Symptoms & Diagnosis

Adapting Borderline Personality Disorder Treatment for Adolescents

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Adapting BPD treatmentIn the first article on this topic, we described Dr. Andrew Chanen’s findings regarding early detection and timely intervention of Borderline Personality Disorder (BPD) in adolescents. Chanen, who founded the HYPE (Helping Young People Early) program inAustralia, believes that much more effective treatment can be implemented during a period of development when dysregulated thinking and behaviors have not yet had years to evolve into entrenched problems in adulthood.

His HYPE (Helping Young People Early) program has proven quite effective in the treatment of BPD and its related symptoms in young people. In this article, we will look at how Chanen adapted traditional therapeutic approaches to BPD specifically for young people.

Assessing the Needs of Adolescents

Chanen is committed to making sure that patients know what the program his offering and how it can help them before they refuse it based on previous ineffective BPD treatment.

“Often young people with BPD have had pretty adverse interactions with mental health services and will often take a fair bit of coaxing, and not know what they’re refusing,” he said.

Chanen explains that young people often come into Borderline Personality Disorder treatment with many other diagnoses.

“They tend to come in with major depression, anxiety disorders, substance use disorders, eating disorders, or bipolar disorder,” he said.

Adolescents also sometimes enter BPD treatment programs with school problems, family problems, or a history of abuse and neglect.

Accommodating Adolescents in BPD Treatment

Chanen said that it’s important to note that young people can’t be expected to act like well-adjusted adults. Accommodations need to be made for young people dropping out of BPD treatment and later rejoining treatment.

By embracing this intermittent therapy rather than fighting it, Chanen avoids confrontation and promotes autonomy and independence. This way, the patients feel more in control of their BPD treatment, rather than getting the message that they need to become a long-term psychiatric patient.

Adapting Cognitive Analytical Therapy

The HYPE program uses a modified form of Cognitive Analytical Therapy (CAT) for both individual therapy and family sessions. CAT is a relational form of cognitive therapy developed for use in adults.

Chanen’s team has modified it for use in the 16 to 24 weekly treatment sessions of the HYPE program. In practice, about one-third of patients disengage from Borderline Personality Disorder treatment before individual sessions, even though most get some form of care or come back for some of them. About one-third complete the full sessions, and the final third is somewhere in the middle.

“You’ve got to remember, this is offering therapy to people who were never asking it for the first place,” Chanen said.  

One important key of the program, taken from the Cognitive Analytical Therapy approach, is the idea of a shared formulation. Developing a shared formulation with the young person about their problems in plain language helps make the therapy more accessible and less adversarial.

In conclusion, Borderline Personality Disorder is a lifespan disorder that can be diagnosed and treated in adolescents and, from Chanen’s studies, it seems that early intervention in adolescents suffering from BPD symptoms can prevent further problems when they become adults.

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