borderline personality disorder look like typical adolescent mood swings and relationship turbulence! The biggest difference is that symptoms of BPD are more extreme and cause intense, persistent distress and disruption to a person’s life and functioning.

Signs and Symptoms of Borderline Personality Disorder

Along with the baseline description above, someone with BPD needs to have at least five of these symptoms present consistently to receive a diagnosis in adulthood. Below you’ll find these symptoms are paired with real examples of how this can show up in a young person’s life. Whether you meet criteria for a diagnosis or not, any of these symptoms is a good signal to get more support and evaluation:

  • Frantic efforts to avoid real or imagined abandonment
    Example: sending 20 DMs to a friend they are worried is upset with them
  • Unstable and intense relationships that alternate between extremes
    Example: hanging out with a new friend to the exclusion of all others for a week, and then blocking them the next week when that friend upsets them
  • Identity disturbance
    Example: being one way with a family member, and totally different with another adult, because they are not sure “who they are” across contexts
  • Damaging impulsivity
    Example: sneaking out and getting a tattoo after fighting with a parent
  • Recurrent suicidal behavior, or self-harm
    Example: cutting themselves, or frequently telling friends or family members they want to kill themselves, when they get upset
  • Extreme reactivity of mood
    Example: screaming at their parent for setting a limit, then crying and seeking comfort from that parent afterwards
  • Chronic feelings of emptiness
    Example: experiencing feelings of numbness no matter what they’re doing 
  • Inappropriate intense anger
    Example: yelling at, or getting violent with, friends
  • Paranoid thoughts or dissociation
    Example: believing everyone is judging or disliking them, or feeling mentally separate from their body

What’s the difference between bipolar and borderline personality disorder?

Many people associate rapid mood changes with bipolar disorder, and these diagnoses can occur together. The difference is that, in bipolar disorder, symptoms of extreme reactivity and impulsivity occur in the context of “manic episodes” which last about a week and are very extreme. Manic episodes usually come between depressive episodes, which are periods of low mood and energy that impact a person’s functioning for 2 weeks or more. In bipolar disorder, manic episodes and depressive episodes are usually distinct from each other and, without treatment, will fluctuate over the course of a longer period of time, like a year. 

In borderline personality disorder, mood changes are both extreme and rapid, and often brought on by events or experiences, unlike bipolar disorder. The same applies for borderline personality disorder vs ADHD, which can also be characterized by impulsivity. ADHD is characterized by difficulties with either attention, impulsivity, or both. It can affect a person’s mood and relationships, but is not defined or diagnosed by those features, unlike borderline personality disorder. 

The simplest explanation is that borderline personality disorder is a personality disorder, which means it affects all areas of a person’s life across contexts, is more extreme, and does not “come and go.”

Causes and Risk Factors for BPD

There appears to be a strong genetic component of borderline personality disorder - risk for developing BPD is five times greater with a first degree relative with BPD, like a parent. Many adults who are diagnosed with BPD in adulthood have similar experiences in childhood - these are considered risk factors:

  • Physical or sexual abuse
  • Extreme neglect
  • Hostile conflict and/or violence in their home
  • Early parental loss or disruption
  • Multiple traumatic experiences

It’s important to note that not all children who experience these things go on to develop BPD or other mental health disorders, but they are considered risk factors. These experiences are all marked by significant disruptions in a person’s crucial early relationships, which is why BPD is often described as an “attachment” disorder, or related to post-traumatic stress disorder (PTSD). 

People with BPD often describe a profound sense of suffering and pain in relationships that has been present their whole life. This is very different from typical teen struggles with changing moods, friendships, and romance. 

What triggers the onset of borderline personality disorder? 

While these events may have occurred in childhood, sometimes the first signs and symptoms of borderline personality disorder emerge in adolescence, when a teen is experiencing the added physical, hormonal, and neurological changes of adolescence

In addition, teens are likely having their first experiences of consistent relationships outside of family members. New independence, new relationships, and pressure to develop a personal sense of identity likely all contribute to the first symptoms of BPD emerging in adolescence. 

Getting a BPD Diagnosis

The best way to determine if a diagnosis of borderline personality disorder applies to your teen is to seek evaluation from an experienced professional. An assessment from a psychologist or other licensed mental health provider can help provide clarity on which mental health diagnosis, if any, best fits your teen’s symptoms. 

