Category: bipolar disorder

Mental Health Medications for Children ages 3 – 12

Mental Health Medications for Children ages 3 – 12

This is an excerpt from an article contributed by Drugwatch, an organization devoted to informing the public about the uses and risks of drugs and medications, and the use of medical devices.

Doctors may prescribe the use of medications to treat the health effects of bullying.

For example, children who suffer from depression or anxiety disorders (two health effects of bullying) may be prescribed selective serotonin reuptake inhibitors (SSRIs), such as Prozac. It’s important for parents to be aware that all SSRIs carry risks.

Childhood Bullying & Its Health Effects

Research shows that bullying behavior can start as early as age 3. Both children who are bullied and those who bully others may have serious lasting health problems as a result of these actions.

Bullying may cause lasting health issues for both parties involved.

A 2017 study by University of Pittsburgh researchers, for example, found that children who are bullied experience mental and physical health issues that can last well into adulthood. The study shows that bullied children are more likely to have trouble with finances and to be treated unfairly by others. They are also more pessimistic about their futures, according to the study.

On the other hand, the study revealed bullies are more likely to be stressed, hostile and aggressive, and to smoke cigarettes and marijuana. Both bullies and their victims are at a higher risk of heart disease, which is the leading cause of death for both men and women.

Doctors may prescribe Cymbalta to treat generalized anxiety disorder in children ages 7 to 17.Childhood developmental or learning disorders are often diagnosed when a child is of school-age. Mental illnesses, however, can be hard for a parent to identify. Although children can develop the same mental health conditions as adults, they sometimes express them in different ways. In 2013 alone, more than 8.3 million children were taking psychiatric medications. About half of the medicated children were between the ages of 6 and 12.

ANXIETY DISORDERS

Anxiety disorders are a group of mental disorders branded by feelings of anxiety and fear. Children may have more than one anxiety disorder. More than 2 million children were on anti-anxiety medications in 2013. The age group with the largest number of medicated children was ages 6 to 12 years.

Generalized Anxiety Disorder (GAD)

It’s perfectly normal for your child to stress about grades or an upcoming sporting event. However, if your child worries excessively or if anxiety and fear affect your child’s ability to perform daily activities, your child may be suffering from GAD. Doctors may prescribe Cymbalta, a serotonin-norepinephrine reuptake inhibitor (SNRI) as treatment. In 2014, the FDA approved Cymbalta for the treatment of generalized anxiety disorder in children ages 7 to 17. SNRI medications carry serious risks, including birth defects, skin disease, suicidal thoughts and liver toxicity. The FDA also warns of Cymbalta discontinuation syndrome, which is when a person experiences withdrawal side effects after stopping Cymbalta. Effexor, another SNRI, has not been approved by the FDA for use in children, but some doctors prescribe it for older teens as an off-label treatment for depression and anxiety.

Obsessive Compulsive Disorder (OCD)

Prozac, Zoloft and Luvox are among the drugs used to treat OCD in children.

Children with OCD experience unwanted and intrusive thoughts — or obsessions. They feel compelled to repeat rituals and routines to try to lessen their anxiety. OCD can affect children as young as 2 or 3, though most children with OCD are diagnosed around age 10. The FDA has approved several drugs to help control the symptoms of OCD in children, including Prozac, Zoloft and Luvox.

The FDA has approved haloperidol, pimozide and aripiprazole to treat tics.

Tourette Syndrome

Children with Tourette syndrome may make unusual movements or sounds known as tics. The FDA has approved haloperidol, pimozide and aripiprazole to treat tics.  All three medications have the potential to cause unwanted side effects, so most doctors prescribe the blood pressure medications guanfacine or clonidine. This is known as “off-label” use because the FDA has not approved either drug for treatment of tics.

MOOD DISORDERS

Every child can feel sad or depressed at times, but mood disorders are more extreme and harder to manage than typical sadness. Doctors may prescribe antidepressants or antipsychotics to treat mood disorders in children. SSRIs are popular antidepressants, despite an increased risk of suicidal thoughts in children. Prozac is the only SSRI approved for use in children older than 8 years of age. Antipsychotics prescribed to children include Abilify (aripiprazole), Thorazine (chlorpromazine), Risperdal (risperidone) and Invega (paliperidone).

