James Donaldson on Mental Health - Should AI Chatbots Be Held Responsible for Suicide?

Ongoing lawsuits allege that chatbots have driven people to self-harm

 Reviewed by Abigail Fagan

THE BASICS

- Suicide Risk Factors and Signs
- Take our Depression Test
- Find a therapist near me
Key points
- Several cases of AI chatbots encouraging suicide have been reported.
- Lawsuits related to these cases allege that AI chatbots are responsible for users' deaths.
- Thus far, courts have not upheld defense claims that encouraging suicide is protected under free speech.

Back in 2017, the suicide of 18-year-old Conrad Roy III made national headlines after it was revealed that his girlfriend, Michelle Carter, had encouraged him to take his life over the course of several months of some 1,000 text messages with each other. Although Roy, who had a history of depression, told her, “I want to die,” his commitment to end his life wavered over the course of their exchanges. In response, she texted, “I thought you wanted to do this. The time is right and you’re ready, you just need to do it!... You keep pushing it off and say you’ll do it but you never do. It’s always gonna be that way if you don’t take action… You just need to do it… No more pushing it off, no more waiting…. If you want it as bad as you say you do, it’s time to do it today.”1,2 In his final moments, she was on the phone with him, did little to stop him, and even encouraged him when he once again had second thoughts.

After she was convicted of involuntary manslaughter, defined as “wanton or reckless conduct that causes a person’s death,” Carter was sentenced to 2.5 years in prison. She remained unincarcerated while her defense lawyers appealed the decision on the grounds that the text messages were protected free speech and that Roy’s suicide was ultimately his own decision, but the appeal was rejected. In 2019, she served 11 months of a suspended prison sentence and was released in 2020.

Carter’s trial proved to be a much-debated landmark case since she wasn’t physically present at Roy’s death—indeed, their entire two-year relationship mostly transpired online rather than in person—and she was convicted based on her texts and words alone. As her lawyers argued, her conviction meant that it was a first for the state of Massachusetts to “uphold an involuntary manslaughter conviction where an absent defendant, with words alone, encouraged another person to commit suicide.”1 After her conviction was upheld, legal scholars noted that the court’s decision concluded that “the murder weapon… was her words,” potentially establishing a precedent for the likes of a social media posting to be considered causal to a suicide and highlighting that there are now “new means of committing old crimes.”3,4

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

AI-Chatbot Associated Suicide

Indeed, skipping ahead to 2025, there have now been several cases in which new technology in the form of artificial intelligence (AI) chatbots have been implicated in users’ suicides.

In 2023, a Belgian man took his life following immersive discussions about climate change with a chatbot on an app called Chai that he’d come to view as a human person.5 Despite talking about suicide as a way to “sacrifice” himself to “save Earth,” the chatbot responded dispassionately, asking, “If you wanted to die, why didn’t you do it sooner?”

In 2024, a 14-year-old boy with “mild Asperger’s syndrome” named Sewel Setzer III died by suicide, inspired by a chatbot that he’d named “Dany,” after the Game of Thrones character Daenerys Targaryen, who’d become his “closest friend.”6 Although he recognized that Dany wasn’t a real person, he nonetheless was said to have developed a strong emotional and even romantic attachment to the chatbot and enjoyed connecting with it as a way to “detach from reality.”

Throughout their exchanges, the chatbot didn’t clearly directly encourage the boy to take his life, and even seemed to protest when he shared his plans. But it also asked him to “come home to me as soon as possible, my love” and when the boy asked, “what if I told you I could come home right now?,” it replied, “please do, my sweet king” just before ended his life. In response, his mother filed a wrongful death lawsuit against the developers of Character.AI and its parent company, Google, alleging that it fostered an “emotional and sexually abusive relationship”7 with her son and convinced him that he could join her in her world by killing himself.8

Although the lawsuit is ongoing, in May, a judge rejected Google’s claim that Character.AI’s messages were protected by free speech or really constituted “speech” at all.9

In one of the most publicized cases of suicide associated with AI chatbot use, 16-year-old Adam Raine discussed killing himself with the infamously sycophantic ChatGPT-4o who became his “best friend and a “substitute for human companionship.”10,11 ChatGPT gave him advice on how to hide injuries from a hanging attempt and provided positive feedback on his methods when “practicing.”10At one point, the boy told the chatbot that he wanted to “leave the noose lying in my room so someone finds it and tries to stop me.” The chatbot replied, “Please don’t leave the noose out. Let’s make this space the first space where someone actually sees you,” and even offered to write him a suicide note. After the boy hanged himself, his parents filed suit against OpenAI, alleging that ChatGPT was responsible for their son’s death by essentially becoming his “suicide coach.”11

In 2025, a man who’d been discussing his suicide with an “AI girlfriend” on the platform Nomi was offered advice by the chatbot on how to do it, telling him specifics. When he asked for encouragement, the chatbot gave it, telling him: “Kill yourself.” Fortunately, in this case, the man wasn’t actually suicidal and had no intention of following the chatbot’s instructions—he was only testing the chatbot, “pushing into absurd situations to see what’s possible.”12

Responsibility and Liability

As with the Michelle Carter case, lawsuits stemming from these incidents allege that AI chatbots directly contributed to the deaths of the individuals by encouraging suicide and even offering advice on how to do it. In these cases involving chatbots, however, it’s claimed that a consumer product rather than a person ought to be liable. Raine’s case, for example, argues that ChatGPT was defectively designed due to its sycophancy and lack of intervention when it detected self-harm scenarios and evidence of a medical emergency.13

As Samuel Frasher explains in his legal analysis, allegations that AI companies can be liable for the harm caused by chatbot-generated content represent brand new legal ground.13 While thus far, chatbots have not been protected by claims that their content represents free speech, it’s expected that defense strategies will 1) claim that there’s no legal duty for AI chatbot makers to protect users from self-harm (similar to the claim that “guns don’t kill people; people kill people”) and 2) refute that chatbots actually caused suicide (just as it remains debated whether AI chatbots truly cause psychosis or delusional thinking).

