Early Diagnosis (Before the Age of 18)

In the spirit of providing impartial information for BPD sufferers and their families, in this information page we will provide the hotly debated reasons why a BPD diagnosis should or should not be given before the age of 18. There are qualified professionals who line up on both sides of this divide.

Reasons Typically Given for Not Making a Diagnosis Before the Age of 18

• The personality is not yet fully developed, so how can one determine that someone suffers from a personality disorder?
• It is difficult to distinguish between adolescence and BPD anyway, so why risk making such a dramatic diagnosis?
• The stigma surrounding BPD may cause the sufferer to despair.
• Given the biosocial nature of the disorder, this diagnosis may burden parents with a tremendous degree of guilt and, thus, lessen the efficacy of the treatment.
• Given the stigma of the disorder as untreatable, clinicians are concerned about making such a diagnosis lest it dissuade other therapists from taking on the case.

So, Why Not Make the Diagnosis?

• Choosing the eighteenth birthday as a pivotal date is quite arbitrary. The human personality may reach full development six months before or after one’s eighteenth birthday, among other possibilities. Furthermore, temperament is inborn and is even evident in infants, so insofar as temperament is a crucial part of the diagnosis waiting overmuch is unnecessary. (Dr. Blaise Aguirre has noted that most of his patients claimed to have already experienced BPD traits during adolescence, if not earlier.)
• The DSM also permits an earlier diagnosis if the traits have already been solidly established for two years.
• A trained clinician can differentiate between BPD and normal adolescence, and should the primary care physician be in doubt BPD experts can be called in to render a differential diagnosis.
• Oftentimes giving the disorder a name allows patients to cope better and more effectively (“know thy enemy”), since they have an explanation for the traits that are hijacking their lives.
• The stigma regarding BPD stems largely from the mental health professionals, not the family members or the sufferers. If the diagnosis is explained to the patients and their families clearly and cogently with compassion and understanding, they will not be thrown by the name (of a disorder that they have never even heard of)!
• Early, focused intervention may save the sufferer and his or her relatives from years of unnecessary suffering , and even from death by suicide during these crucial years. Without a clear diagnosis it is difficult to persuade the health care system to swing into action and provide the necessary care. Instead, each symptom is treated on an individual basis.
• Dialectical Behavior Therapy and other similar treatment protocols do not have side effects, like drug treatment does. So why not teach the sufferer these useful skills at a younger age?
• Today there are several promising treatment protocols for BPD. As Marsha Linehan has said, “It’s a good prognosis diagnosis,” since we have effective treatment options, although we still have no approved drug therapy for the disorder itself.