In the movie, Thirteen, Tracy Freeland is a seventh-grade honor student with a troubling home life. As a girl who formerly channeled her frustrations from home into her studies, her life derails when she meets popular student Evie who introduces her to sex, drugs and thievery. When Tracy’s mother, Melanie, tries to set limits, her daughter acts out more. Melanie backs down again and again guilty over her own preoccupation with relational and financial problems. In the end, Melanie and Tracy have a brutal argument leading to a full picture of a daughter’s distress and her mother’s love.
While some critics disagree, others have said the film highlights the dynamics of adolescent borderline personality disorder (BPD). With one psychiatrist stating, “it should have been titled How to Turn Your Teenager into a Borderline Without Even Being Abusive”. Signs of Borderline Personality Disorder surface in adolescence; but it can be hard for parents to distinguish from typical teenage acting out. How can you know for sure?
What is borderline personality disorder?
To start, many are skeptical of diagnoses like borderline personality disorder (BPD). Psychiatric diagnoses come and go. Dr. Blaise Aguirre, expert psychiatrist and extensive author on the subject of BPD, explains this is largely due to the absence of accurate tools and procedures. While technology has improved greatly, the majority of diagnoses are based on observations and descriptions of behavior alone. Consequently, a behavior such as impulsivity could be a sign used to diagnose ADHD, Bipolar Disorder, or borderline personality disorder. For this reason, Aguirre adds that borderline personality disorder is a mysteriously complex disorder because its own behaviors overlap the behaviors of typical adolescents, along with those characteristic of mood disorders, attention deficit disorders, and even post-traumatic stress disorder. He says it is like all of those but incredibly distinct at the same time. It has obvious characteristics.
Dr. Marsha Linehan, developer of one of the most effective treatments for Borderline Personality Disorder, Dialectical Behavior Therapy (DBT), describes the disorder as “a poorly understood condition characterized by neediness, outbursts and self-destructive urges, often leading to cutting or burning.” In order to be diagnosed, a person must meet five of the nine criteria, including abandonment fears, unstable personal relationships, unstable identity, impulsive behaviors with drugs and sex, suicidal/self-harm behavior, affective or emotional instability, chronic feelings of boredom or emptiness, and dissociative feelings. It is a relational disorder marked by high emotional sensitivity, high emotional reactivity, and a slow return to baseline.
Given those criteria, Aguirre says, it’s not hard to see why normal teenage development can look like emerging adult BPD. Most adolescents have difficulty controlling their emotions, thoughts and behavior. They can be impulsive. Additionally, they have problems in their relationships and confusion over their identities. If my teen has suicidal thoughts or intense anger one day, does that mean she’s got a personality disorder? Not necessarily.
What’s the Difference?
“A lot of people said you know it’s just kind of normal teenage acting out and it wasn’t. And it didn’t feel normal to me” says one mom of child who meets the criteria for BPD.
Many parents feel the behaviors of their teen don’t feel normal, but the actions may look typical of teen development. Dr. Aguirre tells parents to imagine two girls are sitting at a cafeteria in high school. Both have had screaming matches with their parents. They have each made risky choices experimenting with sex, drugs and self-harm. Both can be moody. Both are passionate and caring people. One has borderline personality disorder and the other does not. The difference, he says, is in the function of the behavior.
“Adolescents with borderline personality disorder often use self-harm, illegal substances, and rage to cope with profound misery, intense emotions, emptiness, self-loathing, and abandonment fears,” explains Aguirre. After interviewing teens who cut, he found that some did so because they saw copied others. These teens were confused over why others cut and they stopped because it was painful. Other teens, he found, felt more alive after cutting. They felt calmer, less numb, and said the cutting gave them little or no pain. It is very troubling for a parent of a teen who finds a reduction in pain through self-harm because it will likely be repeated. Aguirre explains that repeating this behavior hard wires it into the brain as a way to problem solve and cope.
Repetitive self-harm behaviors and suicidality are not typical adolescent behaviors. In the same way, alcohol abuse and impulsive sexual activities to ease emotional pain is atypical to adolescence and require a response.
What can parents do?
