Signs of BPD in Teens: Recognizing the Patterns

Accurately diagnosing a teen with Borderline Personality Disorder (BPD) can be challenging, as signs often resemble classic teenage behavior (e.g., mood swings or recklessness) or other mental health disorders. The signs can be difficult to spot but often follow a pattern and are characterized by deep emotional pain, identity struggles, and fear of abandonment. 

It’s important to know the signs and be aware of their behavior patterns, but a clinical diagnosis by a licensed mental health professional is essential for understanding and effective treatment.  

What is Borderline Personality Disorder (BPD)? 

BPD is a complex mental health condition and a cluster B personality disorder, according to the DSM-5, the manual used by psychiatrists to diagnose mental health conditions. It is marked by fears of abandonment, challenges with identity, lack of impulse control, self-harm, and suicidal behaviors. BPD affects nearly 78% of teens who present to the emergency room with suicidal ideation [1].  

BPD is almost three to five times more likely to be diagnosed in women than men. This is the same for youth. BPD statistics for teen boys are much less reported, and many go undiagnosed due to symptom presentation. BPD often presents in teen boys as aggression or substance abuse [2]. 

BPD Terms, Myths, and Misconceptions

BPD is one of the most stigmatized and misunderstood mental health conditions. Movies about BPD, such as Fatal Attraction and Girl, Interrupted, often reinforce stereotypes, portraying borderlines as inherently violent, manipulative, and selfish. This depiction makes it harder for those with BPD to receive a clinical diagnosis and access treatment. 

Social media has increased this misrepresentation, with hashtags and trends constantly labeling or misleading people online about the reality of BPD. Let’s explore a few common terms and clear up any misconceptions about BPD. 

1. “BPD empathy”: This is the belief that people with BPD do not have empathy, often mistakenly or shamefully labeled as narcissistic, sociopathic, or selfish, when in reality they often feel heightened emotions, including those of others. People with BPD can and do feel empathy, although they may struggle to regulate these emotions and express them in a destructive way [3].  

2. “BPD Hypersexuality”: This is the belief that all people with BPD are hypersexual. Although risky sexual behavior is a symptom for some individuals with BPD and they are at an increased risk of risky sexual activity, it is not universal. The behavior often comes from a lack of impulse control or low self-esteem rather than being an “inherent trait of BPD” [4]. 

3. “BPD Split”:  Splitting is used to describe a defense mechanism of many individuals with BPD, meaning they view situations in extremes. This black and white thinking can often shift and intensify emotions.  

Common Signs and Symptoms of BPD in Teens 

Teens with BPD are often labeled as attention-seeking and overdramatic. They may struggle with impulsivity, mood swings, self-harm, or even suicidal ideation. According to the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, teens must present with at least 5 of the nine symptoms for at least a year to be diagnosed with BPD [5]: 

1. Efforts to avoid real or imagined feelings of abandonment 
2. Pattern of unstable and intense relationships
3. Low self-esteem, unstable identity 
4. Lack of impulse control 
5. Suicidal threats, gestures, or self-harm
6. Drastic changes in mood (intense depression, irritability, anxiety) 
7. Chronic feeling of emptiness
8. Difficulty controlling anger, aggression, violence 
9. Paranoia, dissociations, hallucinations (under high stress) 

Diagnosing BPD in Teens: Risks and Benefits

Many parents wonder if BPD can accurately be diagnosed in adolescence, and the answer is yes. Current clinical research accepts that BPD can formally be diagnosed in teens as young as 11, but it’s often more complex than a diagnosis of depression or anxiety. Symptoms must be present for over a year and appear in multiple settings, not just the home [5]. 

Some parents hesitate to get their teens diagnosed with BPD due to fears of stigma or impact on medical records, while other parents are quick to accept the diagnosis without understanding the complexity of BPD. There are risks and benefits to both. 

Risks

• Stigma: A BPD diagnosis carries heavy stigma, which can lead to feelings of shame or being labeled as “difficult”. 

• Medical or Employment Records: Some have concerns that having BPD documented in health or school records can affect future insurance, employment, or education opportunities. There are cases of stigma and discrimination, but general protections are in place as it is considered a disability under the Americans with Disability Act (ADA). 

• Misdiagnosis: Diagnosing BPD in teens can risk misdiagnosis, as teens naturally go through emotional and identity challenges. Also, many symptoms of BPD are common in many other mental health disorders, including ADHD, complex trauma, and bipolar disorder. 

Benefits 

• Early Intervention: Early diagnosis and timely access to specialized therapies can significantly improve emotional regulation, self-esteem, and reduce behaviors of self-harm. 

• Understanding and Support: Diagnosis helps parents and teens make sense of their behavior, which can foster empathy, improve communication, and help them build stronger support systems. 

• Prevention of Negative Outcomes: Undiagnosed BPD can lead to a severe decline in mental health and daily functioning in adulthood. Early diagnosis can prevent symptoms from worsening. Unresolved BPD in teens can drastically raise the risk of substance abuse and suicide.  

Treatment, Healing, and Hope for Teens Suffering from BPD

There is a misconception that because BPD is a “personality disorder,” there is no hope for change, and they simply “are the way they are”. However, patterns of thought can be reframed, and certain behaviors can be changed with treatment, patience, and ongoing support. 

Lotus Behavioral Health helps teens with borderline personality disorder develop skills for regulating their emotions, managing impulsive behaviors, and improving their self-esteem. We offer evidence-based Dialectical Behavior Therapy (DBT), the first line of treatment for BPD, in both inpatient and outpatient settings. For teens who are resistant to treatment, we offer virtual outpatient therapy where they can receive support in the comfort of their own home.  

Contact our admissions team today to learn how we can support your family. 

Sources 

[1] Mental Health America. Borderline Personality Disorder.‍

[2] Bellino, S. et al. (2024). Gender differences in borderline personality disorder: a narrative review. Frontiers in psychiatry, 15, 1320546.

[3] Harari, H. et al. 2010. Double dissociation between cognitive and affective empathy in borderline personality disorder. Journal of Psychiatric Research. 

[4] Sansone, L. A. (2011). Sexual behavior in borderline personality: a review. Innovations in clinical neuroscience, 8(2), 14–18.

[5] Chapman, J. Borderline Personality Disorder. National Library of Medicine. 

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