Is there any good treatment for borderline teenagers?

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Answered by: Margaret, An Expert in the Parenting Troubled Teenagers Category
Are you ready to bang your head on a wall? Do you want to abandon your child in the wilderness? Are you praying for the day they turn 18, when you can change the locks on your doors? Teenagers with borderline personality disorder (BPD) bring out the worst in everyone around them.

A borderline teen is not a “drama junkie” on purpose. Their brain is primed to overreact.Yes, BPD kids really believe that others are out to get them, and that all their problems are someone else’s fault. They are appalled that others mistreat them, and insulted and defensive when they detect criticism, even when there isn’t any. They can never be pleased, and it’s always about them. What makes things more confusing is that they have a loving, sweet and charming side that flips to monstrous in an instant.

“Does this explain why I can go from 0 to 60 in two seconds?”--17 year old, when told her diagnosis was borderline personality disorder

Borderline teenagers are famous for being manipulative and very good at it. They can use their wonderful social skills to get what they want from others. They also turn on the charm to embarrass you in public, in front of friends, neighbors, or teachers. Since they present so wonderfully to other people, you are asked why you get upset at your child. People have recommended that you take care of your own issues instead.

“Borderlines have the thinnest skin, the shortest fuses and take the hardest knocks. In psychiatrists’ offices, they have long been viewed as among the most challenging patients to treat.”

--Shari Roan, Los Angeles Times, September 2009

Even though their manipulation and upheavals are relentless, strive for compassion. Trust me, your borderline teenager will suffer more than you in every important aspect of life. They make a mess of their relationships because of their emotional instability, addictions, and clingy behavior. They drive away good friends, hate them for leaving, and then suffer from loneliness. They make a mess of their jobs, are often demoted or fired, and don’t understand why it happens to them.

For goodness sakes, why?

A biological reason was discovered in a study of people playing a game that required teamwork. Brain scans of normal participants revealed high electrical activity in a brain region called the bilateral anterior insula, the ‘cooperation’ and ‘trust’ region. Brain scans of borderline participants revealed no electrical activity whatsoever. People with borderline personality disorder do not have an internal sense of fairness and social norms, and little to no level of trust.


Borderline personality disorder occurs equally as often in men and women, in all races, and sufferers can have other mental illnesses or substance abuse problems. (From personal observations, BPD teens tend to have a second diagnosis of bipolar disorder.) Best estimates indicate that 1.4 percent of the U.S. adult population have this disorder.

Evidence in infancy

The children who were later diagnosed with borderline personality were more sensitive, had excessive separation anxiety and were moodier. They had social delays in preschool and more interpersonal issues in grade school, such as fewer friends and more conflicts with peers and authorities.

Risks in teenagers

Borderline teenagers are more promiscuous, aggressive and impulsive, and more likely to use drugs and alcohol. Cutting and suicide are more common, “…research shows that, by their 20s, people with the disorder are almost five times more likely to be hospitalized for suicidal behavior compared to people with major depression.”

Treatment offers hope*

There is good treatment for borderline teenagers, a form of psychotherapy called dialectical behavior therapy (DBT). DBT helps teens attain and maintain lasting improvement in their social skills, interpersonal problems, and overall functioning. DBT appears to be the most effective, and it focuses on coping skills, so patients learn to better control their emotions and behaviors. Therapy focuses on the present rather than the past, on changing one's behavior patterns now regardless of how patients feel about the past or if they see themselves as victims. DBT treatment may also be combined with medications that help with mood stability, impulsivity, psychotic-like symptoms, and self-destructive behavior.

When to hospitalize

---In an emergency – when your child has serious suicidal thoughts or an attempt, and/or is in imminent danger to others. Do not hesitate to call the police if you need help getting them to go to the hospital.

---In long-term residential care – when your child has persistent suicidal thoughts, is unable to participate in therapy, has a life-threatening mental disorder (e.g. bipolar), continued risk of violent behavior, and other severe symptoms that interfere with living.

Other treatment a borderline may need:

---Treatment for substance abuse.

---Therapy that focuses on violent and antisocial behaviors, which can include emotional abuse or physical abuse, baiting, bullying, and sexualized behaviors.

---Therapy that focuses on trauma and posttraumatic issues when an adolescent loses their sense of reality.

---Reduce stressors in the young person’s environment. Most adolescents with BPD are very sensitive to difficult circumstances, for examples: an emotionally stressful atmosphere at home; teasing in school; pressures to succeed or change; consistent rules; being around others who are doing better than them, etc.

*Adapted from:

“What Therapy Is Recommended for Borderline Personality Disorder in Adolescents (13-17 years)? Mary E. Muscari, Medscape Today, August 2005, and

“Risk taking adolescents: When and how to intervene”

David Husted, Nathan Shapira, University of Florida College of Medicine, 2004

What parents and caregivers can do

Maintain a united front.

With a partner or spouse, continually communicate and stay on the same page, which prevents the manipulation that turns couples against each other. Have each other’s back even if you’re not in full agreement. Always take disagreements out of earshot of your child because any disagreement they detect will be used against you!

Revise your priorities

1. Put your borderline teenager’s needs after other important things in your day. Their negative influence on your lives can have long term emotional consequences.

2. You and other family members must come first and have a life.

The essentials of job, housing, food, and health care come next.

3. And finally, your borderline teenager. (They will feel slighted, but they always feel slighted, even when you give them 100% of your time.)

Keep things simple.

Resist pressuring your teen to manage all their difficult behavior, instead, focus them on one or two behaviors at a time until they are acceptable if not perfect.

Use praise proactively.

Borderlines crave attention and praise. When they deserve it, pour it on thick. And pour it on thick every single time they demonstrate good behavior and positive intention. One can't go too far. When an argument or fight comes up, search your memory for the most recent praiseworthy thing they did or said, and bring it up and again express your gratitude and admiration. This does two things: it reinforces the positive; and it redirects and squelches a negative situation.

Become skilled in DBT

DBT is proven to be the best treatment for borderline teenagers. It helps them connect with reality when their emotions take over. When everyone practices DBT, it helps create a therapeutic environment in your household.

--Did your friend really intend to upset you? It sounds like they were talking about something else.

--The delay wasn’t planned just to make you mad, perhaps you were just frustrated by being asked to wait and it was no one’s fault.

--The tear in your jacket isn’t a catastrophe. It is easily fixed and I can show you how.

Prevent dangerous risk taking.

Teens with borderline personality are exceptionally impulsive and prone to risky behavior. Consequently, parents should consider the following prevention steps:

--Tightly limiting cell phone use, email, texting, and access to social networking sites

--Using technology to track their communications and location, or disabling access during certain time periods

--Reducing the amount of money and free time available

--Searching their room (this is legal and appropriate whenever there’s risk of harm)

A couple I know fully informed their borderline teen that all Internet activity would be tracked, as well as cell phone calls. The father installed cameras in the home, at the front and back doors, in plain site. Nevertheless, his son continued with bullying and hurtful behavior towards siblings right in front of those cameras, and he would get caught and pay consequences. His persistence in the face of obvious monitoring became a great source of amusement for his parents, which softened his emotional impact on their lives.

Be patient.

You are unlikely to receive the child’s respect, love, or thanks in the short term. It may take years. But be reassured that your child will thank you for your firm guidance and limits once he or she matures to adulthood.

"Having a relative with BPD can be hell. But our message to families is to please stay the course with your (child) because it's crucial to their well being."

--Perry Hoffman, President of the National Education alliance for Borderline Personality Disorder

You never asked for this, but rise to the occasion

Do the best you can as a parent, and accept that this is enough. You cannot control the outcome of your borderline teenager’s life, but you can live with yourself and stay supportive of them through many difficult years. Remember to always keep their good qualities in mind, and love them, even if you can’t love the side that doesn’t function well. And never forget to take good care of yourself.

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