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Many adolescents and teenagers have a day, or even a few days, when they get upset… they are known to slam a door or curse at their parents etc… But teens with mood regulation issues tend to engage in more extreme behaviors — and more often — than the average teen, and these behaviors impair their social, school and working lives.

Mood regulation issues in adolescents are frequently classified as “ borderline personality disorder” or “ bipolar”(another name for which is “manic depression”).

Even for the most seasoned clinician or specialist it is difficult to differentiate one disorder from another in adolescents. However, making the distinction is significant because of the varied treatment options.


Borderline personality disorder (BDP) in adolescents is characterized by impulsive behaviors, shifting moods and more often than not, frequent thoughts of suicide.

For example, a teenager with borderline personality disorder may get angry, slam a door and then proceed to cut them selves or overdose on pills and require medical attention. Another teen with BPD may feel sad and lonely and proceed to abuse alcohol and engage in promiscuous sex, which may result in pregnancy. The point here is that these teens’ extreme behavior typically follows their inability to tolerate negative emotions like anger.

Most adolescents with BPD can cycle through moods more variably and rapidly: They might be sad for several hours, then be in a “normal” mood for several hours, then anxious for one hour, and then angry for several hours, and so on.

If a teen meets 5 of 9 criteria in the DSM-IV(the manual of mental disorders that health professionals use for diagnosis), they may be diagnosed with BPD. The various criteria typically includes extremely poor regulation of mood and behavior that lasts more than a year and that is unrelated to another psychiatric disorder.


The main defining feature of bipolar disorder in comparison to BDP, is a more intense depressed or manic state, lasting for a minimum of several days at a time.

Bipolar disorder is characterized by dramatic or unusual mood swings between major depression and extreme elation, or mania. The mood swings can be mild or extreme. They can come on slowly or quickly, within hours to days. Bipolar disorder usually starts between 15 and 30 years of age. It’s more prevalent in teens with a family history of the mood disorder.

The two subtypes of bipolar disorder are: bipolar I and bipolar II.

Bipolar I: the teenager alternates between extreme states of depression and intense mania. With the mania, the teen might be abnormally happy, energetic, and very talkative, with no need for sleep for days. He or she might also have hallucinations, psychosis, grandiose delusions, and/or paranoid rage, all of which might require hospitalization and medications.

Bipolar II: the teen has depression but a lesser form of elation called “hypomania.” While someone with either mania or hypomania may have grandiose mood and reduced need for sleep, hypomania is a period of incredible energy, charm, and productivity. It’s often associated with high achievers.

While many teens can be irritable with or without bipolar disorder, the irritability that comes with mania or “hypomania” may be more hostile. In fact, some believe there is a link between ADHD and bipolar disorder. Some 57% of teens that have adolescent-onset bipolar disorder also have ADHD.


Adolescents who are diagnosed with bipolar disorder likely need to be on medication. It is usually suggested that in addition to medication, various types of psychotherapy, such as cognitive behavioral therapy, interpersonal therapy and dialectical behavior therapy are helpful in keeping BDP under control. If teens are treated with medication- especially earlier in their treatment history- many with BPD can function well without medication once they have learned effective strategies to manage their emotions and behaviors.

Studies have shown that the technique, dialectical behavior therapy (DBT) is effective for teens with BPD, bipolar disorder and other mood regulation issues. Dialectical behavior therapy, a derivative of cognitive behavior therapy, helps patients identify thoughts, beliefs and assumptions that make their lives challenging and then learn different ways of thinking and reacting. Teaching emotional coping skills to teens with borderline personality disorder

The aim is to teach adolescents and their families a variety of life skills intended to better regulate their emotions and behaviors. These skills modules include:

  • Mindfulness
  • Emotion regulation
  • Distress tolerance
  • Interpersonal effectiveness
  • Walking the middle path

In addition to the conventional treatments Wilderness Therapy (WT) promotes real and long lasting change. Teenagers who enter WT programs with bi-polar disorder learn through intensive individualized therapy how to have greater control over their emotions. The beautiful surroundings the wellness program and the various challenges, also greatly contribute to the overwhelming success WT has had in helping troubled teenagers who struggle with mood regulation issues and disorders.