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Accurately diagnosing a teen with Borderline Personality Disorder (BPD) can be difficult due to ongoing personality development and stigma surrounding BPD; this is where a BPD diagnostic test comes in. Early recognition and diagnosis of BPD in teens increases the effectiveness of interventions and treatment planning.
Getting your teen diagnosed by a mental health professional who specializes in BPD is essential to eliminate other possible causes. Teens with BPD are often angry, impulsive, and believe that others have wronged them or are out to hurt them, which can sometimes be mistaken for other mental health disorders, trauma, or just typical teen behaviors.
Read on to learn more about BPD teens and what to expect during diagnostic testing.
Can Teens Be Officially Diagnosed With BPD?
Yes, teens can officially be diagnosed with BPD. According to the Journal of Adolescent Health, around 11% of teens are diagnosed with BPD, and nearly 78% of teens who make ER visits for suicide attempts meet the criteria for BPD [1]. The DSM-5 recognizes BPD as a formal diagnosis in adolescents if they meet criteria which are the same as those for BPD in adults.
However, diagnosing BPD in teens can be more challenging than in adults due to typical teen mood swings and changes in personality. Some clinicians hesitate to diagnose BPD in teens due to the lifelong stigma associated with the disorder and concerns that symptoms may naturally resolve with brain maturation. However, early diagnosis and intervention decrease the risk of serious consequences such as substance abuse, self-harm, and suicide attempts.
When A BPD Test Is Necessary: Signs of BPD in Teens
Teens with BPD are often labeled as attention-seeking, dramatic, or unstable. If your teen struggles with intense mood swings that go above and beyond what is typical for a teen (e.g., violence), unsafe impulsivity (e.g., reckless driving or unprotected sex), suicidal ideation, or self-harm, a professional BPD test could be helpful.
To be diagnosed with BPD, your teen must show at least 5 of the nine symptoms for a year [2]:
- Efforts to avoid real or imagined feelings of abandonment
- Pattern of unstable and intense relationships
- Unstable sense of self, low self-esteem
- Impulsivity in two or more areas (e.g., spending money, drug or alcohol use, unsafe sex, binge eating, gambling, reckless driving)
- Recurring suicidal gestures, threats, or self-harming behavior
- Increased reactivity of mood (intense episodes of depression, irritability, or anxiety that may last a few hours to a few days)
- Constantly feeling empty
- Difficulty controlling anger, marked by frequent outbursts or physical fights
- Stress-related paranoia or severe dissociation
Teens with BPD often struggle with self-harm and complain of feeling empty. They may suffer from black-or-white thinking and intense emotions, seeing situations or people as either the “best” or “worst”. Self-harm behaviors or aggression, such as punching walls, cutting themselves, or burning their skin, may be used to numb this intense emotional pain or as a cry for help.
What Teens and Parents Can Expect During The Evaluation
A licensed clinician conducts a BPD assessment through a series of detailed interviews with the teen or loved ones, and behavior is observed across various settings. The mental health professional also uses standardized screening tools and the official diagnostic manual (DSM-5) to rule out other mental health conditions that resemble BPD.
The goal of the therapist is to understand patterns of behavior such as emotional instability, impulsivity, self-destruction, and relationships. Parents, caregivers, teachers, or other adults in the teen’s life may also be asked to provide information to understand behavioral patterns better.
After the BPD Test: Next Steps for Teens and Families
After diagnostic testing, individualized treatment planning is often the next step. This often includes a combination of therapies and support. Common treatment approaches for BPD in teens include:
- Dialectical Behavior Therapy (DBT) is the go-to therapy for treating borderline personality disorder by helping teens practice mindfulness, reduce distress, regulate emotions, and strengthen relationships with loved ones. Teens often practice DBT skills in 1-1 therapy, group sessions, and workshops with peer support specialists.
- Internal Family Systems (IFS) views the personality as multiple “parts,” each with its own emotions or beliefs shaped by trauma and life experiences. IFS encourages teens with BPD to integrate these wounded parts and connect to their authentic, “core” self.
- Home-based interventions focus on creating a stable and supportive environment for the teen. Case managers, family support specialists, youth support partners, and family therapists often play a significant role here to ensure teens have access to social supports, mental health resources, and a crisis plan in place.
- Medication such as antipsychotics or antidepressants may be used to treat symptoms of co-occurring disorders, although there is no specific medication designed for BPD.
- Residential treatment may be recommended for some teens with BPD if they are abusing drugs or alcohol, self-harming, or are at an increased risk of suicide, to help stabilize them in a safe and supervised environment.
Is It Possible for Teens With BPD Symptoms to Get Better?
Despite the long-standing stigma that BPD is “untreatable”, recovery rates in teens who receive early intervention are usually optimistic. BPD is not curable, but with proper coping skills, support systems, and sometimes medication, many teens can go on to live healthy, happy, successful lives. Research shows that around 60% of teens with BPD experience significant symptom reduction when they receive treatment [3].
Evidence-Based BPD Treatment for Teens at Clearfork Academy
Clearfork Academy is a network of behavioral health facilities in Texas committed to helping teens recover from personality disorders, substance abuse, and mental health challenges. We provide a combination of evidence-based treatments for teens with BPD, including Dialectical Behavior Therapy (DBT), trauma therapy, and medication management.
Contact our admissions team today to see how we can support your family.
Sources
[1] La Rivière, S. et al. (2018). Borderline Personality Disorder in Adolescents: Prevalence, Diagnosis, and Treatment Strategies. Adolescent health, medicine and therapeutics, 9, 199–210.
[2] Chapman, J. et al. 2024. Borderline Personality Disorder. StatsPearl Publishing. National Library of Medicine.
[3] Steinert, C. et al. (2024). Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World psychiatry: official journal of the World Psychiatric Association (WPA), 23(1), 4–25.
Mike Carter, LCDC
Alumni Relations Manager
Mike grew up on a dairy farm in Parker County, Texas. At the age of 59, he went back to college and graduated 41 years after his first graduation from Weatherford College. God placed on his heart at that time the passion to begin to help others as they walked from addictions, alcoholism, and abuse of substances. He is a Licensed Chemical Dependency Counselor and in the past few years he has worn many hats, from intake and assessment, group counseling, individual and family counseling, intensive outpatient and now he is working with clients, therapist, and families on discharge planning and aftercare. He also coordinates our Alumni Outreach Program.
