Working with teenagers and young adults, I often hear the phrase, ‘I just don’t know who I am’.
It can be a normal teenage response to the rapidly changing period between childhood and adolescence. They’re trying out new behaviours. Ones that are often borrowed from friends, family or celebrity culture.
It is, after all, the point of the teenage years.
Everything from hairstyles to clothes, friends, preferences and careers are tried on for size.
We eventually find our ‘fit’ and move on to the next developmental stage. Where we become more confident of who we are.
Some young adults struggle with identity over a longer-term.
The usual pattern of developmental changes is complicated by identity disturbance or a rapidly changing sense of self.
Identity changes are often seen in young people diagnosed with emotional instability or Borderline Personality Disorder.
They are often linked to a chronic feeling of emptiness.
Teenagers may describe the internal loneliness and numbness that they experience. For parents, this can be terrifying. These feelings are often combined with periods of anger, volatility and rage.
This may form part of an emerging pattern of behaviours that is followed by episodes of self-harm, suicidal thoughts or suicidal gestures.
Parents describe an increase in their own anxiety and fear.
Parenting at this point can feel like they’re in a danger zone. I listen to parents describe sleepless nights, as they feel unable to rest. They feel uneasy about leaving their teenagers alone.
Exhaustion in the family erodes previously settled relationships. The family begins to walk on eggshells. They attempt to avoid rage, destruction or suicidality.
Parents report feeling unable to parent effectively, avoiding situations which may lead to the young person running away from home, self-harming or death.
Creating New Identities
Teenagers, challenged by the feelings of self-loathing that often accompany the emotional disturbances of BPD, frequently describe creating new identities.
They create a new or modified version of themselves.
This may lead to name changes, changes in schools, changes in interests or recalling stories and events that have not happened.
Parents and friends often notice unusual new behaviours, peer groups or feel suspicious that events do not seem to ‘add up’.
Sometimes this may result in fictitious reporting, factious illness or achievements. There can be false allegations or alienation of others. Discord within the family is often extreme.
Teens may incorporate the stories and events from the lives of others into their own life story.
They can take ownership of the narrative of others. The story becomes interwoven in their accounts of their personal history.
It becomes their story to tell.
It may involve aspects of others that are both deemed to be positive or negative. It may be the inclusion of a special skill, a holiday to exotic places, reports of illness, fantasy elements or it could be linked to a deeper longing.
Creating incidents that can have far-reaching ramifications or legal challenges can be very concerning for parents. Parents can feel lied to, manipulated and distressed.
Parents need to remember that their son or daughter is trying to deal with intense and often overwhelming emotions. The fragility of their resilience and attempts to gain acceptance from others are exposed.
Young people describe the intense waves of guilt, shame, grief, panic, abandonment, rage and humiliation that they experience.
The emotional rollercoaster of a young person experiencing the symptoms of BPD can become overwhelming for the whole family system.
Identity Disturbance in Borderline Personality Disorder.
Identity disturbance in BPD can manifest in many different ways. It is a core symptom of BPD.
Many young people suffering from BPD will experience some form of discomfort or shifts in identity.
- Unstable Self-Image.
- Excessive Self Criticism
- Chronic feelings of emptiness and loneliness
- Chronic feelings of being unsettled or bored
- High-risk behaviours to fill the perceived void
- Dissociative episodes
- Unstable friendship groups
- Rapidly changing interests and inability to stay on track
- Borrowing behaviours, interests and expertise of others
- Unstable personal values and goals
- Difficulty in developing a sense of self, beliefs and roles
- Lack of continuity
- Creative storytelling and fantasy
- Inflexible, rigid and explosive
- Factitious Disorder
Teens describe wanting to ‘feel’ something. They often describe that feeling anything is better than chronic emptiness and longing.
Non-suicidal self-harm is prevalent in young people who demonstrate traits of BPD. Cutting, burning and other forms of self-injury can be used to ‘feel’ something.
Teenagers may have a pattern of sabotaging or undermining themselves at home, work or school. Families often report that teens frequently drop out of school prior to graduation, end friendships just as they are becoming close, destroy opportunities as they are about to come to fruition or stop attending therapy just as the ‘work’ is paying off.
Without successful adolescent treatment, this can continue into adulthood. Relationships, marriages and multiple job losses, often follow.
Adolescents in relationships may take on elements of their friends or intimate partners. Teenagers may sometimes confuse their feelings, thoughts and desires with those of people in relationships with them. The feelings of being intertwined and one can be very powerful.
