Are you ready to bang your head on a wall? Do you want to abandon your child in the wilderness? Are you praying for the day they turn 18, when you can change the locks on your doors? Children with borderline personality disorder (BPD) bring out the worst in everyone around them.
A borderline child or teen is not a “drama junkie” on purpose. There brain is primed to overreact.
Yes, BPD kids really believe that others are out to get them, and that all their problems are someone else’s fault. They are appalled that others mistreat them horribly. They are insulted and defensive when they detect criticism, even when there isn’t any. They can never be pleased, and it’s always about them. Most exasperating for you, they turn from monstrous, to sweet and charming, and back to monstrous in an instant.
“Does this explain why I can go from 0 to 60 in two seconds?”
–17-year-old girl when told she was diagnosed with borderline personality disorder
Especially confusing, a borderline teen can be very engaging and affectionate… sometimes at random, and sometimes when they want something. They will also turn on the charm to embarrass you in front of others (such as in family therapy). Since they seem so wonderful to other people, you are asked why you get upset at your clearly wonderful child. People often recommend that you take care of your own issues instead.
Even though their manipulation and upheaval is relentless, strive for compassion. Trust me, your borderline child will suffer more than you in every important aspect of life. They make a mess of their relationships because of their anger, instability, substance abuse. Their clingy behavior is annoying. They drive away good friends, hate them for leaving, and then suffer from loneliness and depression. They make a mess of their jobs, often fired or forced to resign, and bounce from one to another… and they don’t understand why it happens to them.
For goodness sakes, why?
A study published in 2008 in Science showed that brain activity in people with borderline personality disorder was abnormal—their brains lack activity in the ‘cooperation’ and ‘trust’ regions, called the bilateral anterior insula. Borderline personality patients do not have an internal, natural sense of fairness and social norms, and little to no level of trust.
One research study reported that borderline personality disorder occurs as often in men and women, and sufferers often also have other mental illnesses or substance abuse problems. (In my personal observations over many years, teenagers with borderline personality disorder are often diagnosed with bipolar disorder.) Another study reported, “The disorder occurs in all races, is prevalent in females (female-to-male ratios as high as 4:1), and typically presents by late adolescence.” It is estimated 1.4 percent of adults in the United States have this disorder.
In infants: the children who were later diagnosed with borderline personality were more sensitive, had excessive separation anxiety and were moodier. They had social delays in preschool and many more interpersonal issues in grade school, such as few friends and more conflicts with peers and authorities.
In teenagers: they are more promiscuous, aggressive and impulsive, and more likely to use drugs and alcohol. Cutting and suicide are more common. “…research shows that, by their 20s, people with the disorder are almost five times more likely to be hospitalized for suicidal behavior compared to people with major depression.”
Evidence for hope
“Trying to Weather the Storm” (excerpt)
Shari Roan, September 07, 2009, Los Angeles Times
“Borderlines have the thinnest skin, the shortest fuses and take the hardest knocks. In psychiatrists’ offices, they have long been viewed as among the most challenging patients to treat.
“But almost 20 years after the designation of borderline personality disorder, understanding and hope have surfaced for people with the condition and their families. Advances have been made in recent years. Researchers from McLean Hospital in Massachusetts studied 290 hospitalized patients with the condition over a 10 year period: 93 percent of patients achieved a remission of symptoms lasting at least two years, and 86 percent for at least four years. Published in The American Journal of Psychiatry, the research argues that once recovery has been attained, it appears to last.
“Having a relative with BPD can be hell,” says Perry D. Hoffman, president of the National Education Alliance for BPD http://www.borderlinepersonalitydisorder.com. “But our message to families is to please stay the course with your (child) because it’s crucial to their well-being.”
“What Therapy Is Recommended for Borderline Personality Disorder in Adolescents (13-17 years)?”(excerpt)
Mary E. Muscari, PhD, August 9, 2005, http://www.medscape.com/viewarticle/508832
Psychotherapy is the primary treatment of BPD, specifically long-term dialectical behavior therapy (DBT), which helps the person attain and maintain lasting improvement in their personality, interpersonal problems, and overall functioning. DBT appears to be the most effective. It focuses on coping skills, so patients learn to better control their emotions and behaviors. This may be complemented with medications that help with mood stability, impulsivity, psychotic-like symptoms, and self-destructive behavior.
There are several appropriate therapies in addition to DBT, and all share common elements: 1. The bond between the patient and therapist is strong. 2. Therapy focuses on the present rather than the past, on changing one’s behavior patterns now regardless of how patients feel about the past or if they see themselves as victims.
On DBT: I recommend this straightforward self-help lesson to get started learning the concepts and skills: http://www.dbtselfhelp.com/html/dbt_lessons.html.
When to hospitalize
- In an emergency – when your child has serious suicidal thoughts or an attempt, and/or is in imminent danger to others.
- In long-term residential care – when your child has persistent suicidal thoughts, is unable to participate in therapy, has a life-threatening mental disorder (e.g. bipolar), continued risk of violent behavior, and other severe symptoms that interfere with living.
