Tuesday, April 22, 2014

Teen Moodiness, or Borderline Personality Disorder?

Consults New York Times Blog  ~ When The Times’s Personal Health columnist Jane Brody wrote about borderline personality disorder in “An Emotional Hair Trigger, Often Misread,” hundreds of readers had questions about the diagnosis and treatment of the troubling condition, characterized by impulsive behaviors, shifting moods and often frequent thoughts of suicide.

Dr. Alec Miller
via Consult Blogs New York Times
Here, Dr. Alec Miller, professor of clinical psychiatry and behavioral sciences and chief of child and adolescent psychology at Montefiore Medical Center at the Albert Einstein College of Medicine in the Bronx, responds to readers’ questions about borderline personality disorder in teenagers. Dr. Miller has spent the past 15 years working with adolescents and adults with borderline personality disorder and borderline features in inpatient, outpatient and school settings. He is also director of Montefiore’s Adolescent Depression and Suicide Program and co-founder of Cognitive and Behavioral Consultants of Westchester in White Plains, N.Y.

Teenage Mood Swings or Borderline Personality Disorder?

Q. How can one distinguish between BPD and the usual teenage emotional swings? - Toyon

A. Dr. Miller responds:
In order for someone to be diagnosed with borderline personality disorder, or BPD, they need to meet 5 of 9 criteria in the DSM-IV, the manual of mental disorders that health professionals use for diagnosis. These criteria are varied but typically include extremely poor regulation of mood and behavior that lasts more than a year and that is unrelated to another psychiatric disorder.

Many teenagers have a day or even a few days when they get upset and slam a door or curse at their parents. But teens with borderline personality disorder engage in more extreme behaviors — and more often — than the average teen, and these behaviors impair their social, school and working lives.

For example, a teenager with borderline personality disorder may get angry, slam a door and then proceed to cut himself or overdose on pills and require medical attention. Another teen with BPD may feel sad and lonely and proceed to abuse alcohol and engage in promiscuous sex, which may result in pregnancy. The point here is that these teens’ extreme behavior typically follows their inability to tolerate negative emotions like anger.

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