When the relationships end, the young person can be filled with a greater sense of loss and abandonment, feeling that their identity has once again been crushed and lost.
“I feel like I am acting out a role, nothing is really me.”
Identity Disturbance: markedly and persistently unstable self-image or sense of self (DSM-5. American Psychiatric Association) is one of the nine areas of Diagnostic criteria used to distinguish Borderline Personality Disorder.
- Borderline Personality Disorder has a prevalence of between 1.6% – 5.9%.
- A Borderline Personality Disorder is diagnosed predominately in girls, who make up approximately 75% of those diagnosed.
How can parents help their Teens with Identity Disturbance?
Parents describe feeling disempowered. Teens describe ‘falling apart’.
The descriptive phrase ‘walking on eggshells’ becomes the norm.
Family life is disrupted and often is described as chaotic. Parents feel increased pressure of the family system. They are often terrified of the potential outcome of factious events and allegations.
Moreover, they are fearful that they are missing the ‘real’ distress. Siblings can feel set aside and in turn, withdraw as the brother or sister requires a high level of parental involvement.
Young adults who are experiencing intense, unstable emotional responses or who have been described as highly sensitive often require intensive therapy.
D.B.T., along with Family Based Therapy, is an evidence-based treatment, effective in the treatment of BPD.
Family Therapy helps the treatment team understand the interactions between family members. The family is seen as a partner in treatment.
Consistent parenting, supporting treatment and encouraging medication compliance are some of the ways that parents can help.
Validating the adolescents thoughts, feelings, and actions is an essential parenting skill.
This does mean that you agree, like or collude with behaviours, it means that you show understanding where the young person is coming from.
Validation improves relationships. It improves communication by allowing teenagers to see that their parents are listening, understanding and being non-judgemental.
It shows that we care about the other person and our relationship with them. Most importantly, it decreases conflict.
How can parents validate their teenagers’ experiences?
- Parents can practice active listening. We can show that we are listening by keeping eye contact and staying focused on the young person.
- Keeping voices low. Parents should be conscious of keeping a soft, low tone.
- Parents can be very careful to give out listening and understanding clues. We often give out non-verbal messages that extremely sensitive young people can feel injured by. Take care not to walk away, tell them to ‘pull themselves together’, sigh or divert the focus from the young person.
- Try not to tell the young person what to do. Problem-solve together.
- Talk In ‘I’ statements (I think, I feel) rather than ‘you are’ or you should’.
- Encouraging Mindfulness practices. Staying present, whatever the ’emotion’ you are experiencing, helps to ease confusion in young people.
Parents who are able to engage in their own therapy, whilst the young person takes an active role in treatment; actively contribute to strengthening the family relationships.
Families often feel responsible to ‘fix’ the problems alone. It is essential to have a support network for the entire family.
Where there is a need for a higher level of care, for example, in adolescents who are self-harming or suicidal; residential psychiatric treatment should be considered. Treatment programs with intensive and integrated Family Therapy are essential.
Recovery is possible. It is never a straight path. There are often periods of relapse. Lapses are never failures.
They are learning experiences and an opportunity to gain knowledge about ourselves and out internal processes.
Young people are incredibly receptive to treatment. Learning skills to enhance their self-esteem, dreams, goals, and experience a feeling of meaningful connection.
Filling the void by sharing experiences, relieving the emptiness and leaning coping skills are all a recipe for teenage success stories.
Recommended reading for parents:
Parenting a child who has intense emotions. D.B.T. skills to help your teen navigate Emotional and Behavioural Challenges: Pat Harvey & Britt H Rathbone
Borderline Personality Disorders and Adolescents: Blaise Aguirre
Recommended reading for Mental Health Professionals:
The Dissociative Model of Borderline Personality Disorders: Russell Meares
Fiona Yassin, International Clinical Director and Certified Child and Family Specialist at The Wave Clinic, Kuala Lumpur.
Fiona has a specialist interest in Borderline Personality Disorder and Eating Disorders in Teenagers and Young Adults. Having assisted many families around the world navigate the challenges of Parenting adolescents diagnosed with BPD, Eating Disorders and Self-Harm.
Fiona is a Fellow of APPCH, an Accredited Clinical Supervisor (UNCG) and a member of FDAP, NADAAC, ANZMH and IAEDP. Currently completing C.E.D. specialist in Eating Disorders, Fiona has recently enjoyed further training in Psychiatric Disorders across the Female lifespan with Massachusetts General Hospital, Department of Psychiatry.