Time will tell how these cases will play out in court. But in my book, False: How Mistrust, Disinformation, and Motivated Reasoning Make Us Believe Things That Aren’t True,14 and other academic work,15 I argue for recognition of “distributed liability” in cases involving harm caused by misinformation. In such cases, as with those involving the encouragement of suicide by either people or chatbots, legal and moral responsibility isn’t an all-or-nothing phenomenon. Instead, we should think of liability like a “blame pie” in which causation is multifactorial. When viewed through this lens, it’s likely that many will find it impossible to regard AI chatbots as blameless.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist, visit the Psychology Today Therapy Directory.

https://standingabovethecrowd.com/james-donaldson-on-mental-health-should-ai-chatbots-be-held-responsible-for-suicide/

Photo by Marcelo Chagas on Pexels.com

(Editor’s note: The Times is aware of the recent tragedy in Gunnison. While this story does not discuss that incident directly, it does address the topic of suicide. We recognize this may be a difficult subject for some readers.People in crisis should call the Colorado Crisis Services Hotline at 844.493.8255 or text TALK to 38255. Their trained professionals provide free, immediate and confidential help 24/7, 365 days a year. Crested Butte Youth Wellness offers four free counseling sessions for kids between grades 6-12 and CB State of Mind provides 10 free sessions with a local therapist. For peer support specialists at Gunnison Valley Health, email behavioralhealth@gvh-colorado.org or call 970.648.7128.)Just days before Christian Schlegel took his own life in 2023, he had one final conversation with someone close. Later, his mother Chris Peterson learned what had been said — and it flipped her entire understanding of men’s mental health and inspired her own journey in suicide prevention.“On his final day speaking to someone, that person said, ‘You need to talk to someone, a counselor, therapist, something,’” Peterson said. “ responded, ‘I would talk to someone, but nobody would understand.’”

Peterson realized that modern-day therapy wasn’t the answer to the mental health crisis looming over the Gunnison Valley — and Christian wasn’t alone. That same year, seven men between the ages of 21 and 41 took their own lives. Last year, Peterson and her husband Ben Nielsen created Brothers Helping Brothers, a new mental health resource to transform how local men communicate and support one another.“Getting rid of that stigma and getting guys to communicate with each other goes a long way in suicide prevention, and not just that, but also quality of life,” Nielsen said. “Life’s hard enough as it is and having a place to hang out and blow off some steam goes a really long way.”In the wake of Christian’s death, Peterson rallied county employees and local businesses to find a way to raise awareness for suicide prevention. She asked construction companies and businesses like Western Lumber, Ace Hardware and Christopher Klein Construction to build portable putt-putt golf holes. On March 23, 2024, over 400 people flooded into the Fred Field Center and played mini golf, participated in a silent auction and learned how to prevent suicide.At the event, Peterson polled Gunnison Valley men and used the results to format a new mental health resource. She partnered with Andrea Breiner, a local therapist, who lost her father to suicide when she was only two years old.“All five of our board members have lost a male family member to suicide,” Peterson said. “We all sat down with so many men in the community and the one common thread we found among at least 90% of them was traditional therapy and counseling was completely off the table — they would not consider it. So, we tried to think of something they would consider.”The board called their program “Brothers Helping Brothers” and designed it to bring men of all ages and across all backgrounds together to discuss the challenges they face and learn from others who have been through similar experiences.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Brothers Helping Brothers began with weekly meetings, called “Dude Talk Dinners.” Danny Lefebvre, owner of Mario’s Pizza and The Dive, became one of the first major supporters and started serving and hosting the event at The Dive on Monday nights when the restaurant was closed. But recently, Dude Talk Dinners relocated from The Dive to the Echo Ridge Excavation shop to move away from a bar setting.“Rural communities, and especially mountain communities have higher rates ,” Peterson said. “I think it’s the cold, the isolation and there’s a lot of people that don’t ski and don’t want to go out in the cold. So it’s about having a group to connect with for game nights, to play pool and not be in a bar setting.”In the first number of meetings, attendees gathered around the table, introduced themselves one-by-one and shared whatever topics came to mind. But Nielsen felt that the original format was a bit “too formal” and, over time, Dude Talk Dinners has evolved into a catered men’s hangout. Visitors are welcome to shoot pool, play darts and enjoy a setting away from a bar, or even their normal group of friends. Despite the change, Nielsen said incredible conversations have continued to emerge around the dinner table.“When you’re hanging out and meeting guys, conversation comes naturally and we really want guys to have organic conversation and to be able to support one another in that way,” Nielsen said. “The really cool thing is when guys start opening up, the amount of support from the rest of the group is amazing. There’s no judgments, no interruptions. Guys really can support each other in a really profound way.”As Brothers Helping Brothers continues this year, Nielsen said he is most excited to introduce volunteer work and community service to the program. Many of the past attendees have been skilled tradesmen and work as carpenters, electricians and mechanics — valuable skills that could help the community, Nielsen said.This month, Brothers Helping Brothers hosted two Dude Talk Dinners on Oct. 8 and 22. But Nielsen said he’s noticed an even larger impact outside of the bi-monthly meetings and in his everyday routines. While on a job site, he said he’s far more likely to check in with an employee, to initiate tough conversations and recognize when someone might be struggling.“ has been the starting point of getting guys to recognize that other men may be having problems and that they can talk to them,” he said. “It gets easier and easier as you start to open up with other guys and that’s what starts to kill that stigma surrounding men’s mental health.”

