Can a child be diagnosed with borderline personality disorder (BPD)?

From the Guidelines

Children under 18 should not be diagnosed with borderline personality disorder (BPD) due to the ongoing development of their personality and the potential for stigmatization. While some adolescents may exhibit early signs of BPD, such as emotional dysregulation, intense mood swings, and unstable relationships, mental health professionals tend to diagnose other conditions like disruptive mood dysregulation disorder, attention deficit hyperactivity disorder, or post-traumatic stress disorder instead 1. The presentation of mood dysregulation in children and adolescents is often associated with features of borderline personality disorder, raising questions about diagnostic specificity and the overlap between mood and personality disorders 1. If a parent notices concerning emotional or behavioral patterns in their child, they should seek evaluation from a child psychiatrist or psychologist who specializes in childhood mental health. Some key points to consider include:

• The importance of early intervention through therapies like dialectical behavior therapy (DBT) adapted for younger patients, which can be helpful for children showing emotional regulation difficulties, regardless of the specific diagnosis 1.
• The focus of these interventions on developing coping skills, emotional regulation, and interpersonal effectiveness.
• The need for caution when applying personality disorder labels to children, as many childhood behavioral issues may resolve with development, and premature labeling could be stigmatizing 1. Given the complexities and nuances of diagnosing personality disorders in children, a comprehensive evaluation by a qualified mental health professional is essential to determine the best course of action for each individual child.

From the Research

Borderline Personality Disorder in Children

• The concept of borderline personality disorder (BPD) in children and adolescents is controversial, with some studies suggesting that it can be diagnosed in this age group 2.
• Research has shown that BPD in children and adolescents presents similar symptomatology to oppositional defiant disorder (ODD), including difficulties in regulating emotions and irritability 3.
• A study comparing BPD in children and adults found that while there are significant differences between the two age groups, there is enough overlap to warrant further investigation into the construct of juvenile BPD 4.

Diagnosis and Treatment

• Differential diagnosis is important in distinguishing BPD from other disorders, such as bipolar spectrum disorders, major depression, and posttraumatic stress disorder 5.
• Dialectical behavioral therapy (DBT) has been shown to be effective in treating problems related to emotion dysregulation, such as BPD, in adolescents with oppositional defiant disorder and psychiatric comorbidity 3.
• Treatment selection for BPD should be based on individual patient characteristics, with some patients responding better to DBT and others to general psychiatric management (GPM) 6.

Research Findings

• Studies have found that BPD in children and adolescents is associated with a range of symptoms, including affective instability, impulsivity, and difficulties in regulating emotions 2, 4.
• Research has also highlighted the importance of considering the etiology of BPD, including psychodynamic, developmental, and biological theories, as well as family factors such as early loss or separation from parents and physical and sexual abuse 2.