Possible BPD?

[Jstmee]

I think my 12yr old might have borderline personality disorder...

This isn't just a new thing, it's been gradually building for a few years. I'd appreciate if hormones were left out of it.... I understand child development/puberty etc and it's way more than that.

She has very low self esteem, binge eats regularly (taking food without asking to do so and then saying she hasn't), she's so angry 90% of the time and verbally lashes out at myself and my parents. Relationships with her peers aren't always the best and she makes choices that puts herself at risk. I suspect that she may be/have self harmed in the past but whenever questioned about it she blows up at me.

I genuinely feel like I walk on eggshells around her, the hate and attitude rolls off her the majority of the time.

I've been to the GP a number of times, we've had blood tests done around 6 months ago (all clear) and a referral was made to CAMHS but I was told she didn't meet the criteria.

Does anyone have any experience with borderline or emerging borderline personality disorder in teens? What is your experience getting the help and support needed?

She's only 12. They would be reluctant to diagnose anyone under 16/18 with BPD. Her personality is emerging. To put a label on her at this young age would not be useful, do you want her to be diagnosed and if so, why? Also, BPD is very stigmatised. Even by health professionals.
All she is displaying appears normal teenage behaviour. All kids fall out and have mood swings.
I say this as someone with possible BPD...and they only said that due to tw: suicidal acts, fear of abandonment, emotional dysregulation.

I probably had BPD as a child, I'm in my 50s so never got a diagnosis. Is there some history of trauma, as that is very common with BPD? The main issue is around emotional regulation and feeling emotions strongly. What's she like the rest of the time? IME access to CAMHS is really difficult, my DD had some subsidised counselling from a young people's charity (thigh around a different MH condition), and we've also paid, but finding someone who understands BPD can be challenging. It's a very physical experience and the distress felt can't easily be rationalised away in the same way you can't just out-think other emotional pain. Being around people who are good at emotional regulation to help her developing brain is key, but those people don't have to be therapists.

My brother has a diagnosis of BPD, and I'm pretty sure my sister has it as well. I have a diagnosis of CPTSD, which I'm told is often a differential diagnosis for BPD.

All of us experienced serious abuse and grew up terrified and constantly on our guard. My brother as a child of 12 did have an aggression problem, both my sister and I self-harmed and we were all pretty difficult in various ways, major attachment issues etc.

Has your daughter been through any severe trauma that could have caused a personality disruption?

It's impossible to discern from the little you've posted whether there really is a clinical problem, or whether you've just got a shitty teenager (I have one, there's nothing wrong with him, he's just grumpy and knows it all)

How is her behaviour at school? Talk to her head of year who might be able to give you some insights on how she is beyond the home.

There's no massive trauma that's taken place (that I'm aware of). Her dad and I have have separated around 5 years ago and she took that really badly. I've tried counselling through a charity, she lied and manipulated the conversations. She's got a befriender but doesn't talk about anything with her.

She only has two emotions; she's either closed off and doesn't talk or she's screaming and shouting at people.

At school she's manipulative towards her peers, often taking advantage of more vulnerable children. She lies on a regular basis to teachers and to myself. There's been a number of occasions property has went missing and it turns out she's taken it.

Questioning BPD isn't something I'm doing lightly, I haven't immediately jumped to a conclusion because she appears to fit some of the criteria. As I mentioned I do have knowledge and experience of child development and I understand typical teenage behaviours. We are literally at crisis point in our house and I can't seem to get the support we need. I'm already in (private) counselling and have been signed off work; family counselling is an option but my daughter refuses as she doesn't think anything is wrong.

I have BPD, only diagnosed as an adult but since teens/always. I don’t think labelling your child’s problems is helpful or should be the focus. If you are having private counselling then presumably you could pay for private help for your daughter. DBT is a form of therapy used to help people with BPD, it’s been transformative for me. Maybe research DBT for teens and speak to a professional with appropriate experience about your concerns and how to open up a non confrontational conversation with your daughter. Perhaps there’s another trusted adult she may listen to/talk to as well? Good luck with it, sounds hard. Your poor daughter, going through adolescence is so tough.

So one of the reasons that bpd isn't diagnosed as a child is that no one is born with the skills to emotionally regulate, and that teens historically have somewhat poor emotional regulation skills, but many do then go on to develop those skills/ their emotions become manageable.

Its a bit like talking, sometimes people develop bang on track. Sometimes we see something is delayed or not typical but things even out by a certain age or that speech might still be behind but function okay. Or they might really struggle and when you look back signs are clear, but you had to wait until certain mile stones are passed etc

Borderline PD only makes sense if the person was raised in an invalidating environment or as people have said, your parenting was severely lacking, or she was exposed to serious neglect traumas or abuse.
Seriously it seems really odd that your question is about a diagnosis that you seem to want.
Forget about it.
Figure out how to help your daughter and the best thing that any parent can do is to go on a parenting course.

It's not about labelling her, it's about equipping myself and the other adults around her with the correct strategies to support her because clearly what we're doing just now isn't working. Mental health is a tricky situation and it's not a one size fits all kind of deal.