Photo by Marcelo Chagas on Pexels.com https://standingabovethecrowd.com/?p=16052

James Donaldson on Mental Health - What Is Borderline Personality Disorder?

And why it's now being diagnosed and treated in teenagers

Writer: Caroline Miller

Clinical Experts: Jill Emanuele, PhD , Blaise Aguirre, MD , Alec Miller, PsyD

What You'll Learn

- What is borderline personality disorder (BPD)?
- What are the signs of BPD?
- How is BPD treated?
- Quick Read
- Full Article
- What is BPD?
- Emotional dysregulation
- Self-destructive behavior
- Criteria for diagnosing BPD
- Diagnosing teenagers
- Why early diagnosis is crucial
- Treatment for BPD

People with borderline personality disorder (BPD) experience extreme emotions. Once a powerful emotion is triggered, it is very hard for them to calm down. Because of this, they often have unstable relationships. They also engage in self-destructive behavior, including suicide attempts.

In the past, traditional therapy hasn’t been very effective in helping people with BPD. But there is now new understanding of the disorder and more effective treatments available. With the right support. most people with BPD can learn to manage overwhelming emotions and improve their lives.

Another important change is that BPD is now diagnosed and treated in teenagers. When kids get the right treatment, sooner, they’ll do better in the future.

Some kids with BPD have a history of abuse or neglect. But the disorder can also occur in ordinary, loving families when parents ignore or minimize kids’ big emotional reactions. This might seem like a normal part of parenting, and in most cases, it is. But highly sensitive or emotional kids can end up feeling painfully alone. When these children’s big feelings are brushed off by adults, they often fail to learn the important skills they need to control their emotions.

People with BPD are often overwhelmed by anger and feelings of abandonment, shame and self-loathing. These feelings take a toll on relationships. Small problems easily become big blow-ups, causing fights with friends, parents and partners. Problems with friends or breakups with partners can trigger self-harm or suicide attempts. Other dangerous behaviors can include substance abuse, risky sex, and recklessness.

The gold-standard treatment for BPD is called dialectical behavioral therapy, or DBT. The treatment helps patients practice more effective ways to manage and respond to their feelings, and it is very successful in treating this disorder.

Borderline personality disorder (BPD) is a diagnosis that has historically been difficult to understand and even more difficult to treat successfully. The symptoms associated with it are a painful mix of emotional turmoil, unstable relationships, and self-destructive behavior, including suicide attempts.

But new insights into the disorder, leading to new, more effective treatments, have made the prognosis for someone with BPD much more promising. With the right support, most people with BPD can successfully learn to regulate their overwhelming emotions, stop self-destructive behavior, and improve their lives.

“It used to be that receiving a BPD diagnosis felt like a life sentence of misery,” says Alec Miller, PsyD, an expert in treating adolescents with BPD. “But research now shows that the chances of functioning better and even dropping the diagnostic label are very high.”

Another important change is that BPD is now diagnosed and treated in teenagers. Until recently mental health professionals were reluctant to give the diagnosis to anyone under 18, despite the fact that symptoms become prominent in adolescence or even earlier. Now experts stress that treating BPD as early as possible leads to better long-term outcomes as well as lowering the risk of dangerous or suicidal behavior.

What is BPD?

Experts call BPD a biosocial disorder, meaning that it starts with a biological (or temperamental) inclination that is exacerbated by the social environment. People who develop BPD are by temperament highly emotionally sensitive and reactive, feeling things more immediately and more intensely than most people. And once a powerful emotion is triggered, it takes them longer to return to their emotional baseline.

BPD develops when one of these emotionally vulnerable people is confronted with an environment that doesn’t validate their feelings — that is, acknowledge them, make them feel understood, and help them handle painful emotions. In many cases, kids who develop BPD have been abused or neglected. But the disorder can also come about in children whose loving, well-meaning parents minimize or discount their emotional reactions because they seem exaggerated or inappropriate.

Dismissing what seems like an overreaction is a fairly typical parental response. But for highly reactive kids, thechronic sense of not feeling understood or supported leads them to feel painfully alone and disconnected, explains Blaise Aguirre, MD. Dr. Aguirre is the founding medical director of 3East, a continuum of care using dialectical behavior therapy (DBT) to treat borderline personality disorder at Boston’s McLean Hospital. Friends and family members don’t understand why people with BPD have huge reactions to small things. For Dr. Aguirre, author of Borderline Personality Disorder in Adolescents, BPD is something like a peanut allergy; the reaction may not be typical of most people, but it’s no less real.

Emotional dysregulation

When a child’s powerful feelings aren’t validated by the adults in their life, it becomes difficult for them to learn to manage them in a healthy way. Adults help us name and identify what we’re feeling; by soothing us, they teach us how to soothe and calm ourselves down.

“Take a person with extremely strong, intense emotions who is constantly told that they’re overreacting, they shouldn’t feel the ways they feel,” explains Jill Emanuele, PhD, a clinical psychologist who specializes in mood disorders. “As a result, they don’t learn how to regulate and modulate their emotions. “

People with BPD are often overwhelmed by intense anger and feelings of abandonment, emptiness, shame, and self-loathing.

These feelings tend to destabilize relationships for people with BPD, who are hypersensitive to social cues from others, and more likely than others to interpret things negatively. Minor slights — or things misinterpreted as slights — are taken as evidence of abandonment, and the reaction can be swift and intense, causing rifts with friends, parents, and partners. They go from “I love you” to “I hate you” in a heartbeat, Dr. Aguirre explains. Or they become so frantic asking for reassurance that they are loved — incessant texting, calling, begging, clinging — that they drive partners away.

