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Recognizing Borderline Personality Disorder in Children

Could your child’s explosiveness and impulsive behavior be a sign of “borderline personality disorder?”  Are you often confronted with intense rages, hostility, oversensitivity and overreaction, or self-injurious behavior like cutting, burning, or substance abuse?  Are your daughter’s relationships unstable – do friends turn from “soul mates” to worst enemies in the space of hours?  Does your son often misperceive things, inaccurately interpreting conversations around him in the worst possible light? 

If any of this sounds familiar, you need to watch this show. Because these are some of the signs of a little-understood and under-diagnosed condition called “borderline personality disorder” – a condition that used to be acknowledged only in adults, but that the mental health community is now beginning to recognize, and treat, in children too.  And the treatment can make a major difference – not only in your child’s ability to handle the world around her, but in your ability to get along with your child!  Join our host Dr. Winnie King as she learns from two experienced families and a skilled psychologist how to recognize this condition, and find out where to go to get the help you need for yourself and your child.

Guests:

Dr. Lori Greene, PhD - Psychologist with expertise in Borderline Personality Disorder (BPD); Assistant Professor, Dept. of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, NY; Attending Psychologist, Montefiore Medical Center, NY
Amanda - diagnosed with Borderline Personality Disorder 
Sharon - Amanda’s Mother
Olivia - diagnosed with BPD 
Allyson - Olivia’s mother
Dixie and Tom Penney - leaders of  parents’ group teaching Dialectical Behavior Therapy) 

Tips:

Definition of Borderline Personaltiy Disorder - according to The Diagnostic and Statistical Manual of MEntal Disorders, Fourth Edition - published by the American Psychiatric Association:

  1. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
  2. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).
  3. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting."

    The following is a definition of splitting from the book I Hate You, Don't Leave Me by Jerry Kreisman, M.D. From page 10: 

    The world of a BP [person with borderline personality disorder] , like that of a child, is split into heroes and villains. A child emotionally, the BP cannot tolerate human inconsistencies and ambiguities; he cannot reconcile good and bad qualities into a constant coherent understanding of another person. At any particular moment, one is either Good or EVIL. There is no in-between; no gray area; people are idolized one day; totally devalued and dismissed the next.

    Normal people are ambivalent and can experience two contradictory states at one time; BPs shift back and forth, entirely unaware of one feeling state while in the other.

    When the idealized person finally disappoints (as we all do, sooner or later) the borderline must drastically restructure his one-dimensional conceptualization. Either the idol is banished to the dungeon, or the borderline banishes himself in order to preserve the all-good image of the other person.

    Splitting is intended to shield the BP from a barrage of contradictory feelings and images and from the anxiety of trying to reconcile those images. But splitting often achieves the opposite effect. The frays in the BP's personality become rips, and the sense of his own identity and the identity of others shifts even more dramatically and frequently.

  4. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  5. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
  6. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
  7. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphasia, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
  8. Chronic feelings of emptiness.
  9. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  10. Transient, stress-related paranoid ideation or severe dissociative symptoms.

BPD often coexists with other illnesses.
These are the most common illnesses that BPD may coexist with:

  • Post traumatic stress disorder
  • Mood disorders
  • Panic/anxiety disorders
  • Substance abuse (54% of BPs also have a problem with substance abuse)
  • Gender identity disorder
  • Attention deficit disorder
  • Eating disorders
  • Multiple personality disorder

Other Qualities:
Characteristics to Help You Identify Borderline Personality Disorder in Your Child:

Impulsiveness:
  Aggressive behavior, hostility
  Self-injuring
  Suicidal tendencies
  Substance abuse
  Easting disorders

Sensitivity/Oversensitivity
  Noticing personal reactions
  Misperceiving shading into paranoia
  Mood changes

Relationship problems
  Fleeting relationships
  Black and white/ hot and cold
  Unrelenting Crises

Trouble thinking clearly
  Road Rage
  Can’t problem solve

Treatment

Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies. Pharmacological treatments may be prescribed based on specific target symptoms shown by the individual patient. Depending on the patient, antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Anti-psychotic drugs may sometimes be used when there are distortions in thinking.

Detailed information on Dialectical Behavior Therapy (“DBT”) for Patients with Borderline Personality Disorder

Experts say that the most important goal in DBT is helping people create “lives worth living.” While this could mean many things to different people, the one commonality is that DBT’s task is bringing people’s behaviors, particularly behaviors that could result in death, under control.  This is done with skills training, homework assignments, behavior analysis, telephone calls through the week, etc. 

There are four stages:

  1. Move from being out of control of your behavior to being in control (reduce and eliminate life threatening behaviors such as suicide attempts, and self-harm).  Reduce and eliminate behaviors that interfere with treatment: not completing homework, not attending therapy sessions.
  2. Move from being emotionally shut down to experiencing emotions fully  (experience feelings without shutting down, dissociating or avoiding life).
  3. Build an ordinary life, solving ordinary problems (work partner conflicts, job dissatisfaction, career goals).
  4. Move from incompleteness to completeness/connection; attempt to overcome feelings of a spiritual dryness or emptiness inside.)

The Goals of Dialectical Behavioral Therapy Are To:

  • Manage stress
  • Regulate emotions
  • Navigate relationships
  • Develop “Mindfulness”
  • Teach balance

Dialectical Behavior Therapy Tips For Parents of BPD Children:

One tip, partially demonstrated in the show report about Dixie and Tom Penney’s DBT class, is to use a technique called the “DEAR MAN” approach to communicate with your child.  The acronym stands for the following:

D–Describe the situation
E–Express how you feel
A–Ask for what your want
R–Reward or reinforcement for giving you what you want

M–Be Mindful of your objective
A–Act Confident
N–Be ready to Negotiate

Resources:

The National Education Alliance for Borderline Personality Disorder
http://www.borderlinepersonalitydisorder.com/
OR CALL: 914 835-9011.

The Borderline Personality Disorder Resource Center
http://www.bpdresourcecenter.org/

Parent 2 Parent - an online support group for parents
http://www.parent2parentbpd.org/