While some diagnoses, like depression, anxiety, or bipolar disorder may be able to be assessed by a primary care provider, or a mental health professional, by gathering history and symptom reports in one visit, personality disorder diagnoses take more time to assess and diagnose. That being said, if your teen is struggling with any of the symptoms related to BPD, establishing a relationship with a mental health professional is a great first step! 

Can a teen get a borderline personality disorder diagnosis? 

It would be unusual for a young teen to receive any personality disorder diagnosis, since many of the symptom criteria need to have been present for an extended period of time. For borderline personality disorder, a younger person likely would not have had enough life experiences to establish a consistent pattern of relationship disruptions, extreme moods, suicidality, and intense, pervasive distress. BPD is much “more than moody.” 

Similarly, a single instance of self-harm, or suicidality in the context of depression or a significant life event, does not mean a teen has borderline personality disorder. Depending on what symptoms are present, and if a teen has had a history of abuse or loss described above, a diagnosis related to traumatic experiences, such as PTSD, may be more relevant. 

If you are trying to figure out whether your teen has bipolar disorder or borderline personality disorder, remember that bipolar disorder is characterized by discrete episodes of mania and depression that cycle over longer periods of time and aren’t anchored to events, while BPD is characterized by extreme moods across contexts. 

An experienced mental health professional will be able to help your teen determine which diagnosis, if any, is right, and then explore treatment options.

Treatment Options

It’s really important for anyone struggling with borderline personality disorder, or related symptoms, to get mental health support. 

75% of individuals with BPD will have three suicide attempts in their lifetime, and 10% of individuals of BPD will die by suicide. 
Suicide, substance use, and violent death result in a mortality rate 45 times the general population for individuals with borderline personality disorder. 

These statistics show the intense suffering that individuals with BPD go through, and how essential connecting to support can be. 

Despite these challenges, when individuals with symptoms of borderline personality disorder connect to therapy, they often experience relief within the first year of treatment! Dialectical Behavior Therapy (DBT) is an evidence-based treatment developed specifically for borderline personality disorder and is the treatment of choice for the majority of individuals struggling with these symptoms. 

When someone with borderline personality disorder attends a DBT treatment program, this typically involves a combination of individual and group therapy, and training in specific skills related to resolving BPD symptoms. But you don’t need to have a BPD diagnosis to seek DBT - many mental health professionals can incorporate elements of DBT into their care to address symptoms like mood dysregulation, self-harm, and relationship conflict. 

Is DBT the right kind of therapy for my teen? 

DBT, or Dialectical Behavior Therapy, is a form of Cognitive Behavioral Therapy (CBT), developed to treat borderline personality disorder. This is the treatment of choice for BPD given its demonstrated effectiveness in resolving symptoms, decreasing mortality, and improving quality of life for individuals with this diagnosis. 

But you don’t need to have borderline personality disorder to benefit from DBT! DBT has also demonstrated effectiveness for treatment-resistant depression (depression that doesn’t respond to traditional CBT or medication), some eating disorders, trauma-related disorders, and more. Many clinicians will use DBT to address symptoms commonly seen in teens, such as mood dysregulation, self-harm, suicidality, and relationship conflict. 

If you think that any of the symptoms of borderline personality disorder apply to your teen, there is understanding and non-judgemental mental health support available to your family - you are not alone. 

The fastest way to determine if your teen may have borderline personality disorder and find relief, is to connect to a licensed professional who specializes in evidence-based care, like the clinicians at Joon Care. If you’d like to explore therapy options and see how Joon Care can support your teen and family, you can schedule a free consultation call with our team.

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February 22, 2023
Katey Nicolai, PhD | VP of Clinical Services

Katey Nicolai, PhD | VP of Clinical Services

Katey Nicolai, PhD, is a licensed clinical psychologist who received her PhD in Clinical Psychology from Seattle Pacific University. Dr. Nicolai provides services to adolescents and adults using evidence-based treatment rooted in cognitive-behavioral and psychodynamic therapies, including Dialectical Behavior Therapy, interpersonal therapy, and family systems. Dr. Nicolai has specialized training in treating trauma and PTSD, personality disorders, self-harm and suicidailty, family problems, emotion dysregulation, and mood and anxiety disorders.

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