These new kinds of drugs called atypical antipsychotics can have serious side effects in children like drastic weight gain, sedation and movement disorders. Risperdal and Invega also include a side effect called gynecomastia, a condition where boys develop breasts.

Nearly 2.2 million children were on antidepressants in 2013, and more than 830,000 were taking antipsychotics. In addition, doctors often prescribe the anti-seizure drug Depakote for children with bipolar disorder, a use not approved by the FDA. The medication has a black box warning for increased risk of liver failure and pancreatitis in children and adults.

(Blog owner’s note: Antidepressants are sometimes mistakenly prescribed to depressed children who are actually experiencing the depressed phase of bipolar disorder. The risk is that antidepressants can bump a child’s mood way too high, into mania.)

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Doctors use stimulants like Ritalin and Adderall to treat ADHD.

Doctors have been diagnosing children as young as 4 with ADHD. In the past nearly 30 years, the number of children diagnosed with ADHD has grown six-fold. Scientists estimate about 5 percent of children actually have ADHD, but the CDC shows that 15 percent are diagnosed.

Doctors usually treat children with ADHD with stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine and dextroamphetamine). Side effects of these drugs include decreased appetite, sleeping problems and headaches. Less common but more severe side effects include the development of tics and personality changes. Data from 2013 showed more than 4.4 million children were on ADHD drugs.

Children with a history of heart conditions may have a higher risk of strokes, heart attacks and sudden death when taking stimulants. Studies have also found rare cases of children developing hallucinations – such as hearing voices and increased suspicion without reason – or becoming manic.

Children & Medications

Children are particularly vulnerable to the potentially harmful side effects of drugs during important stages of physical and mental development. The amount of mental health drugs prescribed to youth has increased at an alarming rate, and each comes with its own risk.

AUTHOR

Emily Miller
emiller@drugwatch.com
407-955-4198

 

This is the full article from which the above post is excerpted:
“Children’s Comprehensive Health Guide – From Newborn to Preteen”

 

What will happen in your troubled child’s future?

What will happen in your troubled child’s future?

Are you scared for your child’s future? Is he or she is falling behind? On a scale of 1 to 5, where 1 is “Normal” and 5 is “Worst Case Scenario”, what will your child’s future adulthood look like?

This chart depicts a spectrum of outcomes of mentally ill children when they become adults.  No matter how ill your child is, if he or she gets support and treatment early, their future adult life could end up in the NORMAL column, and out of the RED column.  A network of family, friends, and professional staff can keep them from the worst-case scenario in the far right column, and move them in the direction of normalcy.

“Wellbeing” is possibly the most important.

This is a checklist of childhood problems that lead to poor future outcomes as adults.  Jump on them one by one.

  • Friend problems:  they have inappropriate friends, or no friends, or they mistreat friends (and siblings).
  • Behavior problems:  they do or say disturbing things (swearing, hurting, breaking, manipulating, sinking in depression, attempting suicide…). Everyone is stressed.
  • School problems:  disruptive behavior; poor grades (or a sudden drop in good grades); bullying or being bullied.
  • Health problems:  physical health problems become mental health problems, and vice versa:
    • trouble with sleep
    • digestive system and gut problems
    • poor diet and lack of exercise
    • epilepsy or neurological disorders
    • hormones during puberty
    • substance abuse.
Age 16, starting mental health treatment

We designate legal adulthood between the ages 18 and 21.  That’s too young.  Many normal healthy young people at this age are immature and irresponsible, but your son or daughter may lag well behind them.  Your child may need support and rescuing well into the 20’s or early 30’s–this is not unusual.

You’ll survive the marathon of tough years by pacing yourself, finding support for yourself, and protecting your mental health.

There is reason for hope.  Your child may take many horrible directions in their teens and 20’s, and you may feel hopeless about their future, or helpless as you witness their life nosedive.  If you can hang on and marshal support, your child will find a circuitous path to recovery.  It will have sharp turns and back steps and falls, but they’ll find it… and enter stable adulthood.

Age 20, after consistent mental health treatment

Some parents and families have seen the worst.  They’ve endured violence due to their child’s addiction; sat in court when their son or daughter was convicted of a crime; or they waited in the Emergency Room when their son or daughter was admitted for psychiatric care.  They also lived to see their child achieve the sanity to finish their education, support themselves, develop good relationships, and get that future you always wanted for them.