Rifts with friends or breakups with partners are often the trigger for self-harm or suicide attempts, he notes.

Self-destructive behavior

Why does BPD lead to self-destructive behavior?

Without the skills to manage painful feelings in a more effective way, people with BPD  often find unhealthy alternatives, including substance abuse, risky sex, and reckless thrill-seeking.

Self-injury is very often one of these behaviors: Teenagers use things like cutting, scratching and opening wounds to alleviate emotions they find intolerable. “In fact it can work as an emotional regulation strategy,” notes Dr. Miller, cofounder and clinical director of Cognitive and Behavioral Consultants in Westchester and New York City. “The problem is that if it works, they’re more likely to use it again to cope with negative emotions. To reduce self-harm we need to acknowledge what it’s doing for them, and try to give them some safer replacement strategies.”

One dangerous misunderstanding about BPD is that the emotional drama and the self-destructive behaviors, including suicide attempts, are manipulative pleas for attention.

“Historically, people with BPD have been viewed as purposely manipulative,” explains Dr. Emanuele, “using extreme measures to get things, gaming people around them. But that’s not it at all. These people are in intense pain, and feel they can’t get what they need.”

In fact, Dr. Aguirre notes, suicidal feelings are almost universal in people with BPD and reflect a desperate need to escape extreme emotional distress.

Criteria for diagnosing BPD

These are the criteria mental health professionals use to diagnose borderline personality disorder:

- Frantic efforts to avoid abandonment, real or imagined
- A pattern of unstable and intense relationships
- An unstable self-image or sense of self
- Dangerous impulsivity such as unsafe sexual encounters, substance abuse
- Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.
- Emotional instability due to high reactivity
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress-relatedparanoia or severe dissociative symptoms

Diagnosing teenagers

In the past, mental health professionals were reluctant to diagnose anyone under 18 with BPD, even though symptoms usually develop during the teen years. That was, in part, because emotional intensity and impulsive risk-taking are to some extent characteristic of adolescence itself. Typical teenage behavior, it was thought, could be confused with BPD.

But even if the behavior looks similar, the reasons for it are different in typical adolescents and those with BPD, Dr. Aguirre notes. Typical teens experiment with alcohol and sex out of curiosity and impulsivity, while people with BPD use them to escape acutely painful feelings. They may seek out sexual encounters, for instance, because they feel abandoned, and crave closeness, rather than sex itself. They may take dangerous risks because “in that moment of desperation the need to change how they feel makes the behaviors feel like the right thing to do.”

Another reason for not diagnosing BPD in teens was to avoid labeling them with a severe illness that didn’t respond well to treatment. But as the treatment picture has changed, so has the aversion to diagnosis in adolescence. One large study called the McLean Study of Adult Development, which followed BPD patients for 12 years, found that 74 percent of participants had no active symptoms after 6 years, and only 6 percent relapsed in the following 6 years.

The lead author of the study, Mary Zanarini, began to call borderline personality disorder a “good-prognosis diagnosis,” and those who are treated while they’re still teenagers have even more optimistic outcomes.

Why early diagnosis is crucial

If BPD is understood as a lack of emotional regulation skills, it’s crucial to get someone who develops symptoms into treatment as soon as possible, Dr. Aguirre says, “before patterns of maladaptive behavior have set in.”

This is particularly important as young people are developing their identity and sense of self, which is difficult for young people with BPD symptoms. “When your environment doesn’t reflect back what your experience is,” Dr. Aguirre says, “it’s hard to know who you are, what your values are.”

Another reason experts urge earlier diagnosis of BPD is to lessen inaccurate diagnosis of more common disorders like ADHD, depression, and bipolar disorder. Sometimes these are co-occurring disorders, but often they are misdiagnoses. As a result, these teenagers are given medications that aren’t effective, including mood stabilizers and antipsychotics.

“I’ve seen kids with BPD who were on extensive drug cocktails because the clinicians didn’t know what was happening,” adds Dr. Emanuele. “They’re just going after the symptoms. And no medication is going to correct the invalidation that these people feel.”

BPD patients who are admitted to Dr. Aguirre’s unit often come in “zombie-like,” he reports, because they are on so many medications. When they are discharged, he says, half are on no meds at all.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Treatment for BPD

There are a number of specialized psychotherapies that have been developed to treat BPD, but the gold standard treatment — the one with the most evidence for its effectiveness — is called dialectical behavioral therapy, or DBT. The reason it’s called “dialectical” is that it involves two things that might seem to be in opposition but are both important: the need for acceptance and the need for change.

First, a patient’s feelings need to be validated, or accepted without judgment, in order for them to learn more effective ways to manage and respond to them.

“It’s basically ‘I’m doing the best I can’ on the one hand,” explains Dr. Miller, “and at the same time ‘I need to do better’ on the other.”

Validation, which is the first step in DBT, means recognition and acceptance of another person’s feelings as being real.  It doesn’t mean agreeing with the thoughts or feelings.

https://standingabovethecrowd.com/james-donaldson-on-mental-health-what-is-borderline-personality-disorder-2/

James Donaldson on Mental Health - What Is Borderline Personality Disorder?

