DBT-A and Other Treatments for Adolescent Borderline Personality Disorder

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Borderline personality disorder is a serious mental health disorder that affects young people’s sense of self, relationships with others, and perceptions of the world around them.

BPD can look very different in one young person than in another. However, there are some key traits and behaviours that characterise BPD in both adolescents and adults. These include:

  • an unstable sense of self
  • impulsivity
  • intense and changing emotions
  • patterns of unstable relationships
  • chronic feelings of emptiness
  • self-harm and suicidal behaviours

Having a personality disorder doesn’t mean that there is anything wrong with a young person’s personality. Instead, it means that the way they interact with themselves and others is different to other people, making some aspects of daily life difficult. 

Research suggests that personality disorders are, to a large extent, caused by distressing or adverse experiences during childhood that affect the way young people develop emotionally and socially. Consequently, some young people with personality disorders see their behaviours as a normal response to the trauma they have experienced.

Why Is Diagnosing and Treating BPD in Adolescence Important?

Until recently, many researchers and practitioners believed that BPD couldn’t be reliably or accurately diagnosed in adolescents. They thought that it was difficult to distinguish BPD features from characteristics that were part of normal developmental pathways for adolescents and would not persist into adulthood. 

However, research now overwhelmingly suggests many adolescents meet the criteria for BPD and that a reliable and accurate diagnosis is possible. Around 3% of adolescents may have diagnosable BPD. Borderline personality features during adolescence – including self-harm, feelings of emptiness, and impulsivity – are far outside of the range of normal adolescent experiences and behaviours and, without effective interventions, often persist into adulthood.

Despite this evidence, many practitioners are still reluctant to diagnose BPD in adolescence. Some experts think this is because they are afraid of the stigma surrounding a BPD diagnosis and how this might affect young people’s opportunities in work and other aspects of life. 

However, diagnosing BPD during adolescence and providing treatment is crucial to help prevent BPD traits from continuing into adulthood and improving young people’s lives in the future.

What Is Dialectical Behavioural Therapy-A?

Dialectical behavioural therapy (DBT) is a type of cognitive behavioural therapy that was specifically developed for adults with BPD. DBT teaches skills that help individuals manage difficult emotions and change harmful behaviours while encouraging self-acceptance of their feelings and experiences. 

DBT-A is an adaptation of DBT that reflects the specific needs of adolescents. It integrates family and caregivers into weekly skill sessions, reduces the length of treatment, and includes an additional module called “Walking the Middle Path.” This module teaches skills that address the negative impact of emotional deregulation on the relationship between adolescents and their caregivers and promote positive change.

How Effective is DBT-A in Treating Borderline Personality Disorder Among Adolescents?

Research shows that DBT-A is effective in reducing suicidal ideations and non-suicidal self-injury among young people with BPD. A recent study found that it also reduces the core symptoms of BPD and the number of BPD criteria met. Their results showed a significant decrease in all 9 BPD criteria throughout the treatment program, including patterns of unstable relationships, identity disturbance, chronic feelings of emptiness, and impulsivity.

By improving core BPD symptoms among adolescents, DBT-A can help prevent the disorder from persisting into adulthood or reduce its severity. This means that young people may avoid the negative consequences associated with BPD during adolescence and adulthood, including interpersonal difficulties, self-harm, substance abuse, and co-occurring mental health disorders.

It also means that young people can continue to develop positive cognitive, emotional, and social skills that may otherwise be disrupted by BPD symptoms. This helps young people maintain good mental health and social relationships as adults, promoting well-being and quality of life.

What Other Treatment Approaches Are Available?

While DBT-A is the most established treatment for adolescents with BPD, other treatment approaches are available. These include mentalisation-based treatment and adolescent identity treatment. These modalities may be offered alongside or as an alternative to DBT-A.

Experts note that research into treatment approaches for adolescent BPD is still very limited. More research is needed to support the development of effective treatment programs for adolescents and provide the best chances of recovery.

Adolescent Identity Treatment

Young people with BPD usually lack a coherent identity or stable sense of self. They may feel unsure or lack a clear conception of who they are and what they want to do. They often experience quickly changing sets of interests that may be heavily influenced by the people around them. This can leave adolescents with BPD feeling lost, empty, and insecure.

Some experts think that an unstable or incoherent identity may be at the core of many symptoms and behaviours associated with BPD. For example, identity disturbances affect a young person’s ability to form stable and meaningful relationships with other people. They may also make it harder for young people to understand and regulate their emotions and can lead to chronic feelings of emptiness. All of these symptoms may increase the likelihood of self-harm and suicidal behaviours.

Adolescent identity treatment (AIT) works with young people to build a more integrated identity with more stable and fulfilling interpersonal relationships. It combines individual therapy with interventions involving peers, parents, teachers, and schools. AIT sessions focus on creating positive change in the ‘here and now’, emphasising behavioural, psychoeducational and educational elements.

A recent study found that AIT can effectively treat adolescent BPD, reducing BPD criteria and symptoms of depression. It also improved both psychosocial functioning and personality functioning.

Mentalisation-Based Treatment

Young people with borderline personality disorder often have difficulties mentalising – understanding the mental state behind their own or another person’s actions. This can cause problems in interpersonal relationships, make it more difficult to manage emotions, and lead to impulsive behaviours. 

Mentalisation-based treatment for adolescents works with young people to develop mentalisation skills through individual and family therapy. Research shows that MBT-A may reduce self-harm and emergency visits as well as social anxiety, emotional deregulation, and borderline personality disorder traits. 

The Wave Clinic: Specialist Recovery Programs for Teenagers and Young Adults

The Wave Clinic offers transformative recovery programs for young people, supporting them to plan and build fulfilling futures. We specialise in eating disorders, borderline personality disorder, and trauma-focused treatment, sensitively addressing the underlying causes of mental health conditions to promote meaningful healing and lasting change.

Our world-leading programs combine exceptional clinical care with education, community responsibility, and an international gap year experience. We work with young people to find and build stability in their lives and within themselves, grow in self-confidence, and develop the skills they need to follow their dreams.

If you’re interested in our programs, get in touch today. We’re here to help.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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