QUESTION:

Dear Dr. Heller,

Hello.

The instant I had a teacher describe BPD in a course I was taking in college, I knew that my niece could be the "poster girl" for it. However, when I mentioned it to her sister, who then asked my niece's doctor, the doctor said that they do not diagnose it until adulthood. I think she is classic BPD and has been refused treatment at one hospital after a residential stay there for eating disorders. My question is, why does she need to wait until adulthood to be diagnosed and treated for this specific disorder?

Thank you.

DR. HELLER'S ANSWER:

The definition of young adulthood is the question here. Puberty marks the transition from childhood to adulthood in many societies in the world. In the US we arbitrarily define adulthood as age 18.

Clearly the BPD begins at adolescence, when the brain's limbic system goes into hyperdrive. Because with rare exception the diagnosis requires a longstanding pattern early or mid adolescence is a difficult time to make the diagnosis. Self-mutilation, multiple depression admissions, self-destructive behavior and moodiness can sometimes make the diagnosis clear in adolescence.

Waiting until "full adulthood" for treatment can be fatal in the event of suicide, and can establish a lifetime pattern of thoughts and behaviors that will be difficult to overcome later on. I'm a strong believer in early treatment.

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