Borderline children – how they function and how you can help

Are you ready to bang your head on a wall?  Or praying for the day your child turns 18, when you can change the locks on your doors?  Children with borderline personality disorder (BPD) can traumatize everyone around them.

Children with BPD believe others will abandon them, and this makes them do one of two things:

1. 1. Do everything possible to obtain and keep love and admiration;
   2. Or if they detect the slightest hint of disapproval, blame themselves and others; break off relationships; or self-harm to bury horrible feelings of abandonment.

 

A borderline child can be very engaging and affectionate… sometimes at random and sometimes when they want something.  Because they can be vindictive, they may also turn on charm as a way to embarrass you in front of others (such as in a meeting with a teacher or family counselor).  Since they often seem wonderful to other people, parents have been judged.  People often suggest they take care of their own issues instead.

Even if their manipulation or drama can be relentless, strive for compassion.  Trust me, your borderline child will suffer more than you in every important aspect of life.  They can make a mess of their relationships because of hurtful or clingy behavior.  Or they create a toxic work environment.  Or they drive away good friends, hate them for leaving, and suffer from loneliness.

A borderline child or teen is not a “drama junkie” on purpose.  There brain is primed to overreact.

A study published in 2008 in Science showed that brain activity in people with borderline personality disorder was abnormal—their brains lack activity in the ‘cooperation’ and ‘trust’ regions, called the bilateral anterior insula.  People with borderline personality disorder do not have an internal, natural sense of fairness or social norms, and distrust is their default mentality.  Some suggest that borderlines do not receive the attention they need as an infant and toddler.  Early neglect is also a predictor of reactive attachment disorder, which has similar trust issues.

Another study reported, “The disorder occurs in all races, is prevalent in females (female-to-male ratios as high as 4:1), and typically presents by late adolescence.”  It is estimated 1.4 percent of adults in the United States have this disorder.  A different study reported that BPD occurs as often in men and women, and sufferers often have other mental illnesses or substance abuse problems.  (In my observations, teenagers with borderline personality disorder have many bipolar disorder symptoms.)

From infancy, those who were later diagnosed with borderline personality were more sensitive, had excessive separation anxiety, and were moodier. They had social delays in preschool and many more interpersonal issues in grade school, such as fewer friends and more conflicts with peers and authorities.

As teenagers, borderline children can be promiscuous; impulsive and assaultive; more likely to use drugs and alcohol; and more likely to cut themselves and attempt suicide.  “…research shows that, by their 20’s, people with the disorder are almost five times more likely to be hospitalized for suicidal behavior compared to people with major depression.”

Evidence for hope

“Borderlines have the thinnest skin, the shortest fuses and take the hardest knocks.  In psychiatrists’ offices, they have long been viewed as among the most challenging patients to treat.”

Advances have been made in recent years.  One study tracked borderline patients who had been hospitalized at least once over a 10 year period.  With follow up treatment  “93% of patients achieved a remission of symptoms lasting at least two years, and 86% for at least four years.” Published in The American Journal of Psychiatry, the research argues that once recovery has been attained, it appears to last.  (from “Trying to Weather the Storm”, by S. Roan, September 07, 2009, Los Angeles Times)

“…our message to families is to please stay the course with your (child) because it’s crucial to their well-being.”
(Perry D. Hoffman, president of the National Education Alliance for BPD http://www.borderlinepersonalitydisorder.com.)

Treatment

Psychotherapy is the primary treatment of BPD, and the gold standard is dialectical behavior therapy (DBT), which helps the person attain and maintain lasting improvement in their personality, interpersonal problems, and overall functioning.  It simply teaches coping skills so patients learn to control their emotions, calm down, and not destroy relationships. Medications support the therapy by reducing depression or anxiety and self-destructive behavior.

(from “What Therapy Is Recommended for Borderline Personality Disorder in Adolescents (13-17 years)?” by M. Muscari, 2005, http://www.medscape.com/viewarticle/508832)

When to hospitalize:

An emergency hospital stay is recommended if your child has serious suicidal thoughts or an attempt, and/or poses an imminent danger to others, or is incapable of calming down and functioning.

Consider psychiatric residential care if your child has persistent suicidal thoughts; is unable to participate in therapy; or has a co-morbid (co-existing) mental disorder such as bipolar, depression, narcissistic personality disorder.  A child with BPD, at their most extreme, is at very risk risk or suicide or other violent behavior, and other behavioral symptoms that indefinitely interfere with living.

Other mental health supports your borderline child may need:

• Treatment for substance abuse.
• Therapy that focuses on violent and antisocial behaviors, which can include emotional abuse or physical abuse, baiting, bullying, and sexualized behaviors.  (The most effective therapy is DBT or Dialectical Behavioral Therapy.)
• Therapy that also focus on trauma and post traumatic issues if present.
• Reducing stressors in the child’s environment.  Most children with BPD are very sensitive to difficult circumstances, for example:  an emotionally stressful atmosphere; internal and external pressures to succeed or change; inconsistent rules; being around others who are doing better than them.

What parents and caregivers can do

• With a co-parent or support person:  Maintain a united front.
• Communicate privately with each other to effectively set limits.  A BPD child will do everything in their power to split authority figures against each other!
• Have each other’s back even if you’re not in full agreement.
• Never ever give away power by making democratic decisions or explaining your reasoning. Anything you say or do will be challenged or used against you in the future.

Maintain family balance.

Keep things relaxed.  If you need to set boundaries and apply pressure, do it only to maintain  appropriate behaviors and reminders for self-calming.  Let other things go.

