Can a child have a personality disorder?

[Almost_Nobody]

So far I learnt Personality Disorders are seen in  late teens and Adults. And its effect of abused childhood. It shows maximum in 50+  years of age.

Now I find here children may have it.

I heard on a TV show that Children's Personality Disorder like attitude is actually called "Conduct Disorder" and sometimes these are not true disorders. Sometimes these are learnt not inherent type. Conduct disorders sometimes tranform into personality disorders in adulthood. And sometimes not.

Am i correct or wrong?

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Mikki]

I can't give you the clinical answers to your question.  I am no expert. In simple terms, I think that they hesitate to make diagnosis in kids because it could have to do with development, family dynamics, etc. Not all BPD's have suffered abuse, sexual or otherwise. My daughter was never abused by anyone. Sometimes it is nature, not nurture. My husband and I both have a couple of people in our family history that we believe may suffer from this. Again, neither were abused.

Our family doctor suggested that our daughter had BPD when she was in her teens. We took her to a counselor who specialized in troubled teens. He would not make a diagnosis of BPD in a teenager, period.  She is now 30 and has never been treated or diagnosed by a mental health professional. She never believed that it was her that had a problem.  On good advice, we opted not to confront her with the fact that we believe that is what she suffers from.

[Randi Kreger]

YES, kids can be diagnosed. See this from new book, The Essential Family GuideBPD in Children and AdolescentsBorderline Personality Disorder has become a crisis for children and adolescents despite the widespread belief that the diagnosis can only be made in patients age 18 and older. Perry Hoffman of the National Education Alliance for Borderline Personality says that early detection is crucial because an astounding 33% of the adolescents who commit suicide have BPD. “Making the correct diagnosis is a challenge because people don't want to label adolescents with such a devastating illness. This deters recovery." she explains. Blaise Aguirre, M.D., the medical director of the new Adolescent Dialectical Behavioral Therapy Center at McLean Hospital, Belmont, MA., is widely recognized for his work in the treatment of BPD in children and adolescents. Here, he answers some of the tough questions. Randi Kreger: There is a great deal of conflicting information about whether or not children and teens can be diagnosed with BPD. What does the DSM say? And what do you say?Dr. Aguirre: The DSM allows for a BPD diagnosis in childhood if the patient has had the symptoms for more than a year. Some clinicians tend to overlook this. I have seen children as young as 13 meet criteria for the diagnosis. Parents often identify BPD beginning at puberty, when some children start acting out.Many of the BPD kids on our unit at McLean are referred because they begin injuring themselves: cutting, burning, branding, and piercing. They do it to regulate their emotions, mostly anxiety and anger. Some of the kids are referred because of ongoing thoughts of suicide or after suicide attempts. I am sure that some of these children had difficulty regulating their emotions before age thirteen. However, I have not seen cutting before age 12. Kreger: How does one go about diagnosing a child? Are there any tests?Dr. Aguirre: Right now, the diagnosis is made using the DSM, although, increasingly, clinicians look for a series of problems in dealing with emotions—especially anger. The adolescents may have chaotic relationships, be confused about their identity and values, practice self-harm, be overly impulsive, or feel empty. They may also  present cognitive impairments such as irrational beliefs, paranoia, and dissociation. I don't know of any childhood conditions, other than BPD, where all these symptoms are likely to occur. Also, we know that, in some cases, BPD runs in families. We plan to include genetic testing in our future research. We also want to study the question as to which criteria best help in making the diagnosis of BPD in adolescents. We hope to eventually develop a standardized interview that will help clinicians distinguish BPD from normal adolescent behavior. We also hope advanced imaging techniques can help identify brain differences in these children in the future.Kreger: How should parents work with clinicians to obtain a diagnosis?Dr. Aguirre: As with any specific diagnosis, the more a clinician is familiar with the symptoms, the better they can recognize the condition. Because kids can't drive or might not be sexually active, I include other impulsive and disruptive behavior such as skipping school, so called "hooking up," and sneaking out at night. Adolescents who have had more than a year of symptoms often come to us with chronic thoughts of suicide, marked self-loathing, self-injury, relationships characterized with overidealization/devaluation, and stark black-and-white, all-or-nothing-type thinking. Their abandonment fears are profound. Many recognize that they test their loved ones endlessly to get them to prove their love, although they know these tests can be very destructive to their relationships.Kreger: How do you tell the difference between BPD and other disorders? Dr. Aguirre: There is a lot of comorbidity [overlap] between BPD and other childhood disorders. The main differences lie in the degree of self-destructive behavior, the degree of self-loathing, and the unremitting thoughts of suicide.Self-loathing is pretty unique to BPD. Self-injury is very rare in Oppositional Defiant Disorder or Conduct Disorder, although it may be seen in clinical depression. The impulsivity in Attention Deficit Hyperactivity Disorder is sometimes similar to the impulsivity in BPD. Although adolescents with BPD can be aggressive, this is not a common presenting symptom at our unit. Often, when BP adolescents are aggressive, they feel ashamed or remorseful after the event. Children with Conduct Disorder generally do not care at all (or at least do not appear to care) if they have hurt someone. Kreger: Is there anything parents can do for children at risk, such as increasing validation [reflecting your loved one’s feelings without necessarily agreeing]?Dr. Aguirre: Validation is clearly important. The best early intervention is predictable and consistent care giving. Caregivers need to be aware of how the environment may be invalidating. For example, there might be a mismatch between how the caregiver sees the world and how the child sees the world. The most important thing is to close this gap. A way to reduce the gap is not to blame either parent or child, but to recognize the problem and work with a family therapist who is familiar with BPD dynamics.Kreger: What resources can parents find locally for help? How do they find psychiatrists who believe that their children aren’t just “bad kids" or going through a phase?”Dr. Aguirre: This is a particularly hard question.  Many therapists and psychiatrists don't like working with individuals with this diagnosis because it means years of treatment and a lot of frustration. We often don’t have adequate resources in the kid's local community after they’re discharged from our unit. I think the diagnosis will become better understood, especially with the amount of self-injury taking place, and more and more clinics will offer services that treat self-destructive adolescents. Parents need to tell clinicians whom they’re evaluating that they have read up on BPD and that the diagnosis most closely fits their child's behavior.Kreger: How should parents respond to the implicit or explicit accusations that they must have been be abusive?Dr. Aguirre:  In many of the cases we see, there is no evidence that parents have been abusive. Mostly, parents have tried the best they could. However, in some cases, there has been clear sexual and physical abuse. We work from a "no blame" perspective, believing that children and their families have gotten to where they are because of their past and their biology. Dwelling on the past has not been shown to help treat BPD. We work on current symptoms. If a patient has Post Traumatic Stress Disorder, then the trauma work must also be addressed.Kreger: How are medications handled?Dr. Aguirre:  Many kids referred to us have been hospitalized many times. Often, at each of these hospitalizations, the treating psychiatrist is presented with a single part of the whole picture: We call this the “admitting symptom.” For example, the patient is "depressed," "manic," "anxious," or "psychotic.” Usually, past psychiatrists prescribed a medication for each of these symptoms. In subsequent hospitalizations, medications were seldom removed, so we see kids on all the meds from previous hospitalizations. Often, our approach is to be clear as to the clinical criteria that make the diagnosis of depression or psychosis. If there is no clear sense that these diagnoses are correct, we gradually remove the medication. Often, the problem behavior began after a relational conflict, and, unfortunately, there is no medication that heals broken relationships.

[smokey]

Thank you Randi,

If I had been properly diagnosed in my childhood, perhaps I wouldn't be dealing with BPD now... .the idea that "teen angst" can't be distinguished from BPD is nuts.

As a child, I had so many red flags waving all the time, but because it was the 50's and people simply didn't want to recogonize them. 

The sooner kids can get help the better.

smokey

[Cagey]

Thanks for bringing this interview up Randi.  My daughter was dx'ed at about 13 with traits and we were told that if she did not outgrow the traits by adulthood, the dx would then be changed to just plain old borderline. She did not outgrow and the dx changed.

Basically it was: if it walks like a duck and talks like a duck, in all likeliehood, it is a duck.

Cagey

[ILoveTherapy]

Jumping in late, but my 7yo daughter is undiagnosed ODD - oppositional defiance disorder. I have read and re-read the book "Transforming the Difficult Child" by Glasser and it's a perfect fit for my DD. We are trying to work things out here at home with some self help and positive affirmation. We are giving it a few more months and if things aren't progressing, then we are going to seek out a therapist for her.

It's really sad because I'm manic depressive (medicated and in therapy) and I see so many of my early traits in her. I hope I can offer her support and love - something I never got from my BPD mother.

[smokey]

If you see anything suspicious in your child's behavior, pay attention!  I had many obscessive - compulsive behaviors

smokey

[IQU]

SD was diagnosed at about 13yo as a "budding borderline" by her individual therapist. The counselors at the residential center referred to it as borderline and narcissistic "traits" at 14.

[Butterflygirl]

I started cutting at 15. Everyone else was writing their boyfriend's initials on their hand in ink. I cut it in with a razor blade. The rage was there too by then. That started when I was 11. I was being teased by a girl at school and I grabbed her by the hair and pulled her around the school yard. I blacked out and when I found myself in the principle's office they told me what I did. I was bullied a lot and I think this is where my rage comes from. I was not diagnosed then but this was in 1960 when they did not send kids to therapy. By the time I was 18 the BPD was overtaken by my codependency and I ended up being beaten by my BPD husband. I just took it. So I am a non and a BPD. But these things can really start young.

[mamag]

[I can see that abuse as a child causing the behaviors of borderline, but not all kids that have been abused have borderline traits. I searched high and low for even a posibility that my child was abused, in a nutshell she was my only child not exposed to her drug abuser father, but the other 2 kids were till age 5-7. these kids have some emotional problems with attachments and some depression issues, but now they are young adults and pretty level headed, The kid that had no exposure to her dad is borderline, they feel her case is genetic.

[/quote]

[Mikki]

I just wanted to put a little perspective on parents being able to have kids diagnosed. The past few years have seen far more research and information about BPD. These resources were not widely available several years ago.

My daughter was a teen in the late '80's, early 90's. We had her tested for drug abuse and tested for various physical maladies. Nothing. As I have said before, our family doctor told us he though she might be "Borderline". We took her to a counselor and he said that diagnosis was never made in teens. He offered to continue counseling. She has never believed that the problem could have anything to do with her. We had not told her about the possibility of her having this, but we did tell her that we thought we could all benefit from counseling. She refused to go and my husband would not make her. At that time, the only thing I could do was go to the library. There was nothing that I could find but a small paragraph in an abnormal psych book that was of very little value. No criteria was listed. I went back to wondering what in the world was causing my daughter to be a volatile volcano ready to erupt.

Smokey, I doubt your parents would have had a tiny fraction of information to go on even if they had been willing to look.The 50's? Look what happened to the young Kennedy girl who presumably would have had access to the best of what science had to offer at the time.

When I began to look for answers again a few years ago, I found "Stop Walking on Eggshells" and the BPDCentral site and that was how I became educated about BPD. None of that was available to me in 1990. It was amazing to finally begin to understand what we were up against.

I guess I just wanted to caution others not to judge parents too harshly. Many of us really, really tried to get answers. Of course I wish I could have it to do over again, but that it is just to frustrating and sad to dwell on those thoughts.

The good news is that my daughter is much better. And for my part, I have learned so much about how I should interact with her during the times she is stressed and scared.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Abigail]

  According to some of the latest research, children can definitely have BPD and be diagnosed, although it does seem to appear more commonly in adolescence and early adulthood.  And genetics is a big factor.  My neighbor's daughter was just diagnosed at age 20 but her mother said she had symptoms and problems from the time she was 2 years old.  She had her in therapy for many years but she was never diagnosed with BPD and nothing helped.  There was no abuse in her family either.

  I just finished reading "Borderline Personality Demystified" by Dr. Robert Friedal (not positive on the spelling) and he talks about children and BPD in his book.  It was published in 2004 so it is more current than some of the books out there. He is also mentioned on the website of the NEA for BPD, and it has some good information also.  www.borderlinepersonalitydisorder.com

  Abigail