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Is Borderline Personality Disorder (BPD) Treatable in Young Adults?

Est. reading time: 5 mins
Posted Under: Treatment Insights

Clinically Reviewed by: Amanda Fialk, PhD, LCSW, LICSW

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The twenty-something years can be both an exciting but tumultuous phase of life characterized by intense self-discovery, uncertainty, critical decision-making, and identity-exploration. Amidst this whirlwind of young adulthood, borderline personality disorder symptoms tend to emerge and increase in intensity and frequency. This is why it is most commonly diagnosed in late adolescence and early adulthood and often co-occurs with other mental illnesses, such as post-traumatic stress disorder (PTSD), which can make this mental health disorder difficult to treat and manage.

Fortunately, there is cause for optimism as effective treatment modalities do exist, offering a lifeline to those grappling with the diagnosis. At The Dorm, we have seen countless young adults in their 20s with BPD be successful in treatment and go on to live fulfilling, purposeful and independent lives.

In this blog post, we will explore more about what defines this diagnosis, how symptoms present at different ages, and what a sample treatment plan for a young adult might look like as part of intensive outpatient programming.

What is Borderline Personality Disorder (BPD)?

Borderline Personality Disorder (BPD) is a mental illness marked by patterns of unstable and/or explosive emotions, and is associated with impulsive behavior, negative feelings about oneself, and strained personal relationships. As far as mental health disorders are concerned, it’s a fairly common diagnosis: about 1.6% of the general population is diagnosed with BPD, and BPD makes up about 10% of the outpatient psychiatric population as well as 20% of the inpatient psychiatric population.

Some commons signs and symptoms of BPD include:

Feelings of dissociation, often resulting from stress, including derealization, depersonalization, and dissociative amnesia.

Distinguishing Borderline Personality Disorders symptoms in your teens versus your young adult years?

BPD traits tend to be highest in early adolescence, whereas in someone’s late 20’s they will often decline, with the exception of outliers who remain severe throughout adulthood. According to DSM-5 criteria, a patient under 18 can be diagnosed with BPD if symptoms persist for at least 1 year, with research indicating that a BPD diagnosis in teenage years can be made reliably. There are, however, a number of factors that can lead to BPD in your teens or early 20’s including:

  • Environmental Factors: Research shows that maltreatment and traumatic experiences, such as sexual, verbal, or physical abuse, neglect and bullying, can play a role in early onset BPD. 
  • Neurological: Studies have examined the effect of stressful events on biological systems. For example, the impact these events have on biomarkers and morphological changes in brain areas related to BPD and stress.
  • Temperament: Researchers have examined the role of temperament in the onset of BPD, such that traits like impulsivity, nonconformity, and aggression are linked to the disorder.

Treatment for Bipolar Personality Disorder in Young Adulthood

A number of evidence-based treatments have been shown to be effective for BPD, including:

  • Dialectical Behavior Therapy (DBT): This approach to therapy focuses on mindfulness, emotional regulation, and skills for building healthy relationship patterns.
  • Schema Therapy: This approach reshapes an individual’s thinking patterns (schemas) to form healthy patterns.
  • Transference-Focused Therapy: This approach focuses on reducing the transference of emotions to others.
  • Mentalization-Based Therapy: This approach helps clients to understand their own emotions, thoughts, and feelings about others.

Though each type of therapy is shown to have benefits, research indicates that DBT is the most effective treatment for borderline personality disorder, as it is shown to effectively improve symptoms and reduce self-injury, suicide attempts, and inpatient hospitalizations. A 2014 study found that 77% of patients no longer met criteria for BPD diagnosis after completing one year of DBT therapy! 

Do you or a loved one need help with mental health?

The Dorm is here.

What a Sample BPD Treatment Plan for a Young Adult in their 20s Might Look Like

We spoke with Assistant Director of The Dorm, Alexa Connors, to learn about treatment offerings for clients with BPD at The Dorm, where a significant number of young people are navigating this diagnosis.

Clients with BPD will typically start at a more intensive program level, with up to (and sometimes over) 30 hours a week in treatment in order to support clients struggling with managing their emotions, tolerating stressful situations, and navigating interpersonal relationships. A more intensive treatment level of programming will assist the client in learning an abundance of skills, such as DBT, that support their ability to make and maintain healthy relationships.

Programming:

  • There are a number of groups at The Dorm that can assist a client in processing the root cause of behavior and acquiring new skills for coping and interacting with others. Below is a list of some groups we would recommend for a client with BPD:
    • Intensive DBT: This is a skills-based group that focuses on mindfulness, distress-tolerance, interpersonal effectiveness, and emotion regulation with the goal of being able to have better relationships that are healthy as well as ability to regulate emotion so that one can live a life worth living.
    • [Unique to The Dorm] Urge Surfing: This group is centered on skills and processing of emotion to help those who struggle with problematic or harmful coping. The focus of the group is to hold space for openly discussing urges or events that occurred throughout the prior week(s) so that triggers can be analyzed and preventative measures can be put in place with peer-to-peer support.
    • Seeking Safety: BPD is commonly linked to a history of trauma, and the purpose of this group is to foster coping skills that help with dysregulation and distress tolerance. During this group, clients talk through trauma and learn coping skills together that target symptoms of trauma as well as other behaviors which commonly result from BPD, such as substance use.
    • Social Groups & Field Trips: The Dorm hosts a number of social events and activities (such as Dorm Prom, Talent Shows, and Movie Nights), clinician-led social groups, and program-wide field trips, which offer clinicians the opportunity to see their clients put newly-learned skills to the test by building relationships that prove an ability to maintain healthy connections.
  • Coaching:
    • Coaching is a supplement to therapy where a clinician serves as a goal-oriented accountability partner, supporting the client to put their newly-learned skills to practice. For a client with BPD, twice a week is recommended to start. Activities in coaching may look like:
      • 1:1 DBT Coaching: This will help the client to hone in on the skills they are learning in DBT-based groups.
      • Diary cards: Mood dysregulation is a big component of BPD and it can often be hard to decipher the root of one’s mood due to the intensity of feelings that clients with BPD experience. Diary cards are a great way to map out behaviors related to unstable moods that client’s want to increase or decrease. Through tracking, clients understand where they fall within their goals and clinicians have tangible data on what is happening to inform treatment planning with their client.
      • Behavioral Chain Analysis: The purpose of this exercise is to link any maladaptive behaviors, such as lashing out or self-harm, to its root cause. Specifically, understanding what purpose the behavior  serves and what vulnerabilities may lead to acting out the behavior again.
  • Parent Coaching:
    • Parent’s are given their own clinical coach at The Dorm, which creates an opportunity to learn the same skills as their child. This allows parents to be equipped with the proper clinical tools to provide the necessary support for symptom reduction.
  • Individual Therapy:
    • BPD often roots from unhealed wounds. Individual therapy sessions will focus around targeting inner trauma and is an opportunity to privately process behaviors, feelings, and repressed emotions. In working through the patterns that prevent the client from living authentically, they are able to unlock a life of autonomy and independence that is aligned with their goals, culture, and process of self-actualization.

With appropriate, timely intervention and comprehensive, interdisciplinary treatment, individuals with BPD can lead fulfilling lives and experience significant improvements in their symptoms, relationship and quality of life.

If you or a loved one needs support, contact us to speak to our experts. 

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