Hi, just wanted to pop on to talk about my experience. I had the same issues from a very young age (and history of trauma as lost a parent to suicide young) and was misdiagnosed with bpd as soon as I turned 16 having seen camhs for over 10 years. Nothing the suggested or tried helped me and I always wondered why - I actually have adhd and now am emotionally a lot better. Symptoms in women and especially young girls are often not seen as possible adhd (unlike my son who also has adhd diagnosis and is absolutely hyper text book symptoms wise!). Just wanted to add this in case you weren't aware or hadn't thought of it being a possibility. Hope you are okay, it must be very tough. I was a complete nightmare to deal with I'm sure but I was really struggling on the inside and didn't have the proper support. Xx

@WindowsSmindows

Borderline PD only makes sense if the person was raised in an invalidating environment or as people have said, your parenting was severely lacking, or she was exposed to serious neglect traumas or abuse. Seriously it seems really odd that your question is about a diagnosis that you seem to want. Forget about it. Figure out how to help your daughter and the best thing that any parent can do is to go on a parenting course.

Forget about the fact the myself and my daughters relationship is at crisis point? Great advice... Much appreciated!

And I've actually done a number of parenting courses, the most recent 'Understanding your teen' just concluded on Wednesday.

BPD develops from maladaptive behaviours and coping mechanisms - essentially a caregiver not providing the right support and feedback for a young person to learn to express their emotions appropriately. Trauma also comes into play, but often that can be linked - if your parents aren't supporting you emotionally, then you're vulnerable to abuse either from them or from an outside influence. Does any of that ring true?
If you've been reading up on BPD then surely you'll know that there won't be a psychiatrist in the land who will diagnose a preteen with BPD. It's rarely done before 18. Her personality is emerging, her brain is changing. She could be emotionally disregulated beyond the norm for a child, she could be a slightly extreme but normal preteen. The best thing you on your own can do is make sure your parenting enables her to manage her emotions appropriately.

@MummytoCSJH

Hi, just wanted to pop on to talk about my experience. I had the same issues from a very young age (and history of trauma as lost a parent to suicide young) and was misdiagnosed with bpd as soon as I turned 16 having seen camhs for over 10 years. Nothing the suggested or tried helped me and I always wondered why - I actually have adhd and now am emotionally a lot better. Symptoms in women and especially young girls are often not seen as possible adhd (unlike my son who also has adhd diagnosis and is absolutely hyper text book symptoms wise!). Just wanted to add this in case you weren't aware or hadn't thought of it being a possibility. Hope you are okay, it must be very tough. I was a complete nightmare to deal with I'm sure but I was really struggling on the inside and didn't have the proper support. Xx

ADHD had crossed my mind, as did ASD however both have been dismissed by school and EdPsych as her school work is a very high standard.

Have you every considered the possibility she may be autistic? I know this gets thrown around quite a lot on MN but bear with me (I’m Austistic, diagnosed as an adult). There are a lot of overlaps between Autism and Borderline personality disorder, many young women get diagnosed as the latter when they are in fact Austistic. Difficulty regulating emotions, expressing feelings, being closed off at times, exploding at times, manipulating situations to have control of things - they really could be either. Has she ever been assessed by paeds?

Regardless of the diagnosis, I highly recommend “The Explosive Child” by Ross Greene. This book helps you to understand things from your child’s perspective. I have an 8yo DD who is much like me as a child (emotional outbursts, paeds say she doesn’t meet criteria for assessment). The book explains that many things we saw as a problem, DD saw differently. Her behaviour achieved what she wanted so why would she change things? We have used the book to find different strategies to improve life at home and it’s helped massively. She’s still DD, but she’s much happier than she was before.

ADHD had crossed my mind, as did ASD however both have been dismissed by school and EdPsych as her school work is a very high standard.

This gives me the rage! (At the assessors, not you OP) I was very academic at school. My dyslexia meant things were harder the higher up the educational ladder I went but I’ve been educated to Masters level! Academic doesn’t necessarily negate either of those things. Some of the most intelligent people in history/modern successes were/are thought to be neuro-diverse. Sometimes it’s that ND quality that makes us hyper focus in a way that most NTs won’t.

@ThePontiacBandit

Have you every considered the possibility she may be autistic? I know this gets thrown around quite a lot on MN but bear with me (I’m Austistic, diagnosed as an adult). There are a lot of overlaps between Autism and Borderline personality disorder, many young women get diagnosed as the latter when they are in fact Austistic. Difficulty regulating emotions, expressing feelings, being closed off at times, exploding at times, manipulating situations to have control of things - they really could be either. Has she ever been assessed by paeds?

Regardless of the diagnosis, I highly recommend “The Explosive Child” by Ross Greene. This book helps you to understand things from your child’s perspective. I have an 8yo DD who is much like me as a child (emotional outbursts, paeds say she doesn’t meet criteria for assessment). The book explains that many things we saw as a problem, DD saw differently. Her behaviour achieved what she wanted so why would she change things? We have used the book to find different strategies to improve life at home and it’s helped massively. She’s still DD, but she’s much happier than she was before.