How two parents handled a “worst case scenario” and supported their child’s wellbeing:

These are true stories of mothers who stuck by their very ill adult children and provided what little they could to bring a bit of wellbeing.  These mothers found some peace by simply doing what they could.  Their child still had hope.

One had a grown son with schizophrenia and a heroin addiction who lived in squalor in supported housing.  He spent all of his disability assistance money on heroin and nothing else.  Her efforts to help him met with verbal abuse and threats of violence, and she feared for her safety.  What could she do, witness his slow suicide by starvation or overdose?  She arranged to visit him once a week in the parking lot, and brought 2 sacks of groceries in the trunk of her car.  He was to come out and get the groceries while she stood at a safe distance.  This worked.  He was still verbally abusive when he got the groceries, but he got food and she stayed safe.  Did he have wellbeing?  Was his life humane?

He lived indoors
He had enough food and clothing
He had encounters with social services and police, which led to some health care
A support system was available if he was ready for help.

One had a son addicted to methamphetamine who was lost to the streets. One day, she discovered a nest of old clothes and rags in an overgrown area behind her garage, and instinctively knew it was from her son.  “Good,” she thought, “He’s alive; I can keep him safe.”  She rarely saw him come and go, but she replaced the rags with clean blankets and a sleeping bag, and put out food for him, and provided a tent.  She couldn’t free her son from addiction, but she could keep him safe from the streets and its desperate people, and fed and sheltered in a way he accepted.

Like in the previous story, her son had a modicum of safety and support, and ongoing monitoring if he was ready for help.

 

–Margaret

Please share your story.

Take this parenting skills test if you have a troubled child

Take this parenting skills test if you have a troubled child

So how are you doing in your difficult parenting job?  Score your parenting skills on a test designed for parents of children ages 11-15.  This is intended for parents of ‘normal’ children, so you may skip 5, 6, and 7. (If you are brave, have someone else score you too and compare results.)

Parenting Skills Test – printable form

Don’t be hard on yourself if you score low.  Only a “perfect” parent will have an excellent score… and they wouldn’t need to read this blog!

What did you learn?  What are the skills where you scored lowest?  Focus on them.  Troubled kids need to be parented differently.  What you’ve learned by watching skilled parents may not apply to you.  You might be thinking:  “I agree these are good parenting skills, but practicing them is impossible with my child. They hate/defy/scream/fill-in-the-blank constantly.” Suggestion:  Work on one skill at a time, and take the test again in few weeks to see if you’ve improved your score. 

Be and kind forgiving of yourself if you score low

When my child was young and I was stressed, I would have had a low score and fallen in the “Keep trying” group.  My child’s mental health so poor, and she was so at-risk, I could only focus on safety and live one day at a time.

Why 3 of the items don’t apply for parents with mentally ill children, IMHO

#5  “I let natural consequences do the teaching whenever feasible.”  In my case, natural consequences could always be serious and unsafe.  This would have been very unwise.
#6  “I am confident my child has everything she/he needs to make good decisions.”  No way.  They cannot make good decisions when they are irrational–that’s the problem.
#7  “I allow my child to do his/her chores without reminding.”  I gave up on chores.  It was one battle I didn’t have to fight.  It was much easier doing them myself and knowing they’d be done.

Please add a comment if you have found other skills to be effective,

–Margaret

What to know about psychiatric residential treatment

What to know about psychiatric residential treatment

residential centerHave you been searching for psychiatric residential treatment for your child?  Do all the programs sound wonderful?  Ads include quotes from happy parents, and lovely photos and fabulous-sounding activities.  But what’s behind the ads?  Residential treatment programs are diverse, but there are important elements they should all have.  Here’s how to avoid low quality residential treatment.

Psychiatric residential treatment is serious stuff–it’s difficult to do–especially when troubled children and teens are put together in one facility.

Should you ask other parents for their opinion of a program?  In my experience with a child in psychiatric residential care, and as a former employee of one, word-of-mouth is not a reliable way to assess quality or success rate.  There are too many variables: children’s disorders are different; acuity is different; parents’ attitudes and expectations are different; length of time in the facility is different; what happens once a child returns home is different…  It’s most helpful to ask questions of intake staff and doctors or psychologists on staff.  Quality psychiatric residential care facilities have important things in common.

