Borderline Personality Disorder in Children & Teens

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What is borderline personality disorder?
BPD is a mental health condition characterized by a fragile, unstable personality that is highly reactive and easily wounded. It affects the way a person relates to themselves and others. People with this condition have a lower self-esteem and more fragile sense of self, and this in turn hinders their ability to maintain healthy relationships with others.

How common is BPD?
Borderline personality disorder is estimated to affect around 1-2% of the population. Approximately three-quarters of those diagnosed are female, and it’s also a condition that primarily affects the young, with most of its sufferers being teens or young adults.

Understanding people with borderline personality disorder
I once heard a therapist describe BPD patients as being like serious third-degree burn victims: thin skinned and sensitive to the slightest touch. Because of this, they are easily disturbed and highly reactive. It doesn’t take much to make them feel insecure, and when they feel insecure they often end up acting in ways that sabotage relationships or undermine their own goals.

In a handout from the mental health organization MIND, one patient with BPD described her condition in the following manner: “For me it feels like [I’m] a child being forced to live in an adult world. I feel too fragile and vulnerable for the world I live in.”

A 2007 study by Emily Stern showed that BPD patients displayed diminished activity in a part of the brain’s prefrontal cortex that controls planning and emotional reactions. This occurred whenever they had to inhibit a response, in this case reacting to a negative word. In other words, they are less able to get disturbing thoughts out of their mind. Research has also shown hyperactive amygdala activity in BPD patients. This suggests they feel things more profoundly even as they have trouble managing such thoughts. (Small, 2009)

The effects, consequences, & dangers of BPD

Borderline personality disorder is one of the most dangerous mental health disorders, largely because of its connection to suicide. By some estimates, as many as 10% to 20% of BPD patients will go on to eventually take their own life. Other research puts this number much lower, but still finds a heightened risk for suicide.

Borderline personality disorder can also completely derail a person’s life. People with BPD have a hard time forming healthy relationships with others, and are constantly bouncing around from one self-created crisis to the next. Thus they struggle at work, at home, and in their personal lives. People with BPD spend a lot of their time feeling isolated, alone, and suspicious of others, with their erratic behavior further alienating them from the world around them.

Questions & controversies surrounding borderline personality disorder

Like most mental health diagnoses, borderline personality disorder is not without its controversies. Chief among these is that it labels a particular type of personality as a disorder. Since personalities in the mental health profession are seen as something stable and unchanging, this has created controversy. Others point out that many people with BPD seem to outgrow their condition, which calls into question many underlying assumptions about the illness.

That said, I think it’s nonetheless a label that accurately describes the attributes of certain people. So long as you remember that ALL mental health diagnoses are artificial constructs and merely describe a particular set of symptoms at a particular point in time that have no biological or physical marker, and therefore are not written in stone and fail to account for a person’s individuality, then BPD is just as valid as any of the other mental health conditions.

What causes borderline personality disorder?
Like all mental health conditions, the precise causes of BPD are somewhat murky. Yet research has turned up a number of significant risk factors.

Insecure attachment and/or attachment injuries likely play a significant role. In fact, the symptoms of Borderline Personality Disorder are basically an adult version of what we see among children with insecure attachments. Therefore a history of unstable parenting, parental abandonment, mental illness or substance abuse by a parent, being adopted or spending time in foster care, the death of a parent, and other circumstances that lead to attachment injuries likely put a person at greater risk for borderline personality disorder.

Other risk factors include:

  • Verbal and/or emotional abuse
  • Living in poverty/Low SES
  • A history of child abuse or childhood trauma
  • Emotionally distant parenting

There also may be a genetic link, but so far research has yet to turn up any convincing genetic basis for borderline personality disorder.

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