Borderline Personality Disorder,  Parenting

The Borderline Child

I’d like to talk about “The Borderline Child”. Most professionals would say that the Borderline Child does not exist. I recently spoke with a woman I know who has a daughter who has given her a great deal of trouble. The girl, who is only 14, cuts herself, drinks her own urine, has risky sex, does drugs, has run away from home and exhibited a number of other “borderline” behaviors. When I mentioned the diagnosis to the mother, she spoke with professionals who told her that her child was “too young” to be diagnosed with BPD. OK, so what is the cut-off? This is a quote from an article I found on the net from Psychiatric Times magazine. The article is dated 1996 and is by Joseph M. Rey, M.D.:

Seeking to clarify some of these issues, my colleagues and I followed up a group of adolescents who had been referred for assessment to an adolescent unit in Sydney, Australia (Rey and others). Follow-up consisted of a lengthy interview during which a variety of diagnostic instruments and questionnaires was administered. These included the Personality Disorders Examination (Loranger). At the time of initial assessment, the average age was 14 years, while at follow-up it was 20 years. Of the 205 subjects who were located, 145 were fully interviewed. About half of these (44 percent) were female. During the ensuing six years, four of the subjects had died. One female, initially diagnosed as having attention-deficit disorder with hyperactivity, died of a heroin overdose following a period of severe disturbance during which she probably met criteria for conduct disorder. Two males suffered from conduct disorder. One committed suicide; the other died of multiple organ failure caused by hepatitis one day after being released from prison. One male had an adjustment disorder with disturbance of conduct. Reports from relatives at the time of follow-up suggest he was well-adjusted. He died in a car accident. There were 114 (56 percent) individuals with a disruptive disorder diagnosis among the 205 subjects located. Although numbers are too small to draw conclusions, these findings suggest that mortality (3.5 percent) among adolescents with these conditions is likely to be high.

Putting the mortality rate aside, we find that 56% were diagnosed with a disruptive disorder as children. The point here is that there was something wrong with them as children, although it was not labeled a “personality disorder.” If up to 10% of people with BPD take their own life, then it would seem to me that identifying the candidates for BPD as children would be paramount. If there is a constellation of childhood illnesses – childhood bipolar, ADHD, ODD, CD, etc. – then these children can be monitored to help them develop emotional skills to handle their labile emotional states. Here is a quote from a personal interview with a Borderline:

At about the age of 13. I kept feeling like something was missing in me, like I was “”defective””. My social skills were bad, and there was a growing feeling of a void inside me. I went to the school counselor, but as I could not yet identify what was wrong, was not really helped. At 14 I started to suffer from suicidal thoughts. It has never gone since. It’s always there, like some undercurrent. My parents are emotionally crippled in many ways and they could not help or understand, they would tell me to stop being so sensitive.