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Supporting children and young people with borderline personality disorder (BPD)

Information for parents and carers to support children and young people with borderline personality disorder (BPD).

What is Borderline Personality Disorder?

There is considerable debate and controversy about the psychiatric diagnosis of ‘Personality Disorder’ because often clinicians making this diagnosis do not take enough account of the young person’s social context, for example, experiencing complex trauma and/or the impact of social deprivation.  Further, the diagnosis itself can be experienced as stigmatising by many young people.  Some people, however, have found this diagnosis useful because it helps them to name and make sense of their difficulties and experiences, and to get the help that they need.

Clinicians tend to be reluctant to diagnose Personality Disorder in adolescence because this developmental stage is normally a time of change, turmoil, and identity questioning.  However, in those relatively unusual instances when the difficulties in a young person’s personality functioning appear to be experienced most of the time and across all areas of their life, the clinician may consider diagnosing an “Emerging” or “Borderline” Personality Disorder.

Borderline Personality Disorder (BPD) is a mental health problem characterised by significant mood swings as well as difficulties in forming relatively harmonious, stable relationships with others.  The crux of the problem is a real difficulty regulating – or managing - emotions effectively.  Someone with BPD may fear being abandoned by those close to them and  require constant validation and reassurance in their relationships, which itself can prove damaging.  Likewise, their view of others can change suddenly from intensely liking and feeling connected to someone, to mistrusting them and becoming angry and conflictual. Understandably, this affects their ability to maintain long-term relationships, which feeds into their fear of abandonment.  These difficulties usually begin in adolescence and continue into adulthood.  However, with effective treatment, these difficulties can be addressed, helping people to live fulfilled lives.

Signs that a child or young person is affected by Borderline Personality Disorder

Young people with BPD may rapidly cycle rapidly from elation to irritability, from calm to conflict. Their extreme outbursts of anger may feel out of proportion to the actual situation and they may have significant difficulty controlling these outbursts.  Their terror of abandonment may result in frantic efforts or threats to prevent this perceived abandonment, including threats of self-harm and suicide.  While this can be difficult for parents, carers and friends to manage, it is important to remember that the young person is not deliberately trying to be manipulative or attention seeking; rather this is their way of communicating their emotional pain. 

Young people with this diagnosis may show a noticeable pattern of intense, unstable and volatile relationships where they shift dramatically from idealising someone to devaluing them.  They may also be prone to worryingly reckless behavior including unsafe sexual encounters and alcohol and drug use, which can feed into their experience of instability and poor self-image.

It is important to note that these difficulties can overlap with other mental health disorders, and do not necessarily indicate a diagnosis of BPD. If you suspect that a young person may have BPD, it is important to talk to your GP and follow the process to get proper mental health intervention. 

Common issues parents and carers may have to contend with

Living with a young person with BPD is not always easy for the family. It can be very challenging for parents and carers to manage extreme emotional outbursts and instability and it can be a stressful and traumatizing experience witnessing a young person engage in self-destructive behaviours.  This can leave family members feeling helpless and exhausted.

Since young people living with BPD can be volatile and emotionally unstable, parents and carers often feel as if they are walking on eggshells, constantly worried about saying the wrong thing or triggering a situation which everyone finds stressful.  Learning to manage your own feelings during moments of aggression or conflict is key.  Try to discuss challenging behaviour and healthy boundaries when everyone is calm and your child may be less likely to misinterpret or respond negatively to your concerns or requests. 

Young people living with BPD may also find it hard to maintain consistency at school or college. Since there is so much stigma attached to the disorder, it may be difficult to help teachers to understand your child’s behaviour within the context of their emotional difficulties in order to come up with ways of helping them as well as minimising the disruption to other pupils or students.

Parents and carers might also experience people outside the family negatively judging their child’s actions or behaviours, which is hard because they can feel as if their own parenting skills are being questioned. Therefore, it is extremely important for parents and carers to take care of their own mental health and wellbeing in order to continue to help and support their child.

What to say to siblings?

Making extended family aware of your child’s diagnosis can be extremely helpful, especially for those who may be in frequent contact with your child and who may witness or be the focus of any anger or outbursts.  Providing family members with information about BPD may help them remain patient and react in a calm way when these instances occur.  You can let them know that you will discuss any outbursts that may occur with your child when they are calm and more open to conversation and that appreciate them not stepping in or escalating any situations.

Asking family members to not focus or discuss your child’s diagnosis can also be helpful, acknowledging other talents or passions which may be easily overlooked and hopefully allowing for more light-hearted conversations which your child feels comfortable engaging in.

More importantly, for both you and your child, you should try to maintain relationships with friends and family as much as possible even though you may be tempted to withdraw.  We all need support and taking time out to catch up with friends or family can prove beneficial to your own mental health and wellbeing and allow you to support your child better in the long run. 

Additional support for parents and carers