Borderline Personality Disorder (BPD) is a very challenging and complex disorder to treat. Dr. Blaise Aguirre, a recognized child and adolescent researcher of BPD, states that about 11% of clients with the disorder end up in outpatient settings, while about 20% are in inpatient settings with a comorbid diagnosis. For example, someone with BPD may also have severe depression or anxiety.
Last week we discussed borderline personality traits in adolescents with explosive tempers, over-reactive responses, and roller coaster emotions. This week we’ll look at treatment options for adolescents who are exhibiting borderline personality traits and how to identify some of the correct treatments available.
Living with or trying to help treat an adolescent with explosive emotions can feel like an impossible task for everyone involved. There are no quick fixes and therapy sessions (both individual and family) can often end in firestorms. There is no easy way around it. One of the most difficult “symptoms” of BPD traits in adolescents that places a strain on relationships is the fear of being left alone, disliked, or separated. The individual might constantly believe or state “no one likes me” or “I am unloved in this family.” At other times, this same individual might make a contrary statement such as “I always feel loved by my family” or “I am so happy to be in love with you.” It’s almost as if the individual engages in a perpetual cycle of clinging to others and distancing themselves from others. It’s sometimes difficult to determine how that person actually feels about you or perceives you.
For adolescents who are pursuing romantic relationships, they often experience a volcano of emotions that leads to more harm, in many cases, than good. For many teens experiencing BPD traits, romantic relationships often take a very lethal turn including suicidal ideation, suicide attempts, and even homicidal thoughts and attempts. The teen who is very fearful of being left alone or rejected, engages in a series of behaviors that makes the relationship more unstable than it should be. The teen almost becomes desperate in their search for meaning, control, and reassurance. They become close to the person and then distant. This distancing and clinging to others may also include the individual idealizing someone, feeling helpless when they are not around, and in the case of teens experiencing their first “crush,” expressing their “undying love” for their object of desire. This same teen might then change in their emotions at the very moment they feel rejected or do not understand why someone needs personal time alone.
While trying to survive in this whirlwind of confusion and relational tension, the individual may resort to suicidal behaviors, riskiness, substance abuse, or impulsivity. It is not only the romantic relationships that are often affected by the adolescent’s BPD traits, but also their relationship with parents, teachers, coaches, siblings, in-laws, cousins, and others alike. For many families, it will be important to pursue the right kind of treatment in order to tackle this emotional monster correctly. There are various treatment options available but the right option is the key to this complex disorder.
Treatment options for borderline personality disorder traits
- Outpatient therapy: Outpatient therapy is the easiest type of therapy to secure. Insurance will often cover this type of treatment and it’s very easy to make payment arrangements to cover costs. Outpatient therapy is often useful for individuals who are capable of keeping themselves safe, are not exhibiting active suicidal (or even homicidal) thoughts, and can contract for safety. Outpatient settings schedule appointments with clients one time per week for 45-60 minutes. For an adolescent who is experiencing extreme behavioral changes, has attempted suicide, has been hospitalized against his or her will multiple times, and is unable to remain safely within their environment, outpatient therapy is not the correct treatment option.
- Inpatient therapy: Inpatient therapy can come in many forms.
- 28, 48, or 90 day programs: short-term inpatient programs have the goal of stabilizing the individual so that they may return to their normal environment (home, work, school) and be diverted from long-term inpatient care. Such programs also strive to equip the individual with coping skills and resources and to highlight support contacts that the individual could reach out to for support. A short-term program will not “cure” the problem and it certainly won’t change the problem. The short-term program is available for families who are interested in learning about the therapeutic process, helping their teen develop more coping skills, and learning more about themselves and their illness. This is important because when you leave this short-term program you will know what works and what doesn’t work and what type of therapist and psychiatrist you feel most comfortable with. You can consider short-term programs a “trial-run” with the benefit of stabilizing the individual’s mood and thinking patterns. The most important thing to keep in mind is that if the adolescent is so severe that the short-term treatment is not working, the agency will likely make a referral to a higher level of care or suggest other services that might be helpful.
- RTF: A residential treatment facility is a facility that is similar to a group home. It is somewhere adolescents with extreme behavioral and mood challenges live on a daily basis with the goal of reunification with family. RFT’s allow adolescents the ability to engage in individual, family, and group therapy as well as develop more appropriate behaviors to take back into their environment when they are released. RTF’s are often suggested by insurance companies or mental health professionals when the adolescent is unable to remain in the home, school, or community safely. A teenager who puts him or herself at risk and others will greatly benefit from an RTF. It is highly unlikely that a teen with BPD traits will go straight into an RTF without first having been to a hospital or outpatient setting.
- Partial Hospital: A partial hospital program offers the benefit of both “special” education and therapy. The child spends a total of 8-9 hours in a program where the majority of time is spent doing therapy or working on behavior modification. The individual might attend the program during school hours 7:30-2:30 or 3pm. Teens in partial programs often attend school for 2-4hrs a day and then enter into their therapy during the later parts of that school day. In some neighborhoods, a school bus might pick up the individual and drop the individual off at home. This information can be confirmed by contacting your school district.
- School-Based: A school-based program is different from a partial hospital program and might be similar to an outpatient program. A school-based program isn’t apart of a school, but is affiliated with the school in some way. Therapists might visit the school on certain days or have a special part of the school dedicated to mental health. Students come into school-based programs by first seeing a school counselor or other therapist who makes a referral for services. If a school is affiliated with a mental health program, the child will then receive both the educational services from the school and the mental health services as well. Students are able to visit their designated school therapists throughout the day or during their scheduled appointment times. In some situations, the school-based therapist visits the school and participates in the classroom with the student in order to assist them or observe behavior.
- Family-Based program: A family based program is a therapy service that allows the therapist to come to the home, school, or some other setting in the community. A family based team works with the entire family unit, not just the identified patient or client. Family-based teams are trained to tackle the mental health challenges, behavioral challenges, and roller coaster moods of the teen in addition to the behaviors of the family unit itself. For example, a teenager might be causing a great deal of stress in the home, but a family based team will also look at how responses from siblings or parents could be adding to the problem or perhaps even helping the issue. Family based teams offer support to the client and the family unit.
There are a host of other programs out there for adolescents who are struggling with BPD traits. The most important thing to remember is that you must remain aware of the symptoms, seek out a correct diagnosis, and educate yourself about BPD. Whether a formal diagnosis of BPD is received or not, it is important to examine if symptoms resemble the behaviors you have observed in someone you love or even yourself. Being able to identify this means that you will be able to advocate for yourself and encourage a doctor to examine the possibilities.
As always,I wish you well.
Aguirre, B. (2012). Borderline Personality Disorder. Psychiatric Times. Retrieved October 2, 2014, from http://www.psychiatrictimes.com/articles/borderline-personality-disorder-adolescents.