What to ask about the staff:

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  • What is the training and licensure of staff?  Are there therapists with MSW degrees, registered nurses, psychiatrists and psychiatric nurse practitioners, and is a medical professional available on site 24/7?
  • There should be a high staff to patient ratio, and a physically comfortable environment with lots of emotional support.
  • Do the staff seem mature to you?  Do they support each other, are they a team? There is often heavy staff turnover at residential treatment centers because the work is emotionally draining, so staff cohesion is as important as the qualities of each individual.
  • Safety is paramount.  What are the safety and security plans in the facility?  Staff must be able to safely manage anything that can go wrong with troubled kids.  They should be trained in NCI (Nonviolent Crisis Intervention), “training that focuses on prevention and offers proven strategies for safely defusing anxious, hostile, or violent behavior at the earliest possible stage.”

What to ask about programs:

  • Does the program specifically identify parent/family involvement as part of treatment?  Does it emphasize parent partnership with staff?  Ask.  Whether you live close or far from the center, even out-of-state, you should be regularly included in conversations with staff about your child’s treatment.  You should also be included in a therapy session with your child periodically; some facilities can connect with you over Skype.  Your child’s success in psychiatric care depends on their family’s direct involvement.
  • The program should coach you in specific parenting approaches that work for child’s behavioral needs.  While your child is learning new things and working on their own changes, you must know what to establish back home when they return.
  • You should be informed why your child is getting the treatment or behavioral modifications he/she is receiving.
  • Last and most important: when your child leaves, there should be a discharge meeting and a discharge plan.  What this means:  all staff who worked with your child get together with you and discuss what treatment should continue once they go home.  Medication management and therapy is identified in advance, appropriate school accommodations are discussed, changes in the home environment are discussed if needed…  You should never leave without knowing what comes next in the months following care.

Body health is brain health, and vice versa.

  • residential programsMental health treatment will include medication and therapy, but must also include positive activities and an educational program.  The whole body needs care:  exercise, social activities, therapeutic activities (art, music, gardening), healthy food, restful sleep, etc.

Is your child emotionally safe as well as physically safe?

  • You should be able to visit the unit or cottage where your child will live, see their bedroom, and see how the other children interact with staff and how staff interact with each other.

What to ask about the business itself:

  • Can you take a tour ahead of time?  Can your child or teen visit too if appropriate?
  • Are emergency services nearby (hospital, law enforcement) that can arrive quickly?
  • Does the facility have a business license in their state?  Do they have grievance procedures?  Is the center accredited as a treatment facility, and by whom?  In the U.S., the main accreditation authority for healthcare facilities is The Joint Commission.

Psychiatric residential treatment works miracles, but it doesn’t work for all children.  Some need to go into treatment more than once to benefit. Some fall apart a few weeks or months after discharge.  These are common.  What’s important is that staff observations and advice help you and your child with insight and skills for managing his or her unique symptoms, and for communicating effectively.

Good luck.

 

What was your experience when your child was in residential care?  Please share your comment so others can learn.

Brace yourself for borderlines

Brace yourself for borderlines

Borderline personality disorder is “All Of The Above”:  lovely and creative; manipulative and vindictive; tortured and anguished; glowing with energy and joy; self-hating, self-centered, perceptive and gifted, a victim… Without warning, a person can switch from one presentation to another.

Are you ready to bang your head on a wall?  Do you want to abandon your child in the wilderness?  Are you praying for the day they turn 18, when you can change the locks on your doors?  Children with borderline personality disorder (BPD) bring out the worst in everyone around them.

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

Yes, BPD kids really believe that others are out to get them, and that all their problems are someone else’s fault.  They are appalled that others mistreat them horribly.  They are insulted and defensive when they detect criticism, even when there isn’t any.  They can never be pleased, and it’s always about them.  Most exasperating for you, they turn from monstrous, to sweet and charming, and back to monstrous in an instant.

“Does this explain why I can go from 0 to 60 in two seconds?”
–17-year-old girl when told she was diagnosed with borderline personality disorder

Especially confusing, a borderline teen can be very engaging and affectionate… sometimes at random, and sometimes when they want something.  They will also turn on the charm in a way to to embarrass you in front of others (e.g. family therapy).  Since they seem so wonderful to other people, you are asked why you get upset at your clearly wonderful child.  People often recommend 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.

When playing a game that requires teamwork, the brain of a normal person shows activity in the bilateral anterior insula.

For goodness sake, why?

