This One Trait In Teenagers Might Lead To Borderline Personality Disorder

A group psychologists discuss the nature of BPD after tracking borderline symptoms in adolescents.

By Mark Travers, Ph.D. | April 3, 2022

A new study published in Personality and Individual Differences recognizes the presence of 'self-disgust' in adolescents as a telling sign that they might be in danger of developing Borderline Personality Disorder (BPD) in adulthood.

I recently spoke to researchers Diogo Carreiras, Marina Cunha and Paula Castilho about identifying certain traits in adolescence that might help prevent BPD in adulthood. Here's a summary of our conversation.

What inspired you to investigate the topic of Borderline features in adolescents?

Personality disorders are intriguing, especially borderline personality disorder (BPD). These kinds of mental illnesses are complex and affect several areas of a person's life, for example, social relationships, family, self-view, school/work, etc.

Additionally, BPD is associated with worrying suicide rates, overuse of health services, and high emotional pain.

Although personality disorders are usually diagnosed in adults, they present a developmental path and initial symptoms can be detected at early ages. This was why we decided to study borderline symptoms in adolescence.

When reading through the literature, we noticed the pertinence of studying borderline features in adolescence to identify protective and risk factors for the evolution of BPD. Our findings shed light on important psychological processes that might influence the course of BPD, giving clues to help people live a life worth living, accepting who they are, as they are, and providing them healthier emotional regulation strategies.

Prevention is better than cure.

Can you give a brief description of Borderline Personality Disorder? How do these borderline features present in adolescents?

BPD is a personality disorder whose initial features tend to manifest in adolescence. The most common symptoms of this disorder are:

  • feelings of abandonment (and hyperreactivity to rejection)
  • emotional instability and reactivity, for example, feeling intensely sad, happy, and angry in the same day
  • marked impulsivity (act without thinking properly)
  • feelings of emptiness
  • a negative self-view often with harsh self-criticism
  • risk behaviors (including self-harm).

Fears of abandonment, unstable interpersonal relationships, identity disturbance, and feelings of emptiness tend to be similar across ages. Adolescents seem to present higher impulsivity, suicidal behaviors, emotional instability, uncontrolled anger, and paranoid ideation (being suspicious about others' intentions) in comparison to adults.

Adolescents with marked borderline features might seem very unpredictable to other people, in terms of what they feel or do. They might be sometimes sad, or upset, other times very happy without any apparent obvious reason. They might also be very sensitive and reactive to relationships, particularly romantic ones, showing often fear of being abandoned, rejected, or left alone.

When left alone, they would probably try to do something to feel accompanied or prevent others from leaving. Self-harm behavior, such as cutting, burning, or scratching the skin are sometimes employed to numb or block difficult emotions and deal with emptiness feelings and emotional pain.

These are just some general considerations on adolescents' borderline features and there are several symptom combinations. Therefore, there is a need to assess case-by-case.

What was your research methodology? What would you say was your most important finding?

In this article, we used a longitudinal design in which adolescents were systematically assessed over a one-year period. This methodology allowed examining the effect of self-disgust on the evolution of borderline symptoms during that period, bringing a unique insight into this matter.

Although this design was very demanding in terms of time and effort, it captured wealthy and valuable information.

The most interesting finding, never evidenced until now, was the harmful effect of self-disgust on the evolution of youth borderline features. This means that if adolescents view themselves (what they are, what they do) as undesirable, repulsive, and bad they have an increased risk to grow borderline symptoms.

Our results raise evidence that self-disgust should be targeted by psychological interventions to prevent adolescents' borderline features from evolving into a personality disorder.

Your study emphasizes self-disgust as an important indicator of one's tendency to develop BPD in adulthood. Could you explain the concept of self-disgust?

Self-disgust is basically the emotion of disgust/revulsion directed at personal aspects and characteristics.

People might feel disgust when they see, smell or touch external things perceived as revolting and possibly toxic (for example, rotten food, body fluids), having an urge to withdraw from that. People might also feel the same emotion towards moral violations (for example, incest, murder) and personal things (for example, the body, thoughts, behaviors, or personality) that they would like to withdraw from but can't.

In people with BPD, the self-disgust might be related to a persistent feeling of being irrevocably bad, repulsive, or flawed resulting in harsh self-criticism, self-hatred, or self-loathing. This is sustained by previous experiences of invalidation, insecurity, or abuse usually reported by these patients.

Do you have any words of wisdom for adolescents who might be struggling with feelings of self-disgust (or their parents)?

First of all, don't be afraid to ask for help, both parents and adolescents. I know it takes courage, but there are people out there trying to better understand these difficulties to find ways out.

What we feel is valid, real, and true but it does not define our personal value. There are ways of coping with adversity and taking care of ourselves, respecting us, and acknowledging us seems to be a pretty good way to start.

You have been doing a brave job of navigating through very difficult times and experiences. You are not all the bad things you tell yourself you are. There is much more goodness in you than you realize. All humans are imperfect and that will not thwart us from being loved. Learn to love yourself from the bottom to the top. Embrace who you are, as you are, fight for being more of what you want to be, and live your best life.

At what point do such BPD feelings/features become a point of concern and/or demand medical attention?

It's all a matter of degree, frequency, and intensity. It's okay liking to be taller, having blond hair, even wanting to be more outgoing or sociable.

The problem arrives when people don't accept who they are, hate and criticize themselves roughly for being short or shy, and punish themselves for saying something silly in front of other people, for example.

Borderline features and self-disgust become a concern and demand professional intervention when people suffer intensely because of it, isolate themselves from other people, give up on their dreams or their life. They might exist alongside other disorders, for example, depression, anorexia, or post-traumatic stress. In some cases, this might result in life-threatening behaviors, such as self-harm or even suicide attempts. If so, medical attention is mandatory.

Did any gender differences emerge in your study?

In this particular study, we only tested gender differences in the trajectories and borderline features' levels. Boys exhibited lower borderline features than girls which was expected and aligned with previous research.

In adults, the BPD's gender ratio is one man for three women. Considering the trajectories by gender, they were similar and relatively stable over time, with boys always presenting lower levels.

Do you have plans for follow-up research? Where would you like to see research on this topic go in the future?

Yes. This study and others of our research project were necessary to provide evidence of the risk effect of self-disgust and the protective effect of self-compassion on the evolution of borderline features in youth.

Now, we intend to design a group intervention program for adolescents at risk (with subthreshold BPD clinical symptoms) to be implemented in schools.

This intervention program would be designed to teach practical skills, and exercises and cultivate self-compassion in adolescents. Cultivating a kinder internal speech, more awareness of the current experiences, and a feeling of being part of a shared human experience that includes difficulties and struggles are encouraged in these interventions.

We believe that a kinder and more positive self-to-self relationship could counteract the harmful effect of self-disgust and help prevent the development of BPD.