And why it's now being diagnosed and treated in teenagers

Writer: Caroline Miller

Clinical Experts: Jill Emanuele, PhD , Blaise Aguirre, MD , Alec Miller, PsyD

What You'll Learn

- What is borderline personality disorder (BPD)?
- What are the signs of BPD?
- How is BPD treated?
- Quick Read
- Full Article
- What is BPD?
- Emotional dysregulation
- Self-destructive behavior
- Criteria for diagnosing BPD
- Diagnosing teenagers
- Why early diagnosis is crucial
- Treatment for BPD

People with borderline personality disorder (BPD) experience extreme emotions. Once a powerful emotion is triggered, it is very hard for them to calm down. Because of this, they often have unstable relationships. They also engage in self-destructive behavior, including suicide attempts.

In the past, traditional therapy hasn’t been very effective in helping people with BPD. But there is now new understanding of the disorder and more effective treatments available. With the right support. most people with BPD can learn to manage overwhelming emotions and improve their lives.

Another important change is that BPD is now diagnosed and treated in teenagers. When kids get the right treatment, sooner, they’ll do better in the future.

Some kids with BPD have a history of abuse or neglect. But the disorder can also occur in ordinary, loving families when parents ignore or minimize kids’ big emotional reactions. This might seem like a normal part of parenting, and in most cases, it is. But highly sensitive or emotional kids can end up feeling painfully alone. When these children’s big feelings are brushed off by adults, they often fail to learn the important skills they need to control their emotions.

People with BPD are often overwhelmed by anger and feelings of abandonment, shame and self-loathing. These feelings take a toll on relationships. Small problems easily become big blow-ups, causing fights with friends, parents and partners. Problems with friends or breakups with partners can trigger self-harm or suicide attempts. Other dangerous behaviors can include substance abuse, risky sex, and recklessness.

The gold-standard treatment for BPD is called dialectical behavioral therapy, or DBT. The treatment helps patients practice more effective ways to manage and respond to their feelings, and it is very successful in treating this disorder.

Borderline personality disorder (BPD) is a diagnosis that has historically been difficult to understand and even more difficult to treat successfully. The symptoms associated with it are a painful mix of emotional turmoil, unstable relationships, and self-destructive behavior, including suicide attempts.

But new insights into the disorder, leading to new, more effective treatments, have made the prognosis for someone with BPD much more promising. With the right support, most people with BPD can successfully learn to regulate their overwhelming emotions, stop self-destructive behavior, and improve their lives.

“It used to be that receiving a BPD diagnosis felt like a life sentence of misery,” says Alec Miller, PsyD, an expert in treating adolescents with BPD. “But research now shows that the chances of functioning better and even dropping the diagnostic label are very high.”

Another important change is that BPD is now diagnosed and treated in teenagers. Until recently mental health professionals were reluctant to give the diagnosis to anyone under 18, despite the fact that symptoms become prominent in adolescence or even earlier. Now experts stress that treating BPD as early as possible leads to better long-term outcomes as well as lowering the risk of dangerous or suicidal behavior.

What is BPD?

Experts call BPD a biosocial disorder, meaning that it starts with a biological (or temperamental) inclination that is exacerbated by the social environment. People who develop BPD are by temperament highly emotionally sensitive and reactive, feeling things more immediately and more intensely than most people. And once a powerful emotion is triggered, it takes them longer to return to their emotional baseline.

BPD develops when one of these emotionally vulnerable people is confronted with an environment that doesn’t validate their feelings — that is, acknowledge them, make them feel understood, and help them handle painful emotions. In many cases, kids who develop BPD have been abused or neglected. But the disorder can also come about in children whose loving, well-meaning parents minimize or discount their emotional reactions because they seem exaggerated or inappropriate.

Dismissing what seems like an overreaction is a fairly typical parental response. But for highly reactive kids, thechronic sense of not feeling understood or supported leads them to feel painfully alone and disconnected, explains Blaise Aguirre, MD. Dr. Aguirre is the founding medical director of 3East, a continuum of care using dialectical behavior therapy (DBT) to treat borderline personality disorder at Boston’s McLean Hospital. Friends and family members don’t understand why people with BPD have huge reactions to small things. For Dr. Aguirre, author of Borderline Personality Disorder in Adolescents, BPD is something like a peanut allergy; the reaction may not be typical of most people, but it’s no less real.

Emotional dysregulation

When a child’s powerful feelings aren’t validated by the adults in their life, it becomes difficult for them to learn to manage them in a healthy way. Adults help us name and identify what we’re feeling; by soothing us, they teach us how to soothe and calm ourselves down.

“Take a person with extremely strong, intense emotions who is constantly told that they’re overreacting, they shouldn’t feel the ways they feel,” explains Jill Emanuele, PhD, a clinical psychologist who specializes in mood disorders. “As a result, they don’t learn how to regulate and modulate their emotions. “

People with BPD are often overwhelmed by intense anger and feelings of abandonment, emptiness, shame, and self-loathing.

These feelings tend to destabilize relationships for people with BPD, who are hypersensitive to social cues from others, and more likely than others to interpret things negatively. Minor slights — or things misinterpreted as slights — are taken as evidence of abandonment, and the reaction can be swift and intense, causing rifts with friends, parents, and partners. They go from “I love you” to “I hate you” in a heartbeat, Dr. Aguirre explains. Or they become so frantic asking for reassurance that they are loved — incessant texting, calling, begging, clinging — that they drive partners away.

Rifts with friends or breakups with partners are often the trigger for self-harm or suicide attempts, he notes.

Self-destructive behavior

Why does BPD lead to self-destructive behavior?

Without the skills to manage painful feelings in a more effective way, people with BPD  often find unhealthy alternatives, including substance abuse, risky sex, and reckless thrill-seeking.

