Borderline personality disorder (BPD) is common among adolescents. Research suggests that around 3% of adolescents could meet a BPD diagnosis – and may continue to experience the same traits and characteristics into adulthood if they don’t receive effective support.
For adolescents with BPD, early intervention and timely treatment are crucial to prevent long-term harm, such as other mental health conditions or problems in school and social life. But research on adolescent treatment for BPD is still relatively limited, and many established treatments for adults haven’t been studied among young people with the disorder.
That said, as BPD among adolescents is increasingly recognised by scientists, medics, and other experts, research exploring BPD treatment for young people is growing. This blog explores some of the evidence-based treatment options available that can support young people to recover and build fulfilling futures.
What Is Borderline Personality Disorder?
Borderline personality disorder is a type of personality disorder characterised by certain traits and ways of thinking, feeling, and relating to the world. Having BPD doesn’t mean there is something wrong with a person’s personality – it just means that the way they think, feel, and act can make daily life difficult to manage.
Many experts think that BPD traits develop as a normal response to difficult life events (such as childhood trauma) but cause a person harm in the long term.
Every young person with BPD is unique and has their own story. However, there are some core traits that characterise the disorder. These include:
- having an unstable or insecure sense of self with quickly changing interests
- patterns of intense and unstable relationships
- fear of abandonment
- intense emotions
- chronic feelings of emptiness
Contrary to some misconceptions, BPD is treatable. With the right support, young people and adults with the disorder can recover and live normal, fulfilling lives with stable and meaningful relationships.
Conceptualising BPD Among Adolescents
Many professionals and experts used to not recognise BPD among adolescents. Some thought that personality disorders couldn’t be diagnosed before the age of 18 when a young person’s personality was ‘still developing’. They argued that BPD traits may well fall within a ‘normal’ pathway of adolescent development when it’s expected that there may be phases of more impulsive or reactive behaviours.
In the past decade, these ideas have been challenged, and it’s increasingly accepted that BPD can and should be diagnosed among adolescents. Research shows that a significant proportion of adolescents (around 3% according to some studies) could meet a BPD diagnosis with the same symptoms and characteristics seen among adults – and these traits are well outside the range of what is ‘normal’ development.
This also means that terms like ‘adolescent BPD’ can also be misleading. BPD isn’t a different disorder when experienced by adolescents; instead, the same disorder persists from adolescence to adulthood.
Unfortunately, the delay in recognising BPD among adolescents means that research into treatment approaches for under-18s lags behind other research (such as BPD treatments for adults). But there have been some important studies assessing treatments like cognitive processing therapy, mentalisation-based therapy, and psychodynamic group therapy for adolescents.
Why Might Treatment Work Differently for Adolescents and Adults?
Adolescents’ brains work differently from adults’. Our brains continue maturing until our mid-20s, affecting the way we think, feel, react, and process information.
One of the key differences between adolescents and adults is how they process feelings. Studies show that adolescents use different areas of the brain when responding to emotional events. In particular, the amygdala region is more activated, a part of the brain associated with fear, emotion, and motivation. Other research has found that adolescents are more willing than adults to engage in risky behaviours in groups.
These differences mean that adolescents cannot be expected to respond to treatment in the same way as adults. Experts note that adolescents may not be able to mentalise (understand and identify the mental state behind their own or others’ actions) as well as adults, so complex interventions in therapy may be less effective. They may also be more easily influenced by other young people in group therapy settings and more emotionally reactive to events within a therapy session.
What Treatment Approaches Are Effective for Adolescents with BPD?
Randomised controlled studies have found several different treatment modalities that effectively improve BPD features among adolescents. These include:
Emotional Regulation Training (ERT)
Emotional regulation training was developed specifically for adolescents with BPD. It aims to help young people regulate (manage) their emotions and unstable and changing moods. It also helps adolescents develop a more ‘internal locus of control’—the perception that the outcome of their actions is caused by their own abilities and decisions.
ERT sessions teach emotional regulation skills early on in the treatment process so that young people can see meaningful changes quickly. It also involves sessions about ‘knowing yourself’ to support with identity exploration and development.
Cognitive Analytic Therapy (CAT)
Cognitive analytic therapy focuses on relationship problems and how someone’s early relationship experiences influence the way they connect and interact with the others around them.
CAT works by identifying events, memories, thoughts, emotions, and motivations that underpin and sustain harmful thought and behavioural patterns. Once these are identified, a young person can make positive steps to overcome and change these patterns.
Dialectical Behavioural Therapy (DBT-A)
DBT-A is an adaptation of dialectical behavioural therapy for adolescents. Dialectical behavioural therapy embodies the dual aims of radically accepting one’s emotions and experiences while learning skills and strategies for positive change.
DBT-A typically involves a series of group skills learning sessions accompanied by some one-to-one counselling. Skills sessions cover four main areas: mindfulness, interpersonal effectiveness, distress tolerance, and self-regulation. DBT-A includes an extra module (‘walking the middle path’) that focuses on how emotional regulation affects the relationship between adolescents and caregivers – and how to move towards a better dynamic.
Mentalisation-Based Group Treatment
Evidence suggests that group therapy is an effective treatment approach for adolescents with different kinds of mental illness. It can be particularly useful for disorders like BPD, where interpersonal difficulties lie at the core of the diagnosis. During group therapy sessions, interpersonal problems can manifest – and be navigated – with the guidance of a therapist, underpinning a process of learning and change.
Mentalisation-based group treatment works with young people to develop mentalisation skills (understanding the mental state behind their own or someone else’s actions) in a group setting. It may be combined with other treatment approaches – such as individual therapy – to provide a comprehensive recovery program.
Social and Family Systems
When young people begin to form secure attachments in relationships and trust the information they receive from others (known as epistemic trust) it enables greater social learning. They become more able to engage with and learn from other people in their social, family, and work lives.
This means that therapy can have much broader and deeper effects than simply the skills learnt in therapy sessions. Instead, these skills facilitate another learning process outside of therapy sessions – and one that continues after the end of treatment.
But for a young person to learn from their social systems, they need to have positive relationships where they can acquire knowledge and skills. This might be their family, friends, or other support networks. Consequently, treatment programs should also involve social and family systems (for example, through family therapy) to help these relationships build and flourish.
The Wave Clinic: Specialist Recovery Programs for Young People
The Wave Clinic offers specialist mental health treatment for young people from our residential and outpatient spaces in and around Kuala Lumpur, Malaysia. Our residential programs set the global standard for young people’s mental health care, combining evidence-based treatments with education, social responsibility, and an international gap year experience. Surrounded by breathtaking nature – and with unequaled support and care – we guide young people to build self-confidence, skills, and futures.
Situated close by in Kuala Lumpur city center, our outpatient center offers specialized additional support for young people facing challenges in their everyday lives, providing a diverse selection of expertly chosen treatment modalities.
If you’d like to find out more about our programs or start the admissions process, get in touch today. We’re here to make a difference.
