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Personality Disorders

Blocks spelling BPD with arrows pointing to personality disorder concept illustration

Introduction to Personality Disorders

Personality disorders are long-standing patterns of thoughts, emotions, and behaviors that cause problems in daily life. They usually begin in the teen years or early adulthood. In children and younger teens, personality is still developing, so clinicians are careful about using these labels. The DSM-5-TR allows a diagnosis under 18 only when patterns are pervasive and persistent for at least one year, and not better explained by typical development or another condition; antisocial personality disorder isn’t diagnosed before 18. Many traits lessen as kids mature, which is why a thoughtful evaluation matters. Our goal is to support safety and functioning—not to rush to a label. 

Emergency: If your child talks about suicide or has a plan to harm themselves or others, call 911 or go to the nearest ER. In the U.S., you can also call or text 988

Safety note:

If your child talks about suicide or has a plan to harm themselves or others, call 911 or go to the nearest ER. In the U.S., you can also call or text 988.

Signs & Overlap to Watch For

Ongoing patterns that differ from peers—like intense, unstable emotions and relationships; impulsivity; distrust; rigid perfectionism; or fear of rejection—can signal trouble when they show up across many settings and last over time. But many of these features also appear in other conditions (anxiety, depression, ADHD, OCD, trauma-related stress, or autism-related needs) or can be part of normal development for a time. That’s why an assessment is key before naming anything. Family history, stress/trauma, and temperament may raise risk. Medical News Today+1

Colorful gears with a sad face representing emotional regulation and mental health symptoms
Teen girl talking with a counselor during a mental health therapy session

Treatment and Management

At Texas Pediatric Mental Health Services, we start with a full evaluation of symptoms, strengths, medical history, and daily life. With your consent, we coordinate with your pediatrician and school. Treatment focuses on skills and safety, regardless of diagnosis:

  • Therapy (first line): CBT and DBT skills to manage emotions, reduce risky behaviors, and improve relationships; family involvement helps.
  • Medication (as needed): to treat co-occurring problems such as anxiety or depression after careful review.
  • Supports at home/school: routines, coping practice, and simple school accommodations.

We set goals together, track progress, and adjust the plan over time. Many young people improve with the right supports.