Self-injury is very often one of these behaviors: Teenagers use things like cutting, scratching and opening wounds to alleviate emotions they find intolerable. “In fact it can work as an emotional regulation strategy,” notes Dr. Miller, cofounder and clinical director of Cognitive and Behavioral Consultants in Westchester and New York City. “The problem is that if it works, they’re more likely to use it again to cope with negative emotions. To reduce self-harm we need to acknowledge what it’s doing for them, and try to give them some safer replacement strategies.”

One dangerous misunderstanding about BPD is that the emotional drama and the self-destructive behaviors, including suicide attempts, are manipulative pleas for attention.

“Historically, people with BPD have been viewed as purposely manipulative,” explains Dr. Emanuele, “using extreme measures to get things, gaming people around them. But that’s not it at all. These people are in intense pain, and feel they can’t get what they need.”

In fact, Dr. Aguirre notes, suicidal feelings are almost universal in people with BPD and reflect a desperate need to escape extreme emotional distress.

Criteria for diagnosing BPD

These are the criteria mental health professionals use to diagnose borderline personality disorder:

- Frantic efforts to avoid abandonment, real or imagined
- A pattern of unstable and intense relationships
- An unstable self-image or sense of self
- Dangerous impulsivity such as unsafe sexual encounters, substance abuse
- Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.
- Emotional instability due to high reactivity
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress-relatedparanoia or severe dissociative symptoms

Diagnosing teenagers

In the past, mental health professionals were reluctant to diagnose anyone under 18 with BPD, even though symptoms usually develop during the teen years. That was, in part, because emotional intensity and impulsive risk-taking are to some extent characteristic of adolescence itself. Typical teenage behavior, it was thought, could be confused with BPD.

But even if the behavior looks similar, the reasons for it are different in typical adolescents and those with BPD, Dr. Aguirre notes. Typical teens experiment with alcohol and sex out of curiosity and impulsivity, while people with BPD use them to escape acutely painful feelings. They may seek out sexual encounters, for instance, because they feel abandoned, and crave closeness, rather than sex itself. They may take dangerous risks because “in that moment of desperation the need to change how they feel makes the behaviors feel like the right thing to do.”

Another reason for not diagnosing BPD in teens was to avoid labeling them with a severe illness that didn’t respond well to treatment. But as the treatment picture has changed, so has the aversion to diagnosis in adolescence. One large study called the McLean Study of Adult Development, which followed BPD patients for 12 years, found that 74 percent of participants had no active symptoms after 6 years, and only 6 percent relapsed in the following 6 years.

The lead author of the study, Mary Zanarini, began to call borderline personality disorder a “good-prognosis diagnosis,” and those who are treated while they’re still teenagers have even more optimistic outcomes.

Why early diagnosis is crucial

If BPD is understood as a lack of emotional regulation skills, it’s crucial to get someone who develops symptoms into treatment as soon as possible, Dr. Aguirre says, “before patterns of maladaptive behavior have set in.”

This is particularly important as young people are developing their identity and sense of self, which is difficult for young people with BPD symptoms. “When your environment doesn’t reflect back what your experience is,” Dr. Aguirre says, “it’s hard to know who you are, what your values are.”

Another reason experts urge earlier diagnosis of BPD is to lessen inaccurate diagnosis of more common disorders like ADHD, depression, and bipolar disorder. Sometimes these are co-occurring disorders, but often they are misdiagnoses. As a result, these teenagers are given medications that aren’t effective, including mood stabilizers and antipsychotics.

“I’ve seen kids with BPD who were on extensive drug cocktails because the clinicians didn’t know what was happening,” adds Dr. Emanuele. “They’re just going after the symptoms. And no medication is going to correct the invalidation that these people feel.”

BPD patients who are admitted to Dr. Aguirre’s unit often come in “zombie-like,” he reports, because they are on so many medications. When they are discharged, he says, half are on no meds at all.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Treatment for BPD

There are a number of specialized psychotherapies that have been developed to treat BPD, but the gold standard treatment — the one with the most evidence for its effectiveness — is called dialectical behavioral therapy, or DBT. The reason it’s called “dialectical” is that it involves two things that might seem to be in opposition but are both important: the need for acceptance and the need for change.

First, a patient’s feelings need to be validated, or accepted without judgment, in order for them to learn more effective ways to manage and respond to them.

“It’s basically ‘I’m doing the best I can’ on the one hand,” explains Dr. Miller, “and at the same time ‘I need to do better’ on the other.”

Validation, which is the first step in DBT, means recognition and acceptance of another person’s feelings as being real.  It doesn’t mean agreeing with the thoughts or feelings.

https://standingabovethecrowd.com/james-donaldson-on-mental-health-what-is-borderline-personality-disorder-2/

And why it's now being diagnosed and treated in teenagers

Writer: Caroline Miller

Clinical Experts: Jill Emanuele, PhD , Blaise Aguirre, MD , Alec Miller, PsyD

What You'll Learn

- What is borderline personality disorder (BPD)?

- What are the signs of BPD?

- How is BPD treated?

- Quick Read

- Full Article

- What is BPD?

- Emotional dysregulation

- Self-destructive behavior

- Criteria for diagnosing BPD

- Diagnosing teenagers

- Why early diagnosis is crucial

- Treatment for BPD

People with borderline personality disorder (BPD) experience extreme emotions. Once a powerful emotion is triggered, it is very hard for them to calm down. Because of this, they often have unstable relationships. They also engage in self-destructive behavior, including suicide attempts.

In the past, traditional therapy hasn’t been very effective in helping people with BPD. But there is now new understanding of the disorder and more effective treatments available. With the right support. most people with BPD can learn to manage overwhelming emotions and improve their lives.

Another important change is that BPD is now diagnosed and treated in teenagers. When kids get the right treatment, sooner, they’ll do better in the future.