Use praise proactively.  Borderlines crave attention and praise.  When they deserve it, pour it on thick.  And pour it on thick every single time they demonstrate good behavior and positive intention.  One can’t go too far.  When an argument or fight comes up, search your memory banks for the most recent praiseworthy thing they did or said, and bring it up and again express your gratitude and admiration.  This does two things:  it reinforces the positive  and it provides a distraction, either of which may end a fraught situation.

Become skilled in Dialectical Behavioral Therapy (DBT).  It is the gold standard for treating Borderline Personality Disorder.  It is the only therapy proven to promote genuine behavioral change and improve mental health.  You can draw upon questions used in DBT to settle your child and bring his or her back to reality, examples:

• Did your friend really intend to upset you?  It sounds like they were talking about something else.
• The delay wasn’t planned just to make you mad, perhaps you were just frustrated by being asked to wait, and it was no one’s fault.
• The tear in your jacket isn’t a catastrophe.  It is easily fixed and I can show you how.

For specific examples of what your borderline child might say and for how you can respond, see:  How to respond to a manipulative and difficult teenager.

Prevent dangerous risk taking – Young people with borderline personality are  impulsive and prone to risky behavior.  Parents should consider reducing the risks posed by: emotionally-loaded  social contact, excess time or money, freedom to come and go, and places to hide inappropriate materials or actions :

• Restricting and monitoring  cell phone use, email, texting, and access to social networking sites.  This is legal if it’s in your home and you pay the bills, and there is no expectation of privacy.
• Using technology to track their communications, or disabling access during certain time periods
• Reducing the amount of money and free time available
• Searching their room if in your home (this is also legal).
• Building a support network, asking for help from trusted others (like Katy’s proud parents, above–a true story).

A couple I know fully informed their borderline son that all internet activity would be tracked, as well as cell phone calls.  The father also installed cameras in the home, at the front and back doors, in plain sight.  Nevertheless, their son continued with bullying and verbally abusing his siblings right in front of those cameras, and he would get caught and deny it each time.  His denials in the face of clear evidence became a great source of private amusement for his parents.

Be patient – You are unlikely to receive your child’s respect, love, or thanks in the short-term.  It may take years.  But be reassured that your child will thank you for your firm guidance and limits once he or she matures to adulthood.

Address your own PTSD!  Families who live with a borderline child often need help coping with bullying, wrenched emotions, and the instability that person brings into the household.  A parent or family member may need their own therapy, antidepressants, and self-care skills for reducing anxiety.

Simple self-care for you and other family members

• Three or more (very) deep breaths when stressed, the brain needs oxygen to begin a calming process.  Singing is a superb option.
• Magnesium or Kava kava, these substances naturally help calm nerves
• Sleep in a dark, cold room is the best way to promote deep sleep. Avoid screen time an hour before bedtime.
• An activity that feeds your soul, such as a hobby, a loving pet, a gripping novel, just playing
• Direct support from a trusted friend–face-to-face is ideal, but calls, texts, and emails as needed are really helpful too.

Characteristics of untreated borderline personality disorder in adulthood

Good things:  They can be very financially and publicly successful in many fields and hold positions of authority, and often succeed in the creative arts and especially acting.  They are so perceptive that they can ‘channel’ any person they want.  They can be enchanting, and alluring, easily attracting devoted fans, friends, and lovers.

Most challenging things:  Signs and symptoms of BPD may include significant fear of real or imagined abandonment; intense and unstable relationships that vacillate between extreme idealization and devaluation; markedly and persistently unstable self-image; significant and potentially self-damaging impulsivity (spending, sex, binge eating, gambling, substance abuse, and reckless driving); repeated suicidal behavior, gestures, or threats; self-mutilation (carving, burning, cutting, branding, picking and pulling at skin and hair, biting, and excessive tattooing and body piercing); persistent feelings of emptiness; inappropriate anger or trouble controlling anger; and temporary, stress-related disconnection from reality and paranoia.

Help your borderline child with each of these aspects!

• Chronic fear of abandonment which results in a constant search for companionship, no matter how unsatisfying.
• Clinging and distancing: Disruptive relationships due to the person’s alternating clinging and distancing behaviors.  When clinging, they may exhibit dependent, helpless, childlike behaviors. They can over idealize the person they want to spend their time with, constantly seeking that person out for reassurance. When they cannot be with their chosen person, they exhibit acting-out behaviors, such as temper tantrums and self-mutilation. They distance themselves by being hostile and insulting, usually arising from discomfort with closeness.
• Splitting: Splitting arises from the person’s inability feel people are safe, and is the primary defense mechanism in BPD. They view all people, including themselves, as either all good or all bad.
• Manipulation: Separation fears are so intense that people become masters of manipulation. They will do just about anything to achieve relief from their separation anxiety, but their most common ploy is to play one individual against another.
• Self-destructive behaviors: Threats are most often manipulative, but some acts can prove fatal.  Cutting is very common.  Suicide attempts are common yet often happen in relatively safe scenarios, such as swallowing pills at home while reporting the deed to another person.  Another behavior is to set up a scenario where they are victim so as to get attention and love.
• Impulsivity: Extremely rapid shifts in mood can lead to substance abuse, binge eating, reckless driving, sexual promiscuity, and excessive spending or gambling.  These are similar symptoms of bipolar mania, but BPD behaviors happen for different reasons, usually in response to real or imagined abandonment.

You really can turn your borderline child’s future around.

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