It's one of the first things I considered, however ASD has been dismissed by school and EdPsych - they won't support a CAMHS referral since her actual school work isn't effected. It's very frustrating.

@Jstmee sometimes diagnosis can be important because it can help identify streams of support, but even without a specific diagnosis if things might help then its always worth a try!

Obviously its unlikely that a bpd diagnosis (usually eupd is the given diagnosis now due to different diagnosis manuals) will be given until she reaches adult hood, and will need to come from cahms /or private psychiatry.

I understand cahms have declined, can that be re-visited? Is it a sort of an all or nothing for cahms in your area? My area has a midway support and some charity services and youth groups

We are crossing posts. We’ve had similar with DD. She is so like me at the same age, my Dad often comments on it. But she is “fine” in school so she doesn’t meet criteria. Never mind the meltdowns she has at home, sometimes at the school gate because she breaks down as soon as she sees me! So we keep fighting. Also implementing the strategies from the book.

I’m surprised they are refusing the CAMHS if they say it’s not a neuro-diverse issue, surely by their elimination that means she must have Mh needs and that would be CAMHS?

Definitely agree with the link between girls being diagnosed with eupd, and later receiving an asd diagnosis which gives a far better fit!

[quote Barcodes]@Jstmee sometimes diagnosis can be important because it can help identify streams of support, but even without a specific diagnosis if things might help then its always worth a try!

Obviously its unlikely that a bpd diagnosis (usually eupd is the given diagnosis now due to different diagnosis manuals) will be given until she reaches adult hood, and will need to come from cahms /or private psychiatry.

I understand cahms have declined, can that be re-visited? Is it a sort of an all or nothing for cahms in your area? My area has a midway support and some charity services and youth groups[/quote]
CAMHS can be revised but best coming from school and at the moment they won't do it. She's only had 1 day in school since Christmas due to lockdown/phased returns so there's very little chance that'll they do anything this side of summer for her. The GP doesn't put enough in the reports which is one of the main reasons she didn't meet criteria before.

Have you looked into ASD OP? I know a teenage girl who sounds similar to your DD, who now has an ASD diagnoses.

I understand you’re under a lot of pressure and you want to explain your focus on diagnosis, but not sure if you noticed my suggestion of a treatment route (one with huge success rates) of DBT?

Here’s a very well regarded group who provide DBT to teens (as well as adults). Your daughter doesn’t need a formal diagnosis to partake in therapy/training like this, but undoubtedly would benefit from learning to regulate her emotions.

I hope this is helpful and I do recommend you to follow up this lead or other BCAP people specialising in DBT for adolescents if your daughter’s problems are as you describe. DBT can be prescribed via NHS for BPD and presumably also CAMHS but can entail huge waiting lists.

www.mind-reframed.com/dbt-adolescents

My DD meets the criteria for ADHD, she's bright though and it didn't become an issue until GCSE revision and A levels which was the first point she'd really needed to focus (I also didn't get any mental health support because I could hold down a job). She couldn't get any help and dropped out of A levels, though she's happily in an apprenticeship. I commented to her the other day about the overlap between ADHD and BPD symptoms.

One way that's been helpful to me to think about it is that emotional pain is felt in the same part of the brain as physical pain. When she's having strong feelings it's very similar to being in physical pain, she can't think straight or work her way out of it. Trying to negate that pain or minimise it reinforces emotional confusion and you end up in a vicious cycle. It's not about mental health, but the books "how to talk so kids/teens will listen and listen so kids/teens will talk" gave me the skills to support DD around strong emotions. You need to be alongside them rather than in conflict. Also in relation to "trauma" this doesn't have to be anything big, if she was in a situation where there was discord in the house and she picked this up and was frightened, that may well have been traumatic to her. Some kids are just more sensitive than others.

It sounds really difficult for both of you and it's terrible and frustrating that services aren't there, we've been there too. I agree that paying for therapy for her if you can afford it would be good. The other book I'd recommend is The Body Keeps The Score. It is about the effects of trauma, but even if you don't identify that, it's good at explaining how emotional pain is experienced and the connection (or not) with conscious thought.

@Cyberworrier thanks for the link. I did notice but wanted to look into it a bit more, unfortunately that course is way out of my price range but will definitely look into it more.

I'm going to call EdPsych again tomorrow during their drop in times and see if we can push another referral or look for alternatives.

This morning I discovered she's lied to the police regarding a very serious allegation (to try and protect her dad). She's emotionless about it, all she's focused on is protecting her dad. She has tunnel visions in regards to a lot of things that don't go her way/benefit her but this is the most serious.

If she's involved with the police because of her dad then I think you're putting a lot of emphasis on her mental health rather than recognising anyone might behave that way in the situation she's in, that would seem to be a priority to sort out. I don't know how you'd do this, but it needs someone else to help you. Poor kid must be terribly confused with split loyalties, though it sounds really hard for you too.