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Borderline Personality Disorder: Not Just an Adult Condition

Many start engaging in high-risk behaviors, such as substance abuse or self-harm, to help deal with the emptiness. The picture of BPD begins to emerge.

Borderline Personality Disorder: Not Just an Adult Condition

Batya Swift Yasgur, MA, LSW
November 20, 2017

To shed light on this ongoing controversy and its therapeutic implications, Psychiatry Advisor interviewed Carla Sharp, PhD, professor and director of clinical training in the Department of Psychology at the University of Houston, Texas. Dr Sharp is the co-editor of the Handbook of Borderline Personality Disorder in Children and Adolescents2 and the co-founder of the Global Alliance for Early Prevention and Intervention for Borderline Personality Disorder (GAP) Initiative.

Psychiatry Advisor: What is the controversy surrounding the diagnosis of BPD in adolescents?

Dr Sharp: Ever since the first descriptions of BPD and specification of its diagnostic criteria in the DSM [Diagnostic and Statistical Manual of Mental Disorders], there was no restriction placed on diagnosing it in adolescents. Nevertheless, in our training programs, we were taught that one does not make a personality disorder diagnosis before age 18 years, even though the DSM allows for it.

One of the major arguments raised against diagnosis prior to age 18 is that, since the personality is still forming and identity is still being consolidated, a personality disorder cannot be accurately diagnosed.

A strong research base2 has been mounting, especially in the past 10 years, supporting the concept of a diagnosis of BPD in teens. It has been found that personality traits are as stable in children and adolescents as they are in adults. In other words, we have overestimated the stability of personality traits in adults. We used to see them as fixed and stable and postulated that they would be less stable in children and adolescents. But in reality, this is not the case. Traits wax and wane in both age groups.

Psychiatry Advisor: Adolescence is often a time of angst, stormy emotions, moodiness, and confusion. How do BPD traits differ from those of normal adolescence?

Dr Sharp: The first clue that a teenager may not be experiencing “normal” adolescent angst is that these traits likely began before adolescence and even in childhood. Children come into the world with a given temperament, and in the case of these children, they are unusually sensitive. I compare this type of child to a burn victim. When you touch the skin of a burn victim, he or she experiences pain that is far greater than the pain that might be experienced by an ordinary person from the same type of touch.

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