Other treatment a borderline may need:
- Treatment for substance abuse.
- Therapy that focuses on violent and antisocial behaviors, which can include emotional abuse or physical abuse, baiting, bullying, and sexualized behaviors.
- Therapy that focuses on trauma and post traumatic issues when an adolescent loses their sense of reality.
- Reduce stressors in the young person’s environment. Most adolescents with BPD are very sensitive to difficult circumstances, for examples: an emotionally stressful atmosphere at home; teasing in school; pressures to succeed or change; consistent rules; being around others who are doing better than them, etc.
With a partner or spouse: Maintain a united front. Communicate continually to stay on the same page when managing your child and setting limits. Have each other’s back even if you’re not in full agreement. Always take disagreements out of earshot of your child. Any disagreement they hear will be used against you.
Maintain family balance.
Keep things relaxed. If you need to set boundaries and apply pressure, do it only to maintain appropriate behaviors and reminders for self-calming. Let other things go.
Use praise proactively. Borderlines crave attention and praise. When they deserve it, pour it on thick. And pour it on thick every single time they demonstrate good behavior and positive intention. One can’t go too far. When an argument or fight comes up, search your memory banks for the most recent praiseworthy thing they did or said, and bring it up and again express your gratitude and admiration. This does two things: it reinforces the positive; and it redirects and ends a negative situation.
Become skilled in DBT and help your child stay in the here and now. Keep up the reminders that enable them to stay in the moment, to take those extra few seconds to think things through before reacting.
- Did your friend really intend to upset you? It sounds like they were talking about something else.
- The delay wasn’t planned just to make you mad, perhaps you were just frustrated by being asked to wait, and it was no one’s fault.
- The tear in your jacket isn’t a catastrophe. It is easily fixed and I can show you how.
Prevent dangerous risk taking – Teens with borderline personality are exceptionally impulsive and prone to risky behavior. Consequently, parents should consider:
- Tightly limiting cell phone use, email, texting, and access to social networking sites
- Using technology to track their communications (this is legal), or disabling access during certain time periods
- Reducing the amount of money and free time available
- Searching their room (this is also legal)
A couple I know fully informed their borderline teen that all internet activity would be tracked, as well as cell phone calls. The father also installed cameras in the home, at the front and back doors, in plain sight. Nevertheless, his son continued with bullying and hurtful behavior towards siblings right in front of those cameras, and he would get caught and pay consequences repeatedly. His persistence in the face of obvious monitoring became a great source of private amusement for his parents–humor really does provide relief.
Be patient – You are unlikely to receive the child’s respect, love, or thanks in the short-term. It may take years. But be reassured that your child will thank you for your firm guidance and limits once he or she matures to adulthood.
Other characteristics of BPD
Signs and symptoms of BPD may include significant fear of real or imagined abandonment; intense and unstable relationships that vacillate between extreme idealization and devaluation; markedly and persistently unstable self-image; significant and potentially self-damaging impulsivity (spending, sex, binge eating, gambling, substance abuse, and reckless driving); repeated suicidal behavior, gestures, or threats; self-mutilation (carving, burning, cutting, branding, picking and pulling at skin and hair, biting, and excessive tattooing and body piercing); persistent feelings of emptiness; inappropriate anger or trouble controlling anger; and temporary, stress-related severe dissociative symptoms or paranoid ideation.
- Chronic depression: Depression results from ongoing feelings of abandonment.
- Inability to be alone: Chronic fear of abandonment also leads to these adolescents having little tolerance for being alone. This results in a constant search for companionship, no matter how unsatisfying.
- Clinging and distancing: Relationships tend to be disruptive due to the adolescents’ alternating clinging and distancing behaviors. When clinging, they may exhibit dependent, helpless, childlike behaviors. They over idealize he person they want to spend all their time with, constantly seeking that person out for reassurance. When they cannot be with their chosen person, they exhibit acting-out behaviors, such as temper tantrums and self-mutilation. Distancing is characterized by anger, hostility, and devaluation, usually arising from discomfort with closeness.
- Splitting: Splitting arises from the adolescents’ inability to achieve object constancy and is the primary defense mechanism in BPD. They view all people, including themselves, as either all good or all bad.
- Manipulation: Separation fears are so intense that these adolescents become masters of manipulation. They will do just about anything to achieve relief from their separation anxiety, but their most common ploy is to play one individual against another.
- Self-destructive behaviors: The behaviors are typically manipulative gestures, but some acts can prove fatal. Suicide attempts are not uncommon yet usually happen in relatively safe scenarios, such as swallowing pills at home while reporting the deed to another person on the telephone.
- Impulsivity: Poor impulse control can lead to substance abuse, binge eating, reckless driving, sexual promiscuity, excessive spending, or gambling. These behaviors can occur in response to real or perceived abandonment.
Risk taking adolescents: When and how to intervene (excerpt)
David Husted, MD, Nathan Shapira, MD, PhD , 2004
University of Florida College of Medicine, Gainesville
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