Borderline Personality
Disorder in Teens

Massachusetts Center for Adolescent Wellness Logo on a shield

Borderline personality disorder (BPD) has historically been an adult diagnosis. Around 1.4% of U.S. adults experience BPD. 1 Approximately 75% of individuals who receive a BPD diagnosis are women.2 But, men can also be equally affected by the disorder, although they generally receive a misdiagnosis of depression or PTSD.

There is substantial evidence that shows children and teens can start developing borderline personality disorder before reaching the age of 18. Borderline personality disorder in teens is not uncommon. And, children as young as 11 years old can receive a BPD diagnosis. 3   

Being a teen can be hard. Teenagers go through various changes, which include educational and social changes. They also experience hormonal mood swings. Teenagers can sometimes act without thinking which can get them into trouble. 

The typical teenager experience often includes out-of-character:

In some cases, a teen’s emotions can overpower them and control their actions. Certain young individuals might spend a great deal of time worrying about social situations. Knowing the difference between “typical” teenage moodiness and behavior and signs of a mental health disorder like BPD is important.

What is Borderline Personality Disorder? 

BPD is a mental condition that seriously affects an individual’s ability to regulate their emotions.4 When individuals experience this loss of emotional control, it can: 
Research shows that borderline personality disorder can be reliably diagnosed in adolescents. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)5

For a person under the age of 18 to receive a BPD diagnosis, they must have been experiencing the features of BPD for a minimum of one year.

Personality disorder categories can be potentially applied to adolescents and children in those fairly odd instances where the person’s maladaptive personality traits seem to be persistent, pervasive, and unlikely to be restricted to an Axis I disorder episode or a particular developmental stage.

When personality traits are chronic, maladaptive, and inflexible, and cause substantial subjective distress or functional impairment, they constitute a personality disorder, no matter how old the individual is.

Fortunately, there are effective treatments that can help manage BPD symptoms.

teen with borderline personality disorder laying on couch at a therapy session

What are the Symptoms
of BPD in Teens 

Similar to other types of mental health diagnoses, doctors will look at an individual’s age, culture, and so forth, within normal range, and take it into consideration. When healthcare professionals consider a borderline personality disorder in a teen’s diagnosis, they check for key symptoms. 

Examples of these symptoms include:

The following are substantial symptoms that might indicate BPD in a teen.

1. Strong Emotional Reactions

Teens may have strong emotional reactions to what would seem like minor problems. They might seem to overreact to everything. To them, minor problems feel like the world is ending.

2. Behavioral Dysregulation

This is generally one of the first symptoms individuals notice, with some teenagers showing behaviors of self-harm. They might engage in behaviors such as:

  • Burning their skin
  • Cutting themselves
  • Punching a wall 

There may be other problems that show up as well such as engaging in risky sexual behavior or start using substances.

3. Relationship Problems 

Many teens and children with emerging borderline personality disorder have difficulty managing relationships. They might have difficulty keeping their anger under control or they may experience an extreme fear of abandonment. Some teenagers might hold paranoid or irrational beliefs when they’re extremely emotionally distressed. These beliefs and fears might make it difficult for them to develop romantic relationships or friendships.

It’s hard for parents and doctors to notice these symptoms and know if the teen is just going through a normal teen phase or if they have emerging BPD. At the same time, a teen who shows any or all BPD characteristics may wonder to themselves if other individuals can cope with things that they can’t or why other people aren’t struggling in the same way they are.

Teens who experience strong emotions for longer periods than other teens or those who take longer to return to their regular baseline emotions could potentially have the disorder. 

There could be a serious problem if the teens are:

teen being counseled in a therapy session for their borderline personality disorder

How BPD Differs in Adolescents and Adults

Since teenage personalities are still forming, it may be difficult to notice symptoms of BPD in teens compared to adults. Teens might undergo various types of changes. Instability, mood swings, and other symptoms can be signs of stress, hormonal fluctuations, or anxiety.

Teens who are experiencing BPD symptoms require help. Individuals should not hesitate to get their teenager’s help because they’re hoping their teen’s behavior is just a phase or something they’ll grow out of.

It can’t be stressed enough how important an early diagnosis is. The sooner symptoms of borderline personality disorder are diagnosed, the quicker teens can begin treatment and increase their likelihood of living a meaningful, successful life.

Causes of BPD in Teens

Similar to adults, teens have unique responses and reactions to situations. For instance, if a ticklish child should have their arm touched, they’d react differently than a child who isn’t ticklish and had their arm touched. This is the same thing as the reactions of individuals with BPD versus those without the disorder.

When kids grow up in a family or social environment that doesn’t fit with their temperament, they might develop a lack of self-confidence or poor self-esteem. They might have a difficult time trusting other people and have problems with themselves and their own identities. When these kids grow into teenagers, they may feel lost and start engaging in risky behaviors. They may try to find different ways to deal with their feelings of emptiness and this is when BPD symptoms can begin emerging. 

Teenagers can start feeling depressed, which can then easily turn into thoughts of suicide or self-harming behavior. Problems like these should never be ignored. They require immediate attention and treatment. Any feelings, thoughts, or signs of self-harm need to be quickly addressed. While researchers don’t know the exact causes of BPD, research does show that genetics, environment, and social factors can increase a person’s risk of developing the disorder. 