- Don’t diagnose your child. If concerned about your child’s actions, find a qualified mental health professional. They can distinguish between normal adolescent behavior from other disorders. It is not uncommon for clinicians to be uncomfortable making the diagnosis or reluctant to work with teens who have been diagnosed. One parent sought the help of many mental health professionals, but no one mentioned BPD. Another parent was refused care because the case was too difficult for the therapist. She wondered where to find help if the very people trained to treat mental health cases refused her. Dr. Aguirre recommends asking if the clinician has training in Dialectical Behavior Therapy, post-traumatic stress disorder, or has worked with self-harming or suicidal teens. He also recommends writing a list of concerns you have for your child, including specific behaviors, medications with dosages, hospitalizations and past therapies.
- Learn about validation. Validation is helpful for teens with or without BPD. Dr. Linehan explains that validation requires empathy and communicates that another’s response makes sense. In contrast, self-validation acknowledges your own experiences are real and acceptable to you. It frees you up to validate others. Again, to validate another is to accept his or her experience as true and able to be understood. However, validating others does not mean you agree, support his or her actions, or feel the same way. Dr. Aguirre adds, it simply means that you accept that your child has a point of view that might be different from yours and it is real.
- Practice balance. Dr. Blaise lists three parental balancing strategies that work for teens with or without BPD. First, seek to find the balance between being too lenient and taking restrictive control. Then, try to find a fair line between minimalizing a problem behavior versus overreacting to to it. Since teenage years are all about learning to be an adult, Aguirre ends by telling parents to try to find the balance between forcing autonomy and fostering dependence
- Practice Self-Care. Regular eating, sleeping, and exercise help parents handle the ups and downs of their teens from a place of fullness. Self-care is also finding support. This can be a challenge because many families may notice what happens in their home isn’t taking place in other homes. As a result, they isolate themselves. Many families found that even extended family members had difficulty understanding. However, even if support doesn’t come from those nearest you, don’t continue alone. Try finding a therapist for yourself, an online forum, or a group like Family Connections. Family Connections is a free group program designed by families for families of those with symptoms of borderline personality disorder.
Information About Teen Moodiness and Development
Brainstorm the Power and Purpose of the Teenage Brain Drawing on important new research in the field of interpersonal neurobiology, Siegel explores exciting ways in which understanding how the brain functions can improve vital skills teens learn, such as how to leave home and enter the larger world, connect deeply with others, and safely experiment and take risks.
The Teenage Brain: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults Gives parents a developmental understanding of how a teenager’s brain functions and how parents can foster their teen’s growth.
Information About Borderline Personality Disorder
National Education Alliance for Borderline Personality Disorder works with families and persons in recovery, raises public awareness, provides education to professionals, promotes research, and works with Congress to enhance the quality of life for those affected by this serious but treatable mental illness.
National Institute of Mental Health is the foremost federal agency for research on mental disorders. NIMH is part of the National Institutes of Health (NIH), the largest biomedical research agency in the world. NIH is also part of the U.S. Department of Health and Human Services (HHS).
Online Support for Family Members
BPD Central’s forum service “Welcome to Oz” has endless options for a customizable experience. Whether you are a parent, grandparent, or sibling to somebody with BPD or just a close friend/romantic partner; you will find the right avenue to put you in contact with others in similar positions. Because they have grown to more than 20,000 members, they offer 15 diverse and active groups.
Randi Krieger has created a safe haven for those affected closely by somebody who has or may have borderline personality disorder. With stockpiles of information, it is no wonder bpdcentral.com is at the forefront when it comes to highly regarded borderline websites. With the ability to locate therapists through the website as well as a BPD answer line where you can schedule a confidential telephone call, bpdcentral.com is a fantastic resource.
Aguirre, B. A. (2014). Borderline personality disorder in adolescents: what to do when your teen has BPD: a complete guide for families. Beverly, MA: Fair Winds.
Brody, J. E. (2009, June 15). An Emotional Hair Trigger, Often Misread. Retrieved October 18, 2017, from http://www.nytimes.com/2009/06/16/health/16brod.html?_r=1
Teen Moodiness, or borderline personality disorder? (2010, February 25). New York Times. Retrieved July 21, 2017, from https://consults.blogs.nytimes.com/2010/02/25/borderline-personality-disorder-in-teenagers/
Contributed by Angela Blocker, M.A, LMFT Associate
Clinical Supervision by Amy Fuller, PhD, LMFT, LPC