Some kids with BPD have a history of abuse or neglect. But the disorder can also occur in ordinary, loving families when parents ignore or minimize kids’ big emotional reactions. This might seem like a normal part of parenting, and in most cases, it is. But highly sensitive or emotional kids can end up feeling painfully alone. When these children’s big feelings are brushed off by adults, they often fail to learn the important skills they need to control their emotions.

People with BPD are often overwhelmed by anger and feelings of abandonment, shame and self-loathing. These feelings take a toll on relationships. Small problems easily become big blow-ups, causing fights with friends, parents and partners. Problems with friends or breakups with partners can trigger self-harm or suicide attempts. Other dangerous behaviors can include substance abuse, risky sex, and recklessness.

The gold-standard treatment for BPD is called dialectical behavioral therapy, or DBT. The treatment helps patients practice more effective ways to manage and respond to their feelings, and it is very successful in treating this disorder.

Borderline personality disorder (BPD) is a diagnosis that has historically been difficult to understand and even more difficult to treat successfully. The symptoms associated with it are a painful mix of emotional turmoil, unstable relationships, and self-destructive behavior, including suicide attempts.

But new insights into the disorder, leading to new, more effective treatments, have made the prognosis for someone with BPD much more promising. With the right support, most people with BPD can successfully learn to regulate their overwhelming emotions, stop self-destructive behavior, and improve their lives.

“It used to be that receiving a BPD diagnosis felt like a life sentence of misery,” says Alec Miller, PsyD, an expert in treating adolescents with BPD. “But research now shows that the chances of functioning better and even dropping the diagnostic label are very high.”

Another important change is that BPD is now diagnosed and treated in teenagers. Until recently mental health professionals were reluctant to give the diagnosis to anyone under 18, despite the fact that symptoms become prominent in adolescence or even earlier. Now experts stress that treating BPD as early as possible leads to better long-term outcomes as well as lowering the risk of dangerous or suicidal behavior.

What is BPD?

Experts call BPD a biosocial disorder, meaning that it starts with a biological (or temperamental) inclination that is exacerbated by the social environment. People who develop BPD are by temperament highly emotionally sensitive and reactive, feeling things more immediately and more intensely than most people. And once a powerful emotion is triggered, it takes them longer to return to their emotional baseline.

BPD develops when one of these emotionally vulnerable people is confronted with an environment that doesn’t validate their feelings — that is, acknowledge them, make them feel understood, and help them handle painful emotions. In many cases, kids who develop BPD have been abused or neglected. But the disorder can also come about in children whose loving, well-meaning parents minimize or discount their emotional reactions because they seem exaggerated or inappropriate.

Dismissing what seems like an overreaction is a fairly typical parental response. But for highly reactive kids, thechronic sense of not feeling understood or supported leads them to feel painfully alone and disconnected, explains Blaise Aguirre, MD. Dr. Aguirre is the founding medical director of 3East, a continuum of care using dialectical behavior therapy (DBT) to treat borderline personality disorder at Boston’s McLean Hospital. Friends and family members don’t understand why people with BPD have huge reactions to small things. For Dr. Aguirre, author of Borderline Personality Disorder in Adolescents, BPD is something like a peanut allergy; the reaction may not be typical of most people, but it’s no less real.

Emotional dysregulation

When a child’s powerful feelings aren’t validated by the adults in their life, it becomes difficult for them to learn to manage them in a healthy way. Adults help us name and identify what we’re feeling; by soothing us, they teach us how to soothe and calm ourselves down.

“Take a person with extremely strong, intense emotions who is constantly told that they’re overreacting, they shouldn’t feel the ways they feel,” explains Jill Emanuele, PhD, a clinical psychologist who specializes in mood disorders. “As a result, they don’t learn how to regulate and modulate their emotions. “

People with BPD are often overwhelmed by intense anger and feelings of abandonment, emptiness, shame, and self-loathing.

These feelings tend to destabilize relationships for people with BPD, who are hypersensitive to social cues from others, and more likely than others to interpret things negatively. Minor slights — or things misinterpreted as slights — are taken as evidence of abandonment, and the reaction can be swift and intense, causing rifts with friends, parents, and partners. They go from “I love you” to “I hate you” in a heartbeat, Dr. Aguirre explains. Or they become so frantic asking for reassurance that they are loved — incessant texting, calling, begging, clinging — that they drive partners away.

Rifts with friends or breakups with partners are often the trigger for self-harm or suicide attempts, he notes.

Self-destructive behavior

Why does BPD lead to self-destructive behavior?

Without the skills to manage painful feelings in a more effective way, people with BPD  often find unhealthy alternatives, including substance abuse, risky sex, and reckless thrill-seeking.

Self-injury is very often one of these behaviors: Teenagers use things like cutting, scratching and opening wounds to alleviate emotions they find intolerable. “In fact it can work as an emotional regulation strategy,” notes Dr. Miller, cofounder and clinical director of Cognitive and Behavioral Consultants in Westchester and New York City. “The problem is that if it works, they’re more likely to use it again to cope with negative emotions. To reduce self-harm we need to acknowledge what it’s doing for them, and try to give them some safer replacement strategies.”

One dangerous misunderstanding about BPD is that the emotional drama and the self-destructive behaviors, including suicide attempts, are manipulative pleas for attention.

“Historically, people with BPD have been viewed as purposely manipulative,” explains Dr. Emanuele, “using extreme measures to get things, gaming people around them. But that’s not it at all. These people are in intense pain, and feel they can’t get what they need.”

In fact, Dr. Aguirre notes, suicidal feelings are almost universal in people with BPD and reflect a desperate need to escape extreme emotional distress.

