Category: oppositional defiant disorder

Borderline children – how they function and how you can help

Borderline children – how they function and how you can help

Borderline personality disorder makes a child wonderful yet horrible; lovely yet vindictive; a great friend or manipulative bully; anguished or glowing with joy; self-hating yet self-important; self-centered but also charitable.

Are you ready to bang your head on a wall?  Are you praying for the day your child turns 18, when you can change the locks on your doors?  Children with borderline personality disorder (BPD) traumatize everyone around them.

Children with BPD genuinely believe others will abandon them, and this makes them do one of two things:

    1. Do everything possible to obtain and keep love and admiration;
    2. Or if they detect the slightest hint of disapproval, blame themselves or others so as to feel they made the decision.  This will disguise the horrible feelings of abandonment.

 

A borderline child can be very engaging and affectionate… sometimes at random and sometimes when they want something.  They will also turn on the charm as a way to embarrass you in front of others (such as in a meeting with a teacher or family counselor).  Since they seem so wonderful to other people, you may be judged because you get upset at your clearly wonderful child.  People often suggest that you take care of your own issues instead.

Even though their manipulation and upheaval is relentless, strive for compassion.  Trust me, your borderline child will suffer more than you in every important aspect of life.  They make a mess of their relationships because of their anger, instability, substance abuse.  Their clingy behavior is annoying.  They drive away good friends, hate them for leaving, and then suffer from loneliness and depression.  They make a mess of their jobs, often fired or forced to resign, and then bounce from one job to another… and they don’t understand why it happens to them.

A borderline child or teen is not a “drama junkie” on purpose.  There brain is primed to overreact.

A study published in 2008 in Science showed that brain activity in people with borderline personality disorder was abnormal—their brains lack activity in the ‘cooperation’ and ‘trust’ regions, called the bilateral anterior insula.  People with borderline personality disorder do not have an internal, natural sense of fairness or social norms, and distrust is their default mentality.  Some suggest that borderlines do not receive the attention they need as an infant and toddler.  Early neglect is also a predictor of reactive attachment disorder, which has similar trust issues.

When playing a game that requires teamwork, the brain of a normal person shows activity in the bilateral anterior insula.
borderline brain
The brain of a borderline person showed no activity whatsoever during the teamwork game.

Another study reported, “The disorder occurs in all races, is prevalent in females (female-to-male ratios as high as 4:1), and typically presents by late adolescence.”  It is estimated 1.4 percent of adults in the United States have this disorder.  A different study reported that BPD occurs as often in men and women, and sufferers often have other mental illnesses or substance abuse problems.  (In my observations, teenagers with borderline personality disorder have many bipolar disorder symptoms.)

From infancy, those who were later diagnosed with borderline personality were more sensitive, had excessive separation anxiety, and were moodier. They had social delays in preschool and many more interpersonal issues in grade school, such as fewer friends and more conflicts with peers and authorities.

As teenagers, borderline children can be promiscuous; impulsive and assaultive; more likely to use drugs and alcohol; and more likely to cut themselves and attempt suicide.  “…research shows that, by their 20’s, people with the disorder are almost five times more likely to be hospitalized for suicidal behavior compared to people with major depression.”

screaming girl

Evidence for hope

“Borderlines have the thinnest skin, the shortest fuses and take the hardest knocks.  In psychiatrists’ offices, they have long been viewed as among the most challenging patients to treat.”

“…almost 20 years after the designation of borderline personality disorder, understanding and hope have surfaced for people with the condition and their families.  Advances have been made in recent years.  Researchers studied 290 hospitalized patients with the condition over a 10 year period:  93% of patients achieved a remission of symptoms lasting at least two years, and 86% for at least four years.” Published in The American Journal of Psychiatry, the research argues that once recovery has been attained, it appears to last.  (from “Trying to Weather the Storm”, by S. Roan, September 07, 2009, Los Angeles Times)

“…our message to families is to please stay the course with your (child) because it’s crucial to their well-being.”
(Perry D. Hoffman, president of the National Education Alliance for BPD http://www.borderlinepersonalitydisorder.com.)

I recommend downloading this PDF file, “Using DBT Skills to Reduce Emotional Dysregulation and Reactivity in Children/Adolescents and Parents.”  It is lengthy, but provides a clear and straightforward set of slides with wonderful practical ideas that parents can implement at home.

Treatment

Psychotherapy is the primary treatment of BPD, and the gold standard is dialectical behavior therapy (DBT), which helps the person attain and maintain lasting improvement in their personality, interpersonal problems, and overall functioning.  It simply teaches coping skills so patients learn to control their emotions, calm down, and not destroy relationships. Medications support the therapy by reducing depression or anxiety and self-destructive behavior.

(from “What Therapy Is Recommended for Borderline Personality Disorder in Adolescents (13-17 years)?” by M. Muscari, 2005, http://www.medscape.com/viewarticle/508832)

When to hospitalizeemergency room

In an emergency, when your child has serious suicidal thoughts or an attempt, and/or is in imminent danger to others, or incapable of calming down and functioning.

