It is difficult to diagnose borderline disorder accurately in children because similar symptoms may evolve into one of several disorders as the child develops. 15,16 However, the disorder can be readily diagnosed in adolescence or early adulthood. 17,18,22 Nonetheless, there are indications of significant behavioral problems before the full form of the disorder becomes apparent.
Some children do appear to have symptoms that are very similar to borderline disorder in adolescents and adults. Parents of some borderline patients report they detected problems as early as the first year of life. The affected babies seem more “colicky,” cry more, have diminished ability to experience pleasure, sleep less restfully, are upset more readily by changes in routine, and are more difficult to soothe when upset.
In early childhood, children who later are diagnosed with borderline disorder are often described as being more demanding and requiring more attention than their brothers and sisters. Some seem to worry more, have more episodes of sadness, are more sensitive to criticism, continue to be more readily upset by changes in routine or plans, and are more easily angered. They are easily frustrated, and when frustrated they may have severe temper tantrums. Some have great difficulty separating from home to attend school, and under stress may demonstrate physical symptoms such as pulling out small strands of their hair, frequent stomach cramps, headaches, problems eating, and an abnormal sleep pattern.
In spite of these reports from parents, the fact is that we really do not know very much about what people with borderline disorder were like as children. There are relatively few articles in the medical literature about the characteristics of borderline disorder in children, and there is a lack of clear agreement about the presence and the diagnostic criteria of the disorder during childhood.16
A number of different descriptions of behaviors have been developed to diagnose children with borderline disorder. However, they appear to most accurately define those children who will later in life develop a number of different mental disorders, including borderline disorder and other personality disorders, attention deficit hyperactivity disorder and substance use disorders. 4
In general, these are the groups of symptoms in children that suggest a significant problem may be present that requires evaluation and possibly treatment:
- hyper-reactive emotions with severe temper outbursts
- poor impulse control, especially assaultive acts towards themselves or others
- significantly impaired thinking and reasoning
- marked disturbances in personal relationships
In the presence of these symptoms, it is advisable to seek a child psychiatrist experienced in treating borderline disorder.