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.  Borderline personality patients do not have an internal, natural sense of fairness and social norms, and little to no level of trust.  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 the teamwork game, the brain of a borderline person showed no activity whatsoever.

Statistics

Another research study reported that borderline personality disorder occurs as often in men and women, and sufferers often also have other mental illnesses or substance abuse problems.  (In my personal observations over many years, teenagers with borderline personality disorder are often diagnosed with bipolar disorder.) 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.

In infants:  the children 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 jump between any behavior: extremely manipulative; more promiscuous; aggressive and impulsive; more likely to use drugs and alcohol; assaultive; and more likely to cut 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.”

Evidence for hope

Trying to Weather the Storm
Shari Roan, September 07, 2009, Los Angeles Times

“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.

“But 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 from McLean Hospital in Massachusetts studied 290 hospitalized patients with the condition over a 10 year period:  93 percent of patients achieved a remission of symptoms lasting at least two years, and 86 percent 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.

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

Treatment

“What Therapy Is Recommended for Borderline Personality Disorder in Adolescents (13-17 years)?”(excerpt)
Mary E. Muscari, PhD, August 9, 2005, http://www.medscape.com/viewarticle/508832

Psychotherapy is the primary treatment of BPD, specifically long-term dialectical behavior therapy (DBT), which helps the person attain and maintain lasting improvement in their personality, interpersonal problems, and overall functioning.  DBT appears to be the most effective.  It focuses on coping skills, so patients learn to better control their emotions and behaviors. This may be complemented with medications that help with mood stability, impulsivity, psychotic-like symptoms, and self-destructive behavior.

There are several appropriate therapies in addition to DBT, and all share common elements:  1. The bond between the patient and therapist is strong.  2. Therapy focuses on the present rather than the past, on changing one’s behavior patterns now regardless of how patients feel about the past or if they see themselves as victims.

On DBT:  I recommend this straightforward self-help lesson to get started learning the concepts and skills:  http://www.dbtselfhelp.com/html/dbt_lessons.html.

When to hospitalize

  • In an emergency – when your child has serious suicidal thoughts or an attempt, and/or is in imminent danger to others.
  • In long-term 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), risk of violent behavior, and other severe symptoms that interfere with living.

Other treatment a borderline 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 when an adolescent loses their sense of reality.
  • Reduce stressors in the young person’s environment.  Most adolescents with BPD are very sensitive to difficult circumstances, for examples: an emotionally stressful atmosphere at home; teasing in school; pressures to succeed or change; consistent rules; being around others who are doing better than them, etc.

What parents and caregivers can do

With a partner or spouse:  Maintain a united front.  Communicate continually to stay on the same page when managing your child and setting limits.  Have each other’s back even if you’re not in full agreement.  Always take disagreements out of earshot of your child.  Any disagreement they hear 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 DBT and help your child stay in the here and now.  Keep up the reminders that enable them to stay in the moment, to take those extra few seconds to think things through before reacting.

  • 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.

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 really does provide relief.
–Margaret

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.

Other characteristics of BPD

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

Bad 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 severe dissociative symptoms or paranoid ideation.

  • Chronic depression: Depression results from ongoing feelings of abandonment.
  • Inability to be alone: Chronic fear of abandonment also leads to these adolescents having little tolerance for being alone. This results in a constant search for companionship, no matter how unsatisfying.
  • Clinging and distancing: Relationships tend to be disruptive due to the adolescents’ alternating clinging and distancing behaviors. When clinging, they may exhibit dependent, helpless, childlike behaviors. They over idealize he person they want to spend all 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. Distancing is characterized by anger, hostility, and devaluation, usually arising from discomfort with closeness.
  • Splitting: Splitting arises from the adolescents’ inability to achieve object constancy 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 these adolescents 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: The behaviors are typically manipulative gestures, but some acts can prove fatal. Suicide attempts are not uncommon yet usually happen in relatively safe scenarios, such as swallowing pills at home while reporting the deed to another person on the telephone.
  • Impulsivity: Poor impulse control can lead to substance abuse, binge eating, reckless driving, sexual promiscuity, excessive spending, or gambling. These behaviors can occur in response to real or perceived abandonment.

Drawn from:
Risk taking adolescents: When and how to intervene (excerpt)
David Husted, MD, Nathan Shapira, MD, PhD , 2004
University of Florida College of Medicine, Gainesville

–Margaret