Many adolescents experience these symptoms without going on to develop BPD, but those who experience them are 9 times as likely as their peers to develop BPD. They are also more likely to develop other forms of long-term social disabilities.BPD is recognised as a valid and stable diagnosis during adolescence. The diagnosis of BPD (also described as "personality disorder: borderline pattern qualifier") in adolescents is supported in recent updates to the international diagnostic and psychiatric classification tools including the DSM-5 and ICD-11. Early diagnosis of BPD has been recognised as instrumental to the early intervention and effective treatment for BPD in young people. Accordingly, national treatment guidelines recommend the diagnosis and treatment of BPD among adolescents in many countries including Australia, the United Kingdom, Spain, and Switzerland.The diagnosis of BPD during adolescence has been controversial. Early clinical guidelines encouraged caution when diagnosing BPD during adolescence. Perceived barriers to the diagnosis of BPD during adolescence included concerns about the validity of a diagnosis in young people, the misdiagnosis normal adolescent behaviour as symptoms of BPD, the stigmatising effect of a diagnosis for adolescents, and whether personality during adolescence was sufficiently stable for a valid diagnosis of BPD. Psychiatric research has since shown BPD to be a valid, stable and clinically useful diagnosis in adolescent populations. However, ongoing misconceptions about the diagnosis of BPD in adolescence remain prevalent among mental health professionals.
The minds habit of suppressing and avoiding intensely painful emotions may provide some temporary feelings of relief, but dissociation can also lead to unhealthy coping mechanisms, while simultaneously causing the side-effect of blocking out or blunting positive emotions, thereby reducing the access of people with BPD to the valuable information those emotions provide: information that helps to guide effective, healthy decision-making in daily life. Psychotic symptoms
Though BPD is primarily seen as a disorder of emotional regulation, psychotic symptoms are fairly common, with an estimated 21–54% prevalence in clinical BPD populations. These symptoms are sometimes referred to as "pseudo-psychotic" or "psychotic-like", terms that suggest a distinction from those seen in primary psychotic disorders. Recent research, however, has indicated that there is more similarity between pseudo-psychotic symptoms in BPD and "true" psychosis than originally thought. Some researchers critique the concept of pseudo-psychosis for, on top of weak construct validity, the implication that it is "not true" or "less severe", which could trivialize distress and serve as a barrier to diagnosis and treatment. Some researchers have suggested classifying these BPD symptoms as "true" psychosis, or even eliminating the distinction between pseudo-psychosis and true psychosis altogether.The DSM-5 recognizes transient paranoia that worsens in response to stress as a symptom of BPD. Studies have documented both hallucinations and delusions in BPD patients who lack another diagnosis that would better account for those symptoms. Phenomenologically, research suggests that auditory verbal hallucinations found in patients with BPD cannot be reliably distinguished from those seen in schizophrenia.