Borderline Personality Disorder in Children

Borderline Personality Disorder in Children

Borderline personality disorder is a mental health disorder. Children with this condition:

• Have unstable moods and relationships.
• Have trouble controlling emotions.
• Often engage in impulsive or reckless behavior.
• Often fear being abandoned by friends or family.

Children with BPD may need treatment for other mental health issues, such as depression, an anxiety disorder, a substance abuse disorder, or an eating disorder. They may develop suicidal thoughts or behaviors.

What are the causes?

The exact cause of this condition is not known. Possible causes may include:

• Genetic factors. These are traits that are passed down from one generation to the next. Many children with BPD have a family history of the disorder.
• Physical factors. The part of the brain that controls emotion may be different in children who have this condition.
• Social factors. Traumatic experiences involving other people may play a role in the development of BPD. These may include child abuse or neglect.

What increases the risk?

This condition may be more likely to develop in children who:

• Have a parent or close relative with the condition.
• Experienced physical or sexual abuse.
• Experienced neglect or were separated from their parents.
• Have unstable family relationships or an unstable home.

What are the signs or symptoms?

Symptoms of this condition usually start during the teen years or in early adulthood. Symptoms include:

• Extreme overreactions to the possibility of being abandoned by family or friends. This may include explosive responses to seemingly minor events, such as a change of plans.
• Volatile relationships with friends and relatives. This may include extreme swings from feelings of love to intense anger.
• Distorted or unstable self-image. This may affect mood, relationships, and future goals or plans.
• Reckless or impulsive behaviors, such as:
  • Breaking toys or getting angry with parents (in younger children).
  • Shopping sprees, risky sexual behavior, substance abuse, or overeating (in teens).
• Self-harm, such as cutting.
• Expressing thoughts of suicide.
• Extreme mood swings that can last for hours or days.
• Constant boredom.
• Problems controlling anger. This might include frequent fighting or tantrums. This can result in shame or guilt.
• Paranoid thoughts.
• Losing touch with reality, often in order to help deal with unbearable situations (dissociation).
• Trouble controlling emotions.

How is this diagnosed?

This condition is diagnosed based on your child’s symptoms. Information about your child’s symptoms is gathered from family, friends, teachers, and medical and legal professionals. A health care provider who specializes in physical and psychological causes of mental conditions (psychiatrist) will do a psychiatric evaluation. Your child will be diagnosed with BPD if she or he has at least five common symptoms of the condition.

How is this treated?

This condition is usually treated by mental health professionals, such as psychologists, psychiatrists, and clinical social workers. More than one type of treatment may be needed. Treatment may include therapy such as:

• Psychotherapy. This may also be called talk therapy or counseling.
• Cognitive behavioral therapy (CBT). This helps your child to recognize and change unhealthy feelings, thoughts, and behaviors. It helps him or her find new, more positive thoughts and actions to replace the old ones.
• Dialectical behavioral therapy (DBT). Through this type of treatment, your child learns to understand his or her feelings and to regulate them. This may be one-on-one treatment or part of group therapy.
• Schema-focused therapy (SFT). This form of therapy helps a child with a distorted self-image to see him or herself differently. This may be one-on-one treatment or part of group therapy.
• Family therapy. This treatment includes family members.

Medicine may be used to help control emotions and behavior and to treat anxiety and depression. In some cases, a hospital stay may be necessary.

Follow these instructions at home:

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Maintain a daily routine for your child. The routine should include set times to eat and sleep.
• Have your child do regular physical activity to reduce stress. Ask your child’s health care provider to recommend activities.
• Communicate with other family members, close friends, teachers, and any other caregivers about what triggers your child’s symptoms. Keeping a log of symptoms and events can help you figure out your child’s triggers.
• Help your child find comforting people and environments.
• Take care of yourself as well as your child. Consider joining a support group.
• Keep all follow-up visits as told by your child’s health care provider. This is important.
• Coach your child in ways to manage emotions, such as through deep breathing exercises and self-calming techniques.

Where to find more information

• National Alliance on Mental Illness: www.nami.org
• U.S. National Institute of Mental Health: www.nimh.nih.gov

Contact a health care provider if:

• Your child’s symptoms do not improve or they get worse.
• Your child is using alcohol or drugs.
• Your child cannot sleep.
• Your child is eating too much or not enough.
• Your child has new symptoms.

Get help right away if:

• Your child self-harms or expresses serious thoughts about self-harming.
• Your child expresses serious thoughts about hurting others.
• Your child sees or hears things that are not there (has hallucinations).
• Your child is speaking or behaving in a way that is not related to reality.
• Your child is unconscious.

If you ever feel like your child may hurt himself/herself or others, or may have thoughts about taking his or her own life, get help right away. You can go to your nearest emergency department or call:

• Your local emergency services (911 in the U.S.).
• A suicide crisis helpline, such as the National Suicide Prevention Lifeline at 1-800-273-8255. This is open 24 hours a day.

Summary

• Borderline personality disorder (BPD) is a mental health disorder. Children with this condition may have unstable moods and relationships, have trouble controlling emotions, and engage in impulsive or reckless behavior.
• A health care provider who specializes in physical and psychological causes of mental conditions (psychiatrist) will do a psychiatric evaluation. Your child will be diagnosed with BPD if she or he has at least five common symptoms of the condition.
• This condition is usually treated by mental health professionals, such as psychologists, psychiatrists, and clinical social workers. More than one type of treatment may be needed.
• Contact a health care provider if your child’s symptoms do not improve or they get worse.