These risk factors can include:

1. Family

1. Family History

Individuals who have a parent, sibling, or other close family members with BPD may be at a greater risk of developing BPD.

2. Brain Function
and Structure

2. Brain Function and Structure

Individuals with BPD may have functional and structural brain changes, particularly in the brain areas that control emotion regulation and impulses. But, it's not clear if these changes are actual risk factors for the disorder or if the disorder itself caused these changes.

3. Cultural, Environmental,
and Social Factors

3. Cultural, Environmental, and Social Factors

Many individuals with BPD state that they've experienced some type of traumatic life event during childhood such as abandonment, abuse, or hardship. Other individuals might have been exposed to invalidating, unstable relationships or conflicts.
While factors like these can increase an individual’s risk, it doesn’t mean that person will necessarily develop BPD. Likewise, individuals who don’t have risk factors like these can still develop BPD at any time in their lifetime.4

Diagnosing BPD in Teens

While pathologizing a normal behavior should be avoided, diagnosing borderline personality disorder at the right time has essential advantages. In this case, there could be less emphasis placed on psychopharmacology and more on the use of psychotherapy since there’s strong evidence it’s an effective treatment for BPD. 6

An earlier diagnosis also means earlier intervention and thereby helping to prevent behaviors that can severely impact functioning to become definite. Since BPD traits are flexible and malleable in teens, it means intervention is very appropriate during this period. And, there is evidence supporting the use of early BPD intervention treatments in youth.7

A licensed healthcare professional should evaluate a teen’s symptoms of BPD to rule out other possible causes. They’ll talk with the patient and evaluate the reasoning and functioning behind each of the teen’s behaviors.

Risks of Teenage BPD

To gain an understanding of the disorder, it’s essential to learn why a teen might be taking risks and/or engaging in a certain way and why they seem to be acting irrationally. For instance, many teenagers will experiment with drinking. Many will drink to bond with friends, fit in, or experience something new. Just because a teenager begins drinking doesn’t necessarily mean they have the disorder.

However, if a teen is drinking because they’re trying to change how they feel fundamentally, it could indicate a sign of the disorder. An individual with an underlying mental health disorder might begin drinking to avoid issues, wi.

Other, less harmful behavior could mean there’s a potential problem as well. For instance, many teenagers with BPD will stay in their bedrooms and study for hours to avoid having to deal with more serious issues. While this may not appear to be risky behavior, it could be a sign that they’re having problems managing their emotions. If the teenager meets with a therapist, they’ll talk about such situations and learn different skills required to manage their disorder successfully.

a MCAW meeting where a teen is in group therapy for borderline personality disorder

Co-Occurring Illnesses

BPD frequently occurs with other mental health disorders, like PTSD. These co-occurring conditions can make it more difficult to diagnose BPD and treat it successfully, particularly if the individual is experiencing symptoms of other conditions that overlap with their BPD symptoms. 

For instance, an individual with BPD also might be more likely to have symptoms of:

BPD is typically diagnosed in early adulthood or late adolescence. On occasion, an individual younger than 18 years old may receive a BPD diagnosis if their symptoms are substantial and last a minimum of a year.

Treatment for BPD in Teens

BPD has been historically viewed as challenging to treat. However, with new, evidence-based treatment, a lot of individuals with BPD experience fewer and less severe symptoms, a better quality of life, and improved functioning. It’s essential for teens with BPD to be treated by a licensed mental health professional. Receiving treatment from a poorly trained provider can be ineffective and potentially even dangerous.

Many factors impact how long it takes for patients to experience improved symptoms once they begin treatment. it’s essential for individuals with BPD and their families and loved ones to receive support and be patient during treatment.

A few treatments are frequently used to manage borderline personality disorder. These are:

1. Cognitive Behavioral Therapy (CBT)

CBT can help teens identify and change behaviors and core beliefs that stem from inaccurate perceptions of themselves as well as other people and issues interacting with other people. It can help teens decrease anxiety symptoms and mood swings and may decrease the number of suicidal behaviors or self-harming.

2. Mentalization-Based Therapy (MBT)

This is a form of talk therapy that assists teens in identifying and understanding what other people may be feeling and thinking.

3. Transference-Focused Therapy (TFP)

TFP is designed to assist teens in understanding their interpersonal issues and emotions through the relationship between the therapist and the teen. The teen will then apply what they learn to other situations and scenarios.

4. Self-Care Activities

Some types of self-care activities include:

  • A nutritious diet
  • Regular exercise
  • Taking medications as prescribed
  • Good sleep habits
  • Healthy stress management

Proper self-care can help decrease common BPD symptoms such s irritability, impulsive behavior, and mood changes.

5. Medications

These can’t cure borderline personality disorder, but they can help treat other disorders that frequently co-occur with BPD such as anxiety, depression, and impulsivity. Often individuals are treated with a few medications, but there’s not much evidence that this is a necessary or effective approach. Individuals with BPD are encouraged to speak with their healthcare provider about what they can expect from each prescribed medicine and its side effects.

