Borderline personality disorder (BPD) is a type of personality disorder characterized by instability. BPD typically emerges during adolescence or early adulthood.

While BPD diagnosis usually occurs during late adolescence or early adulthood, doctors have identified BPD in people as young as age 11.

BPD is a serious condition. Early diagnosis and intervention are essential for a positive outcome. Multiple treatment options can help someone manage their symptoms.

This article defines BPD in teens and discusses symptoms, risk factors, treatment options, diagnosis and outlook, and prevention.

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BPD typically emerges during adolescence or early adulthood. Studies have found that doctors can reliably identify BPD in someone as young as 11 years old.

Research estimates that 1.6% of the general population has BPD. Older evidence suggests BPD is more common in females than males, but later studies suggest this may not be true.

What is BPD?

BPD is a serious mental health condition that affects how well someone can regulate their emotions. It features a pattern of marked impulsivity and instability in self-image, effect, and interpersonal relationships.

Oftentimes, BPD co-occurs alongside other mental health conditions, such as:

  • depression
  • bipolar disorder
  • post-traumatic stress disorder (PTSD)

Learn more about BPD here.

Symptom type and severity vary on an individual basis.

According to the National Institute of Mental Health, BPD symptoms can include:

  • impulsive or reckless actions
  • quickly changing interests
  • extreme changes in mood
  • extreme changes in feelings for others

Other symptoms may include:

  • attempts to avoid real or perceived abandonment
  • a pattern of intense and unstable relationships with loved ones, friends, and family
  • a distorted self-image or sense of self
  • impulsive, dangerous behaviors
  • self-harming behavior
  • recurring suicidal threats or behaviors
  • intense and highly variable moods, with episodes lasting a few hours or a few days
  • chronic feelings of emptiness
  • feelings of disassociation
  • inappropriate and fierce anger, or issues controlling anger

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

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If someone is experiencing any BPD symptoms, it is essential to seek medical support as soon as possible. Early diagnosis allows for early intervention, which may lead to a more favorable outcome.

Since BPD symptoms include self-harming and suicidal thoughts and behaviors, someone experiencing these thoughts and behaviors may need urgent help.

One potential risk factor for BPD is a person’s environment. According to a 2021 research review, environmental risk factors include:

  • childhood trauma, such as physical or emotional abuse
  • emotional and physical parental neglect
  • chronic exposure to bullying

Temperamental and personality factors are also associated with BPD. The 2021 review notes that some traits may predispose someone to BPD, including:

  • inappropriate anger
  • poor emotional control
  • impulsivity
  • aggression

Changes in brain structures or functions that regulate emotion and impulses may also be a risk factor, but it is unclear whether BPD causes these changes first.

There may also be a genetic component to BPD.

Learn more about the causes of BPD in females here.

Psychotherapy is a common BPD treatment. Also known as “talk therapy,” psychotherapy aims to help someone understand and change how they think, act, and feel.

Two kinds of psychotherapy that can treat BPD are:

  • Dialectic behavioral therapy (DBT): DBT uses a behavioral, problem-solving focus with acceptance-based strategies and an emphasis on opposing ideas to help someone manage their emotions and relationships.
  • Cognitive behavioral therapy (CBT): CBT aims to help someone understand and be able to change the thoughts and feelings that influence their behaviors.

Medications are another treatment option but are not usually preferred for BPD. In some cases, a doctor may prescribe medications for co-occurring conditions.

Learn more about therapies for BPD here.

A doctor can use interviews, self-report questionnaires, and discussions to diagnose BPD. Diagnosis also involves an examination of co-occurring conditions.

Doctors use the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) to diagnose BPD and other mental health conditions. To make a diagnosis, at least five DSM-5-TR diagnostic criteria must be met.

The criteria include:

  • abandonment avoidance
  • unstable interpersonal relationships
  • identity disturbance
  • impulsivity
  • suicidal and self-harm behaviors
  • affective instability
  • chronic feelings of emptiness
  • stress-related paranoid ideation
  • inappropriate, intense anger

The symptom must have a significant impact on a person’s life and be present for at least 1 year.

During diagnosis, a doctor also evaluates an adolescent’s suicidal and nonsuicidal self-injury behavior.

Treatment from a licensed mental health professional can help a person with BPD improve their functioning and quality of life. Treatment can also decrease symptom frequency and severity.

BPD outcomes can vary. Someone with BPD may experience higher levels of instability during early adulthood. For example, they may require intensive health resources and experience unemployment or difficulties with work.

Suicide is a major concern. Research suggests that up to 10% of people with BPD die by suicide. This is why early intervention and finding the right treatment are so important.

Generally, effects on a person’s functioning and suicide or self-harm risk decrease with age. Someone in their 30s or 40s may experience greater stability.

Early identification and treatment can help improve BPD outcomes.

Studies suggest that internalizing, or bottling up, symptoms of mental health conditions, such as depression and anxiety, might signal a predisposition to BPD in certain situations.

As a result, talking about any mental health concerns and getting the support a person needs may help prevent BPD onset.

BPD is a personality disorder characterized by impulsivity and instability. Symptoms include self-harming or suicidal behaviors, extreme mood changes, impulsive behavior, unstable relationships, inappropriate anger, and abandonment avoidance.

BPD diagnosis typically occurs before or during early adulthood, but BPD can be diagnosed in people as young as age 11. A doctor typically uses interviews, questionnaires, and discussions to examine someone’s behaviors and make a BPD diagnosis.

Risk factors for BPD include a person’s environment, such as childhood trauma and maladaptive parenting. Genetics and changes in brain structure may also play a role.

Psychotherapy is a standard treatment for BPD. Sometimes, doctors prescribe medications in certain cases.

BPD commonly causes instability in early adulthood and may become more stable as a person ages. Suicide is a major concern for BPD.

Getting early and appropriate treatment from a licensed mental health professional can help a person manage their symptoms and improve their quality of life.