How do I document symptoms of borderline personality disorder (BPD) in a 14-year-old female patient?

Documenting Symptoms of Borderline Personality Disorder in a 14-Year-Old Patient

Borderline personality disorder (BPD) should not be formally diagnosed in patients under 18 years old, but concerning symptoms should be documented as "emerging BPD traits" or "BPD features" while focusing on specific observable behaviors and emotional patterns. 1, 2

Age Considerations and Diagnostic Challenges

When documenting symptoms in a 14-year-old girl with possible BPD traits, several important considerations must be kept in mind:

• Most personality disorders, including BPD, are not formally diagnosed until adulthood (typically 18 years or older)
• Adolescence is characterized by identity formation and emotional development that can mimic BPD traits
• Documenting specific behaviors rather than applying a diagnostic label is most appropriate

How to Document Effectively

Focus on Observable Behaviors

Document specific behaviors using objective language:

• "Patient demonstrates rapid mood shifts from calm to intense anger within single session"
• "Patient reports feeling 'empty inside' and engages in self-harm behaviors (specify type)"
• "Patient describes intense fear of abandonment when friends don't respond to texts"

Use Structured Assessment Approaches

While formal diagnosis isn't appropriate, structured documentation helps:

• Document using DSM-5 symptom categories but avoid formal diagnosis
• Consider using age-appropriate screening tools to document symptom severity
• The Revised Diagnostic Interview for Borderlines (DIB-R) measures four key aspects: Affect, Cognition, Impulse Action Patterns, and Interpersonal Relationships 3

Document Functional Impairment

Specify how symptoms impact daily functioning:

• Academic performance and school attendance
• Peer relationships and social functioning
• Family relationships and home environment
• Self-care abilities

Sample Documentation Template

Patient presents with emotional and behavioral patterns suggestive of emerging personality traits that warrant monitoring. These include:

1. Affective symptoms: [document specific mood instability, anger outbursts, etc.]
2. Interpersonal difficulties: [document relationship patterns, abandonment fears]
3. Impulsive behaviors: [document specific behaviors like self-harm, substance use]
4. Identity concerns: [document unstable self-image, chronic emptiness]
5. Cognitive symptoms: [document paranoid ideation, dissociative symptoms if present]

Functional impact: [document specific impairments in school, home, social settings]

These symptoms are being monitored as potential emerging personality traits. Current focus is on addressing specific behaviors and symptoms rather than establishing a personality disorder diagnosis given patient's developmental stage.

Risk Assessment Documentation

Thorough risk assessment documentation is crucial as approximately half of young people with BPD traits report self-harm 4:

• Document specific self-harm behaviors (method, frequency, intent)
• Assess and document suicidal ideation, as BPD is associated with high suicide risk 4
• Document any unsafe behaviors related to appearance concerns or body image issues
• Note any substance use or high-risk sexual behaviors

Differential Diagnosis Documentation

Document consideration of other conditions that may present similarly:

• Major depressive disorder
• Bipolar disorder
• Post-traumatic stress disorder
• Body dysmorphic disorder (if appearance concerns are prominent) 4
• Normal adolescent development

Common Pitfalls to Avoid

1. Avoid premature labeling: Don't document "patient has BPD" for someone under 18
2. Avoid stigmatizing language: Focus on behaviors rather than judgmental terms
3. Don't overlook comorbidities: Document other mental health concerns that may be present
4. Don't dismiss as "just adolescence": Document concerning patterns even while acknowledging developmental context

By focusing on specific symptoms and behaviors rather than applying a diagnostic label, you can document concerning patterns while respecting developmental considerations and avoiding potential stigma associated with personality disorder diagnoses in adolescents.