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Borderline Personality Disorder (BPD) is a chronic mental health condition characterized by fears of abandonment, low self-worth, and lack of impulse control. BPD is thought to affect around 0.9% to 3% of teens. Many youth with BPD also struggle with co-occurring mental health challenges such as depression, eating disorders, self-harm, and substance abuse [1].
With access to treatment such as Dialectical Behavior Therapy and family support, teens can go on to live healthy, functional, successful lives. However, under stress or triggered by feelings of rejection or abandonment, teens may experience a BPD episode, which is a period of intense emotional distress.
Read on to understand more about what BPD episodes in teens look like and how to encourage them to use healthy coping skills to manage.
What is a BPD Episode?
A BPD episode is a period when symptoms of BPD become intense or unmanageable. Intense mood swings and self-destructive behaviors such as drug use or self-harm often characterize episodes in teens. Episodes are usually triggered by feelings of rejection or abandonment, but can also happen under academic or transitional stress.
Around 78% of teens who attend the emergency room for suicidal behaviors or attempts meet the criteria for BPD, highlighting the severity of behavior during an episode. Many teens who experience a BPD episode also experience paranoia, dissociation, or may become violent, often requiring a brief hospitalization to help stabilize them [1].
Signs and Triggers of BPD Episodes in Teens
If a teen is experiencing a crisis or BPD episode, there are several signs that can indicate they need intervention and support. Typically, a BPD episode in teens presents with:
Sign/Symptom | Trigger/Example |
Intense fear of perceived or real abandonment or rejection | A friend cancels plans with your teen, and they automatically think it’s because they don’t like them anymore. |
Unstable relationships with family, friends, and loved ones | One day, they may view their boyfriend or girlfriend as perfect and can do no harm, and the next day, see them as neglectful or cruel |
Changing self-image, unstable sense of self | They frequently change their interests, opinions, or goals to fit in with a certain group of people or feel accepted by those around them |
Impulsive or self-destructive behavior | Under stress, teens with BPD may engage in risky behaviors such as unsafe sex or drug and alcohol use |
Explosive anger, mood swings | Reacting with intense anger to jokes or sarcasm, especially if their sense of self feels attacked |
Self-harm, or suicidal tendencies | Cut, burn, or hurt themselves as a way to relieve emotional distress. They may also threaten or attempt suicide. |
How to Support a Teen During a BPD Episode
Supporting your teen during a BPD episode often requires patience, empathy, and self-care. It can feel frustrating, stressful, and test your own emotions, but it’s really important to stay calm and provide a sense of stable, grounded support for your teen. Here are a few tips:
- Practice breathing and stay grounded. Your calm presence can help teens feel safer when their nervous system feels overwhelmed.
- Validate their feelings and acknowledge their pain without judgment. e.g., “I can see you’re under a lot of stress right now, and that’s okay. I am here to support you through it.”
- Avoid arguing or trying to “fix” or challenge their feelings. Sometimes teens with BPD may seem overdramatic, but their experience and the distress they are feeling are very real.
- Encourage them to use their coping skills, such as deep breathing or sensory distractions. Put on some of their favorite music, ask them to go on a walk with you, or invite them to play a game or watch a show on Youtube or Netflix as their period of emotional distress passes.
- If self-harm or suicidal behaviors are present, contact a mental health provider or emergency services and let them know your teen is experiencing a mental health crisis.
- For immediate mental health support, you can also call or text 988 to reach the 988 Suicide & Crisis Lifeline, which can provide you with emergency resources or access to services in your local area.
Treatment Options for Teens with BPD
Effective treatment for teens with BPD requires a comprehensive approach to stabilize their behaviors, help them work through complex emotions, and build healthy coping skills to manage distress. Treatment plans for teens with BPD are often personalized to their unique needs and family situations, however Dialectical Behavior Therapy (DBT) is often the first-line treatment with the most success in treating BPD patients.
Medication is also used in cases where teens struggle with symptoms of anxiety, depression, or impulse control. Teens with BPD have high rates of comorbidity, many struggling with ADHD, ODD, or anxiety disorders.
In the case a teen is experiencing a BPD episode with self-harm or suicidal behaviors, a clinical assessment using a suicidal ideation scale may be used to determine the level of immediate threat and safety. Sometimes residential treatment is required in this instance to help stabilize them and provide them with around-the-clock care to ensure their safety.
Dialectical Behavior Therapy
DBT is the most common treatment option for BPD in teens, which targets self-harm, suicidal behavior, and managing emotional distress. During sessions, teens focus on improving four key skill areas with the therapist, including mindfulness, distress tolerance, emotional regulation, and interpersonal relationships. Throughout the course of DBT, teens with BPD learn how to:
- Practice non-judgment about themselves and others
- Accept situations they have no control over
- Communicate effectively with others, practice empathy, and active listening
- Increase the amount of positive experiences they have
- Manage emotions and develop self-awareness
Is There Hope for Teens with BPD? Understanding Remission
It’s important to keep in mind that BPD is treatable, and early intervention can make a significant difference. Teens can manage various aspects of their personality, identify triggers, and use coping skills before entering adulthood, which greatly improves their ability to function independently as adults.
For teens who receive effective behavioral interventions, psychiatric management, and social supports, research shows nearly 60% experience a significant reduction in symptoms. With ongoing support, relapse rates are typically low, with only about 15% of BPD patients losing sustained remission after four years [2].
Trauma-Focused Care for Lasting Recovery at Clearfork Academy
Clearfork Academy is a network of behavioral health facilities in Texas committed to helping teens recover from behavioral addictions, substance abuse, and mental health disorders. Our licensed and accredited facilities are dedicated to providing comprehensive, evidence-based care and education for parents and caregivers of youth. We understand the complex nature of personality disorders and are committed to helping teens with BPD end destructive behavior patterns.
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] de La Rivière, S. G. (2018). Borderline Personality Disorder in Adolescents: Prevalence, Diagnosis, and Treatment Strategies. Adolescent health, medicine and therapeutics, 9, 199–210.
[2] Fitzmaurice, G. (2010). Time to attainment of recovery from borderline personality disorder and stability of recovery: A 10-year prospective follow-up study. The American journal of psychiatry, 167(6), 663–667.
Founder & CEO
Originally from the Saginaw, Eagle Mountain area, Austin Davis earned a Bachelor of Science in Pastoral Ministry from Lee University in Cleveland, TN and a Master of Arts in Counseling from The Church of God Theological Seminary. He then went on to become a Licensed Professional Counselor-Supervisor in the State of Texas.
Austin’s professional history includes both local church ministry and clinical counseling. At a young age, he began serving youth at the local church in various capacities which led to clinical training and education. Austin gained a vast knowledge of mental health disorders while working in state and public mental health hospitals. This is where he was exposed to almost every type of diagnosis and carries this experience into the daily treatment.
Austin’s longtime passion is Clearfork Academy, a christ-centered residential facility focused on mental health and substance abuse. He finds joy and fulfillment working with “difficult” clients that challenge his heart and clinical skill set. It is his hope and desire that each resident that passes through Clearfork Academy will be one step closer to their created design.
Austin’s greatest pleasures in life are being a husband to his wife, and a father to his growing children. He serves at his local church by playing guitar, speaking and helping with tech arts. Austin also enjoys being physically active, reading, woodworking, and music.
