Borderline personality disorder (BPD) is a serious mental health condition that usually develops during adolesence. BPD affects the way young people relate to themselves, others, and the world around them. It’s characterised by unstable relationships, an incoherent or unstable sense of self, impulsivity, intense emotions, and a fear of abandonment.
Many researchers now think that borderline personality disorder is a developmental disorder that stretches across a person’s lifespan. This means that a combination of factors, including genetics, personal characteristics, and childhood experiences, make up a developmental pathway that leads to the onset of the disorder.
Among these factors, family environments and relationships with primary caregivers seem to play a key role. Emotional distance from parents during childhood or experiences of neglect may affect a young person’s attachment style and ability to understand their own and other’s mental states. This, in turn, can lead to some of the key traits of BPD, such as a fear of abandonment, intense emotional reactions, and impulsivity.
As much as family systems can be fundamental in the development of BPD, they may also be crucial in treatment and recovery, especially among adolescents and young adults. Family interventions can help to establish family structures, parenting skills, and interpersonal family dynamics that lead to more stable interpersonal relationships, better emotional regulation, and fewer self-harming behaviours.
This blog offers some information on the types of family interventions used in treating adolescent BPD and how they can support young people to manage and recover from the disorder.
Why Is BPD Treatment for Adolescents and Early Intervention Important?
While BPD was previously mainly diagnosed among young people over the age of 18, adolescent BPD is now recognised as a valid and reliable diagnosis. Data suggests that at least 3% of adolescents may meet the DSM-V criteria for the disorder. For adolescents with a BPD diagnosis, receiving effective and tailored treatment is fundamental for their recovery.
However, researchers suggest that young people should start receiving treatment far before they meet the full criteria for a BPD diagnosis. Evidence shows that BPD can have a big impact on a young person’s well-being and development even when they only meet one or two of the diagnositic criteria (as opposed to the five required for a diagnosis). This includes higher mental health service use and more difficulties managing every day life.
This means that it’s important for adolescents to access BPD treatment in the earliest stages of the disorder. Early interventions can help to prevent symptoms from developing, protect against co-occurring mental health conditions, and promote mental health and well-being into adulthood.
What Are the Benefits of Family Interventions in BPD Treatment Among Adolescents?
Many adolescent treatment programs for BPD now include family therapy, alongside other treatment approaches and support structures like dialectical behavioural therapy and social work. Family therapy may support young people and families to manage and recover from BPD in several ways.
Healthy Family Systems
Young people with BPD have often grown up in a chaotic or dysfunctional family environment, preventing them from developing healthy interpersonal boundaries and relationships. Family therapy can help families develop stable family structures with effective boundaries that encourage supportive, caring relationships.
These healthy structures support young people to move away from harmful behaviours that may have developed from dysfunctional family systems and replace them with positive ones.
Communication Between Therapists and Adolescents
Families can be an invaluable source of information about adolescents’ behaviours, emotions, and experiences. They can help therapists gain a deeper understanding of a young person’s experience that they may not be able to ascertain directly from the adolescent.
Co-operation Between Therapists and Family Members
While families have the potential to play a key role in an adolescent’s recovery, difficult relationships between family members and therapists can hinder the process. One of the benefits of family therapy is that supports effective cooperation and builds trust between therapists and family members, helping them to work as a team within a young person’s recovery journey.
Parenting Skills
Family therapy can help teach parents effective skills for responding to their child’s behaviours that discourage harmful behavioural patterns and promote positive change. Parents may learn how to act as a role model for their children, encouring healthy interpersonal behaviours, coping mechanisms, and other traits.
Education and Understanding
Psychoeducation usually makes a significant part of family therapy. Psychoeducation supports parents in understanding both their own and their child’s behaviors, helping them to act and respond in positive ways.
Hope for the Future
Family therapy sessions can help parents feel empowered and optimistic about their child’s recovery. Educational sessions support parents to understand BPD as a treatable condition from which recovery is possible. At the same time, skills training helps families feel empowered in a young person’s recovery as an active component of positive change.
What Types of Family Interventions Can Help to Treat BPD?
There are several different types of family interventions that may be offered to adolescents with a BPD diagnosis or BPD symptoms. As well as family therapy sessions that focus on structures and dynamics within families, interventions also include skills training sessions for MBT and DBT.
Dialectical Behavioural Therapy Family Interventions
Dialectical behavioural therapy (DBT) typically plays a core role in treating adolescent BPD. DBT works with young people to develop skills to manage and change harmful behaviours and difficult emotions while encouraging radical acceptance of themselves and their feelings. DBT sessions often take the form of multi-skills training groups alongside one-to-one sessions.
In DBT family interventions, parents and other family members participate in skills training sessions with, or separately from, the young person with BPD traits. DBT skills modules for families teach members to practice validation, mindfulness, and acceptance of self and others. These skills, in turn, help young people manage emotional responses and experience less intense emotions, reducing the intensity of conflicts and harmful behaviours. They also encourage relationships between family members to be closer and warmer.
A study among adolescent girls who were at risk of developing BPD and their mothers found that positive interpersonal behaviours (such as positive escalation, supportive actions, and effective communication) were linked to decreased severity of BPD scores over time. This means that positive behaviours from caregivers – such as those taught in DBT family training sessions – have the potential to reduce BPD symptoms among adolescents.
Another study among adolescents with suicidal or self-harming behaviours found that DBT sessions accompanied by multi-family skills training and family skills sessions were more effective than usual treatment in reducing suicidal and self-injurious behaviour, suicidal thoughts, and depressive symptoms.
Family Therapy in Mentalisation-Based Programs
Mentalisation-based treatment (MBT) is another key treatment approach for adolescent BPD. Mentalisaiton-based treatment supports young people to understand the mental states behind the actions of themselves and others. MBT helps adolescents to manage their emotional responses and improve interpersonal relationships.
Research has found that mentalisation-based treatment, including family therapy, is more effective than the usual treatment in reducing self-harm, depression, and borderline personality features and improving interpersonal functioning.
Moving Forward in Research and Practice
While research shows that family interventions can play a valuable role in young people’s recovery from BPD, it’s yet to become an established treatment for young people. Experts suggest that developing clinical practical guidelines for the implementation of a family systems approach by mental health support services could help to promote a more consistent approach to family interventions, which enables easier access to treatment and more effective follow-up.
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