Kids and BPD
Date: March 2, 2012
“With borderline personality disorder in children, it’s hard not to trip over the approach/avoidance you face,” says child psychiatrist Patrick Kelly. “You resist giving them a “borderline” diagnosis because personality isn’t fixed before adulthood. Then, too, you ask yourself, how can I label someone who’s not an adult with what’s mistakenly thought to be a permanent and nasty condition?
“Moving totally away from the borderline term, however, isn’t helpful,” he says. “It deprives a family of the ability to look for therapy or research what their child has.”
Kelly’s tactic is to talk first about borderline behaviors. What parents hear from him is that some of their child’s actions mirror those of adults with BPD. Parents also hear that with early therapy and concerted work, their child “can avoid ever getting a BPD diagnosis.”
It’s no surprise that the pediatric treatment enlists families. The degree, however, is unusual. “It’s almost as though the family has the BPD, our approach is that inclusive,” Kelly says. As in adults, psychotherapy is the prime approach, particularly dialectical behavioral therapy (DBT). That method balances validation of patients with their increasing necessity to change. “DBT for adolescents comes with an additional protocol,” says psychiatrist Shannon Barnett, who has “had good success” with the technique. Part of it—walking the middle path—aims to sidestep power struggles that destabilize families. Both parents and teens are monitored and counseled to avoid extremes of emotion and behavior, to ask, before things escalate, what is the middle path here?
Therapy for borderline is no psychic Band-Aid. The Hopkins program that Barnett helps run, for example, requires its 13- to 20-year-old clients’ strong commitment to individual and group therapy for at least 12 weeks and includes families.
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