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How to Treat Borderline Personality Disorder in Children

written by: Roohi Khan • edited by: Emma Lloyd • updated: 5/19/2011

Children with borderline personality disorder exhibit explosive and impulsive behavior, intense rage and hostility, oversensitivity and over-reaction, self-injurious behaviors, instability in relationships, and impaired thinking and reasoning. Treatment for children is similar to adults.

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    With experts having acknowledged the fact that borderline personality disorder (BPD) does indeed exist in children, there has been a significant improvement in the treatment strategies of this disorder in recent years.

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    Psychotherapy

    Like all personality disorders in children, psychotherapy is the main treatment approach used for BPD. For the success of psychotherapy, it is essential that the child develops a feeling of trust and closeness with the therapist, which is often difficult to establish with such patients. This, in turn, is believed to improve the ability of the child to develop relationships with other people. The technique of validation helps the child accept himself or herself as unique and deserving.

    There are two types of psychodynamic therapy which have been proven to be effective in children with BPD. Transference-focused therapy is based on the concept that the child's perception of self and others is split into extremes of good and bad, which gives rise to the self destructive symptoms of BPD. It is believed that these unhealthy dyadic perceptions are also revealed in their interactions with the therapist who can help the child integrate these different representations of self and develop better methods of self-control.

    The second form of therapy is called mentalization-based therapy and it stresses on recognizing feelings and attitudes as a way of explaining behaviors.

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    Dialectical Behavior Therapy

    Dialectical behavior therapy or DBT aims at teaching skills to manage intense emotions, reduce self-destructive behaviors, handle relationships, manage stress, teach balance, and develop 'mindfulness' (being aware and attentive to the current situation while balancing both the emotional and cognitive states).

    There are four stages involved in this treatment of borderline personality disorder:

    • Moving from being out of control to being in control which includes reducing self-destructive behaviors and reducing behaviors that interfere in treatmen.
    • Moving from being emotionally detached to experiencing feelings completely.
    • Solving ordinary problems and having a normal life.
    • Moving from feeling incomplete to feeling connected for overcoming the feelings of emptiness inside.
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    CBT

    Children with BPD often have beliefs and thinking patterns which adversely affect the child's perception of self and the way he or she interacts with the world. Cognitive Behavioral Therapy or CBT works at identifying and challenging them in an emotionally neutral and structured setting.

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    Family Therapy

    Family therapy involves helping the family of these children understand the disorder and how they can contribute to the treatment of this personality disorder. It aims at improving communication with the child, decreasing alienation and relieving family burdens.

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    Group Therapy

    Professionally-led or self-help groups can prove to be effective treatments for adolescents with borderline personality disorder. DBT or CBT interventions usually involve a group leader that provides a direction to the group and gives homework assignments between sessions.

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    Medications and Hospitalization

    There are no medications that can cure BPD. However, antidepressants, antipsychotic drugs, and antianxiety medications may be used to alleviate symptoms, especially severe suicidal ideation and intent. Hospitalization for a short duration may be required for the management of crisis situations where the child or adolescent may have severe depression or have suicidal tendencies.

    The presence of this personality disorder and the importance of providing the right treatment in children has only recently been acknowledged by the mental health community. Psychotherapy, CBT, and DBT can make a major difference in the ability of the child in handling life in general and relationships in particular. Parents should take immediate steps by getting their child into treatment so that it paves the way for them to live a normal life as adults. 

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    References

    The Borderline Personality Disorder Resource Center: A BPD brief

    http://www.borderlinepersonalitydisorder.com/documents/A_BPD_Brief_Jun06.pdf

    BPD Demystified: Borderline disorder in children

    http://www.bpddemystified.com/index.asp?id=20

    Mentalhelp.net: Borderline Personality Disorder Treatment

    http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=476&cn=8

    Keeping Kids Healthy: Recognizing Borderline Personality Disorder in Children

    http://www.keepingkidshealthy.org/topics/borderline/