Signs Of Borderline Personality Disorder In Child, And Tips

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Children experience emotional outbursts and impulsiveness occasionally. But if that happens too often, it may be due to a borderline personality disorder (BPD). Borderline personality disorder in children is a mental health problem characterized by extreme emotions, impulsive behavior, emotional dysregulation, and severe problems with self-worth, which makes maintaining long, stable, and strong relations with others difficult (1). Most often, the signs and symptoms of BPD appear in childhood, but the condition becomes prominent only during teenage or adulthood. Read on as we tell you about the signs, causes, diagnosis, and treatment of BPD in children.

Causes And Risk Factors Of BPD

The exact cause of borderline personality disorder in children is unknown. Problems with chemicals in the brain responsible for mood regulation might trigger the development of BPD (1). The following factors may put a child at a higher risk of developing BPD (2).

• It may run in the family. Studies indicate that genetics account for about 40 to 60 percent of variations in the onset and severity of BPD (11).
• It is more common in children with a natural tendency to get upset easily.
• Growing up in a household where children do not receive enough support and training to handle their big emotions.
• Children with improper chemical processing in certain brain areas responsible for mood regulation showcase certain associated signs such as anxiety, depression, and difficulty controlling destructive urges (12).
• It might be more common in children who might have experienced childhood trauma such as physical, emotional, or sexual abuse, neglect, or loss of a parent or had attachment difficulties with parents. Imaging studies of the brain indicate that childhood trauma may influence certain changes in the amygdala, hippocampus, and medial temporal lobes (13).

Research finds

A small study on 500 college students found that BPD symptoms were related to internet addiction severity (8).

Symptoms Of BPD

Some mood swings and behavior changes are normal and happen to everyone, especially moody children. But in people with BPD, these problems can be severe, repetitive, and may cause a disturbance with routine life. Some common symptoms of borderline personality disorder in children include (1) (2) (14).

• Intense emotions and mood swings
• Substance use
• Binge eatingⁱFrequent episodes of uncontrolled eating of unusually large amounts of food in one sitting
• Spending a lot of money
• Trouble maintaining relationships
• Risky sexual behavior
• Behavioral issues
• Rash driving
• Low self-worth
• A severe feeling of being left alone
• Aggressive behavior
• May judge other people as only ‘good’ or ‘bad’ and no in-between. May also shift from one viewpoint to the other suddenly.

The following symptoms may also be seen:

• Feeling empty inside
• Anger issues
• Violent tantrums
• Self-harm
• Suicidal thoughts or attempts
• Episodes of paranoiaⁱA psychological condition that involves an irrational fear and distrust of others trying to harm or deceive them
• Episodes of psychosis (inability to distinguish between real and imaginary)
• Brief but intense episodes of anxietyⁱAn overwhelming feeling of fear, dread, and uneasiness which may range from mild to severe and depressionⁱA condition that is characterized by persistent sadness, loss of interest, withdrawal from activities, and even suicidal ideations in severe cases

Children with BPD may experience emotional dysregulation, making it challenging for them to manage emotions and resulting in extreme reactions to everyday situations.

Complications Of BPD

Children with BPD may also have other mental illnesses or childhood disorders, such as depression, bipolar disorderⁱA mental illness that involves extreme shifts in mood, energy, and activity levels fluctuating between mania, depression, and periods of normalcy , and attention-deficit hyperactivity disorder (ADHD), substance use disorderⁱCompulsive use of alcohol, nicotine, tobacco, medications, and other legal or illegal drugs despite the threat of danger to self and others , or eating disorders. The children might have repeated emotional crises. They may develop promiscuous behavior as adolescents. Children with BPD may also have suicidal tendencies (2) (3).

Trishna Saikia, a blogger, shares about her Border Personality Disorder (BPD) and the complications it causes. She writes, “Being diagnosed with Borderline Personality Disorder has suddenly pushed me into a pool of déjà vu… I was scared. I cried for days. I asked my parents if they would abandon me too. And slowly as I learnt about the disorder all my actions started making sense for me… I am often surprised by how easily I get overwhelmed by the slightest of trigger. I do not have a handle on how I might react to a certain incident. Sorrow, anger, irritation and frustration are my best buddies. Something as simple as a taunt activates something painful inside. I never seem to forget that incident or forgive that person. I do not understand moderation, so any emotional expression is extremely intense and painful (i).”

Diagnosis Of BPD In Children

There are no specific blood tests or brain scans to diagnose borderline personality disorder in children. However, the healthcare provider may advise these tests to rule out other conditions.  