While certain individuals with BPD take medicine to help manage their symptoms, the FDA hasn’t approved any medications as a specific BPD treatment. It’s common for individuals who have the disorder to take medicine to help decrease their symptoms or help manage other symptoms or conditions.

These conditions include:

  • Anxiety
  • Bipolar disorder
  • Depression
  • Psychosis

Even though medicine can be helpful, group and individual therapy using general psychiatric management (GPM) or dialectical behavior therapy (DBT) is the most effective option of treatment for individuals who receive a BPD diagnosis. They’re also proven to be helpful in teens with BPD.

6. Dialectical behavior therapy (DBT)

DBT is often used to treat teens with BPD. This very effective treatment option targets suicidal behavior and self-harm behavior. It addresses other types of destructive behavior like substance abuse.

During therapy sessions, the therapist will work with the teen to help break down behaviors. They’ll then provide the teen with specific skills to deal with difficult emotional circumstances and situations.

Four separate skill sets are emphasized in DBT:

  • Emotion regulation
  • Mindfulness
  • Distress tolerance
  • Interpersonal effectiveness

In DBT sessions, teen patients will learn how to:

  • Increase positive experiences
  • Be non-judgmental about the experiences of others and their own
  • Communicate effectively with other people
  • Manage overwhelming emotions that keep them from being able to take control of their lives
  • Accept circumstances they have no control over

DBT is frequently combined with CBT to help maximize each of the teen’s treatment sessions. Teens will then stop self-destructive behaviors, better control their emotions, and have a simpler time managing their feelings.

Good Psychiatric Management for Adolescents (GPM-A)

This treatment gives mental healthcare professionals a simple-to-adopt resource for teens with severe personality disorders. GPM-A focuses on offering teens the life-building skills required to effectively understand and manage their disorder. The skills they learn will help them focus on the concept that they’re not just a patient, but instead, they’re still living a complete life outside of their therapy.

Teenagers with BPD who receive GPM-A treatment can learn how to see their experiences healthily, identify what they’re good at, and develop non-reactive critical thinking skills.

While GPM and DBT can be extremely efficient, they’re not appropriate for all patients. Also, neither of them is more effective than the other. A patient’s mental healthcare provider will assist them in deciding which treatment method is right for them.

The teen’s treatment team might recommend other forms of therapy they think will be most effective in easing the teen’s symptoms and helping them lead a better life. It’s always essential for patients (or the teen’s parents) to perform their research and make sure the type of treatment recommended is evidence-based and only administered by a licensed mental healthcare professional.

Find Treatment for Borderline Personality Disorder in Teens With MCAW

Borderline personality disorder in teens can cause them to struggle with various behavioral or mental health issues. There’s hope and the Massachusetts Center for Adolescent Wellness (MCAW) works with teens and their families to rebuild relationships and trust. Reaching out for help when you suspect BPD in your teen is the first step to recovery. At MCAW, we’ll sit down and consult with you about the different BPD treatment options available and help find the right treatment plan for your teen. 

Contact us to schedule your free consultation and learn more about our BPD treatment options. 


  1. National Institute of Mental Health. Personality Disorders. Retrieved on 2/22/2023 from:

  2. National Alliance on Mental Illness. Borderline Personality Disorder. Retrieved on 2/22/2023 from:
  3. National Library of Medicine. Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies. Jean Marc Guilé, Laure Boissel, Stéphanie Alaux-Cantin, and Sébastien Garny de La Rivière. Adolesc Health Med Ther. 2018; 9: 199–210. Published online 2018 Nov 23. doi: 10.2147/AHMT.S156565.

  4. National Institute of Mental Health. Borderline Personality Disorder. Retrieved on 2/22/2023 from:
  5. National Library of Medicine. Borderline personality disorder in adolescents: the He-who-must-not-be-named of psychiatry. Marie-Pier Larrivée, MD, FRCP (c)* Dialogues Clin Neurosci. 2013 Jun; 15(2): 171–179.

    doi: 10.31887/DCNS.2013.15.2/mplarrivee.

  6. National Library of Medicine. Clinical trials of treatment for personality disorders. Joel Paris. Psychiatr Clin North Am. 2008 Sep;31(3):517-26, viii. doi: 10.1016/j.psc.2008.03.013.

  7. National Library of Medicine. Prevention and early intervention for borderline personality disorder

    Andrew M Chanen 1, Louise K McCutcheon, Martina Jovev, Henry J Jackson, Patrick D McGorry. Med J Aust

    . 2007 Oct 1;187(S7):S18-21. doi: 10.5694/j.1326-5377.2007.tb01330.x.

Clinically Reviewed by:

Dr. Melanie Carbonneau PhD, LMHC, MT-BC

Dr. Melanie Carbonneau PhD, LMHC, MT-BC

Melanie Carbonneau is the Clinical Director at Massachusetts Center for Adolescent Wellness and is a licensed counselor and certified music therapist with a Ph.D. from Lesley University. She leads MCAW with a focus on holistic care, emphasizing the importance of family and community involvement in the healing process.