Criteria for diagnosing BPD

These are the criteria mental health professionals use to diagnose borderline personality disorder:

- Frantic efforts to avoid abandonment, real or imagined

- A pattern of unstable and intense relationships

- An unstable self-image or sense of self

- Dangerous impulsivity such as unsafe sexual encounters, substance abuse

- Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.

- Emotional instability due to high reactivity

- Chronic feelings of emptiness

- Inappropriate, intense anger or difficulty controlling anger

- Transient, stress-relatedparanoia or severe dissociative symptoms

Diagnosing teenagers

In the past, mental health professionals were reluctant to diagnose anyone under 18 with BPD, even though symptoms usually develop during the teen years. That was, in part, because emotional intensity and impulsive risk-taking are to some extent characteristic of adolescence itself. Typical teenage behavior, it was thought, could be confused with BPD.

But even if the behavior looks similar, the reasons for it are different in typical adolescents and those with BPD, Dr. Aguirre notes. Typical teens experiment with alcohol and sex out of curiosity and impulsivity, while people with BPD use them to escape acutely painful feelings. They may seek out sexual encounters, for instance, because they feel abandoned, and crave closeness, rather than sex itself. They may take dangerous risks because “in that moment of desperation the need to change how they feel makes the behaviors feel like the right thing to do.”

Another reason for not diagnosing BPD in teens was to avoid labeling them with a severe illness that didn’t respond well to treatment. But as the treatment picture has changed, so has the aversion to diagnosis in adolescence. One large study called the McLean Study of Adult Development, which followed BPD patients for 12 years, found that 74 percent of participants had no active symptoms after 6 years, and only 6 percent relapsed in the following 6 years.

The lead author of the study, Mary Zanarini, began to call borderline personality disorder a “good-prognosis diagnosis,” and those who are treated while they’re still teenagers have even more optimistic outcomes.

Why early diagnosis is crucial

If BPD is understood as a lack of emotional regulation skills, it’s crucial to get someone who develops symptoms into treatment as soon as possible, Dr. Aguirre says, “before patterns of maladaptive behavior have set in.”

This is particularly important as young people are developing their identity and sense of self, which is difficult for young people with BPD symptoms. “When your environment doesn’t reflect back what your experience is,” Dr. Aguirre says, “it’s hard to know who you are, what your values are.”

Another reason experts urge earlier diagnosis of BPD is to lessen inaccurate diagnosis of more common disorders like ADHD, depression, and bipolar disorder. Sometimes these are co-occurring disorders, but often they are misdiagnoses. As a result, these teenagers are given medications that aren’t effective, including mood stabilizers and antipsychotics.

“I’ve seen kids with BPD who were on extensive drug cocktails because the clinicians didn’t know what was happening,” adds Dr. Emanuele. “They’re just going after the symptoms. And no medication is going to correct the invalidation that these people feel.”

BPD patients who are admitted to Dr. Aguirre’s unit often come in “zombie-like,” he reports, because they are on so many medications. When they are discharged, he says, half are on no meds at all.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Treatment for BPD

There are a number of specialized psychotherapies that have been developed to treat BPD, but the gold standard treatment — the one with the most evidence for its effectiveness — is called dialectical behavioral therapy, or DBT. The reason it’s called “dialectical” is that it involves two things that might seem to be in opposition but are both important: the need for acceptance and the need for change.

First, a patient’s feelings need to be validated, or accepted without judgment, in order for them to learn more effective ways to manage and respond to them.

“It’s basically ‘I’m doing the best I can’ on the one hand,” explains Dr. Miller, “and at the same time ‘I need to do better’ on the other.”

Validation, which is the first step in DBT, means recognition and acceptance of another person’s feelings as being real.  It doesn’t mean agreeing with the thoughts or feelings. When people feel accepted and understood, it has a calming effect and allows them to learn skills to regulate emotions and develop safer, more effective alternatives to the self-destructive behaviors they have been using.

“It’s essentially a skills-based approach which says that if our patients could do better, they would, but they’re lacking skills,” explains Dr. Miller, who is the author of Dialectical Behavioral Therapy with Suicidal Adolescents. “It’s so easy for us to tell people to stop problematic behaviors but it’s better to teach them new skills.”

DBT skills are very effective for getting patients to stop self-injury and suicidality, Dr. Aguirre notes. It’s tougher to change the self-loathing and self-hatred that can become fused with a borderline person’s identity.

He also notes that availability of DBT and other treatment for BPD is limited, which means that a lot of teenagers who should get treatment aren’t getting it. “The number of people with emotion regulation problems is outstripping the number of DBT providers,” he says, “and we know that because suicide rates in adolescents continue to go through the roof.”

Dr. Miller stresses the urgency of getting teens with BPD into treatment: “If you throw yourself into treatment, you can be a very successful, highly functional adult.”

Dr. Emanuele adds that she’s seen many patients dramatically improve their lives. “Over the years, I have repeatedly seen DBT give participants the hope and reality of a ‘life worth living,’ ” adds Dr. Emanuele. “And that’s something they had not been able to imagine or experience before.”

Frequently Asked Questions

At what age does BPD develop?

Symptoms of BPD (borderline personality disorder) usually develop during the teenage years.

How old do you have to be to be diagnosed with BPD? https://standingabovethecrowd.com/?p=16055

James Donaldson on Mental Health - Why Many Autistic Girls Are Overlooked

They often go undiagnosed because they don’t fit autism stereotypes and they mask symptoms better than boys do

Writer: Beth Arky

Clinical Experts: Wendy Nash, MD , Susan F. Epstein, PhD

https://www.youtube.com/watch?v=bPOUMxBnwