Table Of Content“This is a great book to learn about the early signs of
borderline personality disorder in adolescent children
in ways that increase awareness and might facilitate
earlier interventions.”
—F rederic Bien, Ph.D., president, Personality Disorder Awareness
Network (PDAN), www.pdan.org
“. . . empowers families with a wealth of information
to better understand and help their loved ones.”
—L ynn Courey and Mike Menu, co-founders of the Sashbear
Foundation, “making waves for BPD,” http://sashbear.org
Praise for The firsT ediTion of
Borderline Personality disorder in adolescents
“. . . a long overdue book that eloquently and expertly
addresses the wide-ranging issues surrounding borderline
personality disorder in adolescents. This compassionate
book is a must for parents with children suffering from
borderline personality disorder, as well as clinicians,
educators, pediatricians, and clergy trying to understand
and help adolescents with this serious, chronic disorder.”
—P erry D. Hoffman, Ph.D., president of the board of directors,
National Education Alliance for Borderline Personality Disorder
“a must-have book for every parent with a borderline child.”
—R andi Kreger, coauthor, Stop Walking on Eggshells: Taking Your Life Back
When Someone You Care about Has Borderline Personality Disorder
“Families and their children with BPD will fnd this book a
very useful guide as they struggle together toward a more
fully realized life.”
—M ary C. Zanarini, Ed.D., director, Laboratory for the Study of
Adult Development, McLean Hospital, and associate professor
of psychology, Harvard Medical School
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S e c o n d e d i t i o n
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Borderline
Personality
Disorder
in Adolescents
S e c o n d e d i t i o n
What To Do When
A Complete
Guide for
Your Teen Has BPD fAmilies
BLAiSE AguiRRE, MD
Assistant Professor of Psychiatry, Harvard Medical School,
and Medical Director, 3East, McLean Hospital
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© 2014 Fair Winds Press
Text © 2007, 2014 Blaise Aguirre, MD
This edition published in the USA in 2014 by
Fair Winds Press, a member of
Quarto Publishing Group USA Inc.
100 Cummings Center
Suite 406-L
Beverly, Massachusetts 01915-6101
www.fairwindspress.com
All rights reserved. No part of this book may be reproduced or utilized, in any form or
by any means, electronic or mechanical, without prior permission in writing from the
publisher.
First Edition published in 2007
18 17 16 15 14 1 2 3 4 5
ISBN: 978-1-59233-649-4
Digital edition: 978-1-62788-193-7
Softcover edition: 978-1-59233-649-4
Library of Congress Cataloging-in-Publication Data available
Cover design by Megan Jones Design
Book layout by Sporto
Printed and bound in U.S.A.
The information in this book is for educational purposes only. It is not intended to replace
the advice of a physician or medical practitioner. Please see your health care provider before
beginning any new health program.
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To all the young people with BPD who fight courageously
through the chaos of BPD to ensure that they have more
settled lives and more harmonious relationships. You
have taught me so much and know who you are.
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C o n t e n t s
Introduction 8
s e c t i o n 1 Understanding Borderl ine
Personal i ty d isorder 13
C hapter one W hat Is Borderline Personality Disorder? 14
C hapter two Diagnosing BPD in Adolescents 34
C hapter three B ehavioral Differences between BPD and
Typical Teens 59
C hapter Four H ow BPD Develops: Genes, Biology,
and Environment 81
C hapter Five B PD Myths and Misunderstandings 102
C hapter six W hen BPD Isn’t Your Child’s Only
Psychiatric Disorder 119
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s e c t i o n 2 treatment 133
C hapter seven A dvice on How to Find Treatment 134
Chapter eight H ow Dialectical Behavior Therapy Can Help 146
C hapter nine O ther Effective Approaches 165
C hapter ten T he Effect of Medication on Adolescents
with BPD 181
C hapter eleven T ips and Strategies for Parents of
BPD Adolescents 197
s e c t i o n 3 new HoPe for l iv ing witH BPd 207
C hapter twelve V oices of BPD 208
C hapter thirteen B PD and Adoption 232
C hapter Fourteen BPD: The Good Prognosis Diagnosis 242
Resources 252
B ibliography 256
Acknowledgments 276
About the Author 278
Index 279
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i n t r o d u C t i o n
y colleagUes and i interviewed a teenager and her family
who sought treatment for her at McLean Hospital in Belmont,
mMassachusetts, where I practice. She had been referred to us for
treatment of mood problems and bipolar disorder even though she had
all the classic symptoms of borderline personality disorder (BPD): fears of
abandonment and emptiness, self-injury, overidealizing and later devaluing
her boyfriend, suicidal thoughts, reactive mood swings, and impulsivity.
The girl’s parents wondered why she wasn’t getting any better despite
all the medication she had been on. We reviewed her symptoms and point-
ed out that she met criteria for BPD but not bipolar disorder. The father, a
prominent psychiatrist who worked with adult patients, became very upset
and asked for a meeting without his daughter.
“How,” he asked after she left the room, “can you make the diagnosis
of BPD in a child? Giving her that diagnosis means years of misery and
hopelessness for her and for us. You forget I am a psychiatrist. I know bor-
derlines. They’re impossible!”
Years ago, I might have agreed with this father. Years ago, I myself saw
firsthand the devastating suffering of a close friend who struggled with the
8
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