BPD may not likely be considered a prospective diagnosis by physicians due to the misconception that the condition is a mere passing phase and can not occur in those under the age of 18. In children and especially teens, symptoms of BPD get attributed to developmental or hormonal changes, emotional instability, stress, or anxiety. Commenting on this, BPD expert Blaise Aguirre says, “It is outrageous to think a clinician would not diagnose BPD when a person is seventeen years and 364 days old and then diagnose it the next day when the teen turns eighteen (15).” However, it is important to note that the evolving nature of this condition and the supporting research suggest an onset in the pediatric population, encouraging pediatricians and child psychologists to thoroughly reevaluate the child’s symptoms to arrive at a BPD diagnosis.

To be diagnosed with BPD, the child must exhibit at least five of the symptoms mentioned above before reaching adolescence (2). According to the Diagnostic and Statistical Manual (DSM-5-TR) for psychological disorders, the child must compulsorily exhibit at least one of the symptoms of impulsivity, risk-taking, or hostility (13). Early diagnosis of BPD can allow for timely intervention and support and ensure the child receives appropriate care.

Quick fact

Studies suggest that the prevalence of BPD in adolescents is around three percent (9).

Treatment Of BPD In Children

The treatment of BPD can be a little difficult, and it is not uncommon for the symptoms to return. Moreover, children with this psychological condition may also have disturbed relationships with their counselors and doctors. However, the treatment is long and eventually helps reduce the symptoms, avoid harmful behaviors, and help your children manage their emotions better. The treatment may include one or a combination of the following (1).

• Counseling and therapy

A counselor plays a vital role in treating BPD in children. However, children with BPD may like their counselor one day and may hate them the other day. The children may develop more hatred for them, especially when the counselor asks them to change their behavior. A counselor specializing in dialectical behavior therapy (DBT) can be instrumental in treating this condition. They may also consider using mentalization-based treatment and transference-focused psychotherapy to enable the child to recognize their feelings and problematic interpersonal relationships (13).

• Medications

Antidepressants, anti-anxiety medicines, mood stabilizers, and low-dose antipsychotics in combination with counseling and therapy can help treat BPD in children.

• Healthy habits

Sufficient sleep, healthy diet, regular exercise, and abstinence from drugs and alcohol can help reduce stress and anxiety. It reduces the frequency and intensity of symptoms of BPD in children.

Point to consider

DBT emphasizes skill sets, such as mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance (10)

Ways That Help A Child Cope With BPD

The following tips may help you support your child with BPD.

• Be patient and non-judgmental.
• Promote a calm environment at home.

• Design strategies to control impulsivity.
• Help your child develop better interpersonal skills.
• Encourage your child to indulge in activities such as meditation, deep breathing, yoga, and relaxation techniques. You can do it with your child as a team.
• Exhibit and demonstrate love and support.
• Educate yourself about BPD.
• Lower your expectations and set realistic goals.
• Validate their emotions.
• Speak to the child honestly.
• It is difficult, but try not to lose your calm.
• Talk to them in clear, straightforward language. Also, be mindful of your nonverbal communication such as gestures, facial expressions, body language, etc.
• Be alert and aware of any signs of suicidal behavior.
• Make a daily schedule and stick to it.
• Encourage a healthy lifestyle and diet.
• Be consistent with their appointments with the therapist.
• Ensure regular consumption of the prescribed medicines and no dose is missed.
• The school, teachers, coaches, and other caregivers should be informed and kept in the loop about the treatment. All of you should be on the same page regarding the child’s care.
• Talk about the child’s condition to their siblings and explain how they can help in empowering the child.
• If there are any other accompanying medical conditions such as a mental disorder, cardiac conditions, and learning disabilities, ensure they are monitored well and take all their medications properly.
• Keep an eye on any new and sudden changes in their dressing style, behavior, choice of friends, routine, etc.
• Support groups and counseling services focused on BPD can prove beneficial for you. Reach out to professionals who specialize in childhood mental health for guidance.

Infographic: Managing Borderline Personality Disorder

A child with borderline personality disorder may experience overwhelming emotions. Teaching them to manage their emotions will make them more aware of their condition and develop better coping skills. This infographic enlists some self-help techniques for children with borderline personality disorder.

Illustration: Momjunction Design Team

Illustration: Signs Of Borderline Personality Disorder In Child And Tips

Image: Stable Diffusion/MomJunction Design Team

Watch this video through a mother’s eyes, offering a firsthand perspective on coping with a child diagnosed with Borderline Personality Disorder. Grasp insights into navigating emotions and fostering acceptance in the face of this mental health challenge.

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Dr. Neha Bhave SalankarMD

Dr. Neha Bhave Salankar is a consultant psychiatrist at Bhave Institute of Mental Health based in Nagpur and has around 11 years of experience in the field. Having been a meritorious student throughout, she bagged the prestigious gold medal for medicine in MBBS and MD psychiatry.

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Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU).

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