Consider psychiatric residential care when your child has persistent suicidal thoughts, is unable to participate in therapy, has a co-morbid (co-existing) mental disorder (e.g. bipolar, depression, narcissistic personality disorder), a risk of violent behavior, and other severe symptoms that interfere with living.

Other mental health supports your child may need:

  • Treatment for substance abuse.
  • Therapy that focuses on violent and antisocial behaviors, which can include emotional abuse or physical abuse, baiting, bullying, and sexualized behaviors.
  • Therapy that focuses on trauma and post traumatic issues.
  • Reducing stressors in the child’s environment.  Most children with BPD are very sensitive to difficult circumstances, for example:  an emotionally stressful atmosphere; internal and external pressures to succeed or change; inconsistent rules; being around others who are doing better than them.


What parents and caregivers can do

  • With a co-parent or support person:  Maintain a united front.
  • Communicate privately with each other to effectively set limits.  A BPD child will do everything in their power to split authority figures against each other!
  • Have each other’s back even if you’re not in full agreement.  Anything you say or do will be used against you.


Maintain family balance.

Keep things relaxed.  If you need to set boundaries and apply pressure, do it only to maintain  appropriate behaviors and reminders for self-calming.  Let other things go.

Use praise proactively.  Borderlines crave attention and praise.  When they deserve it, pour it on thick.  And pour it on thick every single time they demonstrate good behavior and positive intention.  One can’t go too far.  When an argument or fight comes up, search your memory banks for the most recent praiseworthy thing they did or said, and bring it up and again express your gratitude and admiration.  This does two things:  it reinforces the positive;  and it redirects and ends a negative situation.

Become skilled in Dialectical Behavioral Therapy (DBT).  It is the gold standard for treating
Borderline Personality Disorder.  It is the only therapy proven to promote genuine behavioral change and improve mental health.  You can ask questions or bring your child back to reality with the following examples
.

  • Did your friend really intend to upset you?  It sounds like they were talking about something else.
  • The delay wasn’t planned just to make you mad, perhaps you were just frustrated by being asked to wait, and it was no one’s fault.
  • The tear in your jacket isn’t a catastrophe.  It is easily fixed and I can show you how.

 

business card

Prevent dangerous risk taking – Teens with borderline personality are exceptionally impulsive and prone to risky behavior.  Consequently, parents should consider:

  • Tightly limiting cell phone use, email, texting, and access to social networking sites
  • Using technology to track their communications (this is legal), or disabling access during certain time periods
  • Reducing the amount of money and free time available
  • Searching their room (this is also legal)

A couple I know fully informed their borderline teen that all internet activity would be tracked, as well as cell phone calls.  The father also installed cameras in the home, at the front and back doors, in plain sight.  Nevertheless, his son continued with bullying and hurtful behavior towards siblings right in front of those cameras, and he would get caught and pay consequences repeatedly.  His persistence in the face of obvious monitoring became a great source of private amusement for his parents–humor made the monster smaller.

Be patient – You are unlikely to receive the child’s respect, love, or thanks in the short-term.  It may take years.  But be reassured that your child will thank you for your firm guidance and limits once he or she matures to adulthood.

knives in your heart
Never expose your heart like this!  Armor yourself. Visualize those knives as fluff balls. Visualize your child as a toddler with a just another temper tantrum.  You can handle it.

Address your own PTSD!  People who live with someone with BPD need help coping with bullying, wrenched emotions, and the instability that person brings into the household.  A parent or family member may need their own therapy, antidepressants, and self-care skills for reducing anxiety.

Self care for you and other family members

  • Three or more (very) deep breaths when stressed, the brain needs oxygen to begin a calming process.  Singing is a superb option.
  • Magnesium or Kava kava, these substances naturally help calm nerves
  • Sleep in dark, cold room is the best way to promote deep sleep. Avoid screen time an hour before bedtime.
  • An activity that feeds your soul, such as a hobby, a loving pet, a gripping novel, just playing
  • Direct support from a trusted friend–face-to-face is ideal, but calls, texts, and emails as needed are really helpful too.


Characteristics of BPD in adulthood, if untreated

Good things:  They can be very financially and publicly successful in many fields, especially in the creative arts, and especially acting.  They are so perceptive that they can ‘channel’ any person they want.  They can be enchanting, and alluring, easily attracting devoted fans, friends, and lovers.

Most challenging things:  Signs and symptoms of BPD may include significant fear of real or imagined abandonment; intense and unstable relationships that vacillate between extreme idealization and devaluation; markedly and persistently unstable self-image; significant and potentially self-damaging impulsivity (spending, sex, binge eating, gambling, substance abuse, and reckless driving); repeated suicidal behavior, gestures, or threats; self-mutilation (carving, burning, cutting, branding, picking and pulling at skin and hair, biting, and excessive tattooing and body piercing); persistent feelings of emptiness; inappropriate anger or trouble controlling anger; and temporary, stress-related disconnection from reality and paranoia.

Help your child with guidance and mentoring on each of these aspects… and be relentless!

  • Chronic fear of abandonment which results in a constant search for companionship, no matter how unsatisfying.
  • Clinging and distancing: Disruptive relationships due to the person’s alternating clinging and distancing behaviors.  When clinging, they may exhibit dependent, helpless, childlike behaviors. They can over idealize the person they want to spend their time with, constantly seeking that person out for reassurance. When they cannot be with their chosen person, they exhibit acting-out behaviors, such as temper tantrums and self-mutilation. They distance themselves by being hostile and insulting, usually arising from discomfort with closeness.
  • Splitting: Splitting arises from the person’s inability feel people are safe, and is the primary defense mechanism in BPD. They view all people, including themselves, as either all good or all bad.
  • Manipulation: Separation fears are so intense that people become masters of manipulation. They will do just about anything to achieve relief from their separation anxiety, but their most common ploy is to play one individual against another.
  • Self-destructive behaviors: Threats are most often manipulative, but some acts can prove fatal.  Cutting is very common.  Suicide attempts are common yet often happen in relatively safe scenarios, such as swallowing pills at home while reporting the deed to another person.  Another behavior is to set up a scenario where they are victim so as to get attention and love.
  • Impulsivity: Extremely rapid shifts in mood can lead to substance abuse, binge eating, reckless driving, sexual promiscuity, and excessive spending or gambling.  These are similar symptoms of bipolar mania, but BPD behaviors happen for different reasons, usually in response to real or imagined abandonment.

You really can turn your child’s future around.

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Get your power back and reduce your child’s tantrums

Get your power back and reduce your child’s tantrums

If you have lost control of your troubled child and your household (most of us have), you know how hard it is to get things back on track.  This is especially for following house rules. Each time you try to enforce a rule, it’s ignored, or your child throws a huge tantrum, and you give in rather than expend more of your precious energy.  Who wants to invite another backlash?  Who wouldn’t give up, and choose the lesser of two bad options by allowing them to get their way?

A powerful tantrum is a good thing… only if you’re holding the line.  It’s evidence that you are regaining authority.

This seems counterintuitive, but the more your child fights back, the more power they lose, and the more you recover your authority.  It is normal to fight back harder and harder against rules and boundaries, then have an over-the-top tantrum.  It’s a psychological response that psychologists call an “extinction burst.”  It means the original behavior goes extinct and behavior improves thereafter.  It has been measured through behavioral observations of people of all ages and has nothing to do with troubled behavior.  The term “extinction burst” is even used by dog and horse trainers to describe a behavioral change in training. 

It goes like this: parents set a rule and start firmly enforcing it, and one of two things happen: 1) a huge tantrum, or 2) things are OK for a little while, and then tantrums start again.  If you can hold the line, psychological studies show that when massive tantrums fade, the extinction burst peaks.  They give up their own power and change their behavior.  Look at this diagram:  The vertical scale indicates level of bad behavior.  When a rule is firmly enforced (intervention), the tantrum peaks then it falls off quickly.

If you can stick it out through that huge tantrum, you will see fewer tantrums over time.  It works, but one must be like a rock and have support when The Big One happens. But be prepared, you might need to face several extinction bursts.  Little by little, simple rules will be followed, or they’ll be followed most of the time (you will always be tested).  But by this point, enforcement becomes easier.

Plan for major tantrums ahead of time and recruit help for holding a firm protective wall.

For explosive and aggressive children, it can be scary or dangerous to be on the receiving end because you know about the potential for violence and harm.  Prepare family members and others, and explain how the tantrum will be handled and how everyone will be kept safe.

Rules for house rules:

  1. Few
  2. Fair
  3. Strictly Enforced

Run a tight ship at home, but only have a few hard-and-fast rules, maybe 2 or 3, to save your energy.  Holding fast on enforcement is draining. Pick the rules carefully because they need to make sense and feel fair to everyone. Rules should also consider safety and family wellbeing, examples: we will eat every dinner together as a family; curfew is 8 pm; if there is any outburst, the person must stay in their room for 15 minutes, then they can come out, etc.

You may be surprised how relieved everyone will be after living through chaos for so long!  They will be thankful someone is finally in charge instead of the troubled child.  When I put on my armor and set about getting my power back, it was exhausting and very stressful, but consistent order brought a sense of security and safety. Use common sense and be flexible, set aside some rules temporarily if your child is in crisis or the family is too stressed at the moment.  Be very strict on only a few critical things, for example:  have zero tolerance for violence against others and alcohol and drug use.

You earn more respect when you are in control and better protect everyone’s peace of mind. 

You are the king or queen of your home, it is not a democracy.  Make reasonable and fair rules, enforce the rules with an iron hand at first, and then relax bit by bit, and live in a peaceable kingdom (with problems you can handle).

 –Margaret