Many people experiencing borderline personality disorder (BPD) first receive a diagnosis in their teens. It’s a mental health condition that can manifest with many possible symptoms and presentations. People living with BPD experience it in different ways, and often have varying opinions about using the term to identify themselves. It’s common for teens and pre-teens with BPD to experience other mental health conditions, such as depression or post-traumatic stress disorder (PTSD).

Borderline personality disorder can run in families, and research suggests it may be influenced by a mix of genetic, biological, environmental, and social factors. Childhood trauma, abuse, neglect, or chronic emotional invalidation may increase a young person’s risk, but these experiences do not automatically cause BPD. Likewise, some people develop BPD without a history of severe childhood trauma.

“It is more accurate to think of adverse childhood experiences being a risk factor rather than a cause,” said Nicholas Shields, LPC-MHSP, program administrator at Knoxville’s Embrace U location. “However, it can be one of the greatest risk factors for BPD.”

This article explores childhood experiences that may contribute to BPD risk, especially in teens and adolescents.

What is Borderline Personality Disorder (BPD)?

Borderline personality disorder involves difficulties with a person’s sense of identity, their relationships or their emotions. People experiencing BPD may have intense or overwhelming feelings that can change quickly. Most people receive a BPD diagnosis when their symptoms start to make it hard to cope on a daily basis.

Some common symptoms of BPD include:

• An overwhelming worry that you’ll be abandoned or rejected. You may take drastic action to prevent this from happening.
• Taking big risks or doing things without thinking, such as binge eating or self-harm
• Intense emotions that can change very quickly (e.g., feeling elated one moment and deeply distressed after something happens to change that)
• Feeling unable to control your actions when your emotions are intense
• Not feeling a clear sense of self. You may also feel like a different person depending on who’s around you.
• Having difficulty with relationships. You might tend to see relationships as either perfect and great or absolutely terrible.
• Feeling lonely or empty a lot of the time
• Experiencing paranoia or dissociation

Because many BPD symptoms involve emotions, relationships, and identity, they can sometimes look like typical adolescent struggles. The difference comes down to how long symptoms last, how intense they are, and whether they interfere with school, home life, friendships, or safety. According to Shields, clinicians often will look at duration, intensity, and functioning across settings when deciding whether a teen’s symptoms may need professional attention.  

What Childhood Experiences May Increase the Risk of BPD?

The causes of borderline personality disorder aren’t always clear. While many people with this condition have a genetic predisposition or early traumatic experiences, some don’t. Traumatic experiences might include abuse and neglect. Other situations that make you feel unsafe or invalidated can have similar effects. An unstable home environment, insecure relationships and ongoing stress can all contribute to BPD. Too much stress at certain stages of development can affect function and connectivity in certain areas of the brain. This results in emotional and cognitive differences that cause difficulties. People who develop this condition often have multiple co-occurring disorders, according to a review of 20 years of research on BPD. These may include mood and anxiety disorders or behavioral disorders like addictions or eating disorders.

Nationally, BPD is usually diagnosed in late adolescence or early adulthood, and the National Institute of Mental Health (NIMH) notes that people under 18 may be diagnosed when symptoms are severe and last at least one year. In Tennessee’s 2023 Youth Risk Behavior Survey, 15% of high school students reported attempting suicide, equal to about 4.5 students in a classroom of 30. These statistics do not mean that every teen experiencing suicidal thoughts or self-harm has BPD. However, because BPD can involve intense emotional distress, impulsivity, self-harm, and suicidal thoughts, they highlight the importance of recognizing patterns and seeking support.The causes of borderline personality disorder aren’t always clear. While many people with this condition have a genetic predisposition or early traumatic experiences, some don’t. Traumatic experiences might include abuse and neglect. Other situations that make you feel unsafe or invalidated can have similar effects. An unstable home environment, insecure relationships and ongoing stress can all contribute to BPD. Too much stress at certain stages of development can affect function and connectivity in certain areas of the brain. This results in emotional and cognitive differences that cause difficulties. People who develop this condition often have multiple co-occurring disorders, according to a review of 20 years of research on BPD. These may include mood and anxiety disorders or behavioral disorders like addictions or eating disorders.

Unstable Family Relationships

Growing up in an unstable home environment can create conditions for children to develop BPD as a teen or an adult. Because BPD can run in families, having a family member with unmanaged BPD symptoms can be a contributing factor. Inappropriate boundaries with family members, such as parents oversharing about problems in their relationship, may cause a child to have similarly unhealthy boundaries. Being separated from a parent, having a caregiver with a substance use disorder or having invalidating relationships can also increase your likelihood of developing BPD.

In the case of siblings, if one child is diagnosed with BPD, there’s a 15-25% chance that the other sibling can also have it. Furthermore, if the siblings are identical twins, then it’s an 85% chance that the second twin will also be diagnosed. Siblings raised in the same environment can potentially respond differently to similar stressors due to individual temperament.

“If one sibling has an intense emotional temperament, but the other child doesn’t, only one might develop symptoms associated with BPD,” said Shields.

Abuse and Neglect

Some young people develop BPD when their physical or emotional needs are neglected. Sexual assault, coercion or manipulation can lead to the kinds of symptoms that characterize BPD. Teens and adolescents may also develop this disorder after being physically abused.

However, severe trauma or abuse is not required for a BPD diagnosis. Shields notes that while childhood trauma and abuse are common factors, they are “not a diagnostic criterion for BPD in the DSM-5.”

Traumatic Events

Other types of traumatic experiences and losses can contribute to borderline personality disorder. For instance, losing a parent or a caregiver who was close to you or witnessing hostility and violence. Events without a specific cause, like car accidents and natural disasters, can also bring about symptoms of BPD. What matters is not only what happened, but how young the person experienced it, what support they received afterward, and whether the stress became chronic or overwhelming.

Fear, Distress, and Emotional Invalidation

Being exposed to long-term distress for any reason (e.g., feeling that you or your loved ones may be in danger or witnessing someone else’s emotional turmoil) can cause difficulty with your emotions, sense of self and relationships. Situations that put children in an adult role prematurely, such as earning money for their family, can cause a high level of ongoing stress.

Emotional invalidation happens when a child’s feelings are dismissed, minimized, criticized, or treated as wrong. In everyday life, this might sound like telling a child they are “too sensitive,” shaming them for crying or repeatedly brushing off their fear, sadness, or anger.

“Emotional invalidation can involve a child’s feelings being dismissed or being told their feelings are wrong,” said Shields. “Over time, this can contribute to trouble managing emotions and low self-esteem.”

Can Adolescents be Diagnosed with BPD?

Diagnosing BPD in adolescents can be complicated because teens and pre-teens are still developing emotionally, socially, and neurologically.

“Most teens are impulsive due to the prefrontal cortex still developing,” said Shields. “However, when these behaviors become riskier (self-harm/substance abuse) as a way to seek emotional relief, it could be a sign that something more serious is going on.” 

 Mood shifts, impulsivity, identity questions, and changing relationships can all be part of adolescence.

But when these patterns are persistent, intense, or unsafe, they may need professional attention.

“The combination of symptoms of BPD overlapping with typical adolescent emotional development and the fact that personality is still being formed in those adolescent years makes diagnosing BPD complicated,” said Shields.

Get Help for Borderline Personality Disorder at Embrace U

Even experts disagree about what borderline personality disorder is and how it should be identified and treated. Unfortunately, this can result in misunderstandings and misdiagnoses. In our outpatient programs for adolescents and teens at Embrace U, we provide a lot of education to help patients learn about their conditions and take an active part in their own treatment processes. We also involve family members to ensure that patients have the support they need to maintain their mental health after treatment. 

For adolescents with BPD traits or significant emotional dysregulation, treatment often focuses on building practical skills for everyday life. Shields notes that dialectical behavior therapy (DBT) is commonly used to help adolescents develop distress tolerance, mindfulness, emotional regulation, and interpersonal skills.

Some care providers are hesitant to diagnose teens with BPD. However, when left untreated, the emotional symptoms and relationship dynamics that characterize BPD have a very real impact on teens’ lives. A BPD diagnosis does not mean an adolescent will struggle forever.

“There are a lot of opportunities for hope and healing when it comes to BPD,” said Shields. “Effective treatment exists and with treatment most people experience significant symptom reduction and healing over time.”

Treatment at Embrace U is about more than labeling and symptom reduction. We help teens develop a healthy self-image and positive skills for healthy relationships and emotional regulation. The things you learn in treatment will continue to benefit you long into adulthood.

Have questions about borderline personality disorder or treatment? Contact our team or give us a call today.