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Early Detection and Timely Intervention of BPD in Adolescents

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BPD Adolescent DetectionWhen adults enter treatment for Borderline Personality Disorder (BPD), they generally have already experienced many years of dysfunction, resulting in what Dr. Andrew Chanen refers to as “trying to unscramble an egg” by undoing many ingrained behaviors that have set in over time. Early intervention with young people, on the other hand, can address behavioral problems and their root causes before they become completely entrenched.

Chanen is a leading expert on Borderline Personality Disorder. Working in Melbourne, Australia, Chanen runs an early intervention program for young people with personality disorders called HYPE (Helping Young People Early).

In Chanen’s view, Borderline Personality Disorder is primarily a disorder of young people, with the peak of behavioral problems arising between the ages of 14 and 22 and diminishing with each passing decade. For quite some time, the diagnosis of personality disorders in adolescence (especially BPD) has been controversial because of the notion that these diagnoses are stigmatizing.

While the DSM criteria for BPD is the same in adults and adolescents, the disorder presents differently or is interpreted differently in teenagers, as they are developmentally prone to over-emotionality and acting out.

“Even if you only have one BPD feature, this differentiates you from other people,” Chanen said.

Many of the symptoms of and disorders associated with BPD, such as substance abuse, interpersonal conflicts, mood disorders, and eating disorders, can carry over into adulthood. Early intervention and BPD treatment can prevent these issues from developing into lifelong struggles for someone with BPD.

Adolescent BPD Treatment

In a study comparing Chanen’s HYPE program with several other treatments, the HYPE program showed faster rates of improvement and better results after a two-year follow up. Chanen says that the key difference is the comprehensive integrated intervention that HYPE features.

His program uses an integrated team, so that the same person or group of people is responsible for the three main parts of the program – case management, individual therapy, and family intervention – as well as medication and therapy for disorders that may co-occur with BPD.

When delivering these programs to young people, it is important to make them developmentally suitable. Because youth are often reluctant to commit to a long-term period of therapy, Chanen’s program consists of a limited number of sessions (18 to 24).

The program uses treatments designed for adults, but adjusts them to make them suitable for young people. Both Cognitive Analytic Therapy and Systems Training for Emotional Predictability and Problem Solving have been adapted in this way.

In extreme situations, Chanen recommends brief and goal-directed inpatient care. “There’s kind of a myth that admission to a hospital is always contraindicated in BPD,” he said. “Particularly early on, where they’ve had a helpful engagement with the mental health system, you can often use brief goal-directed inpatient care quite creatively and constructively.”

In a follow-up article, we’ll take a closer look at how Chanen recommends addressing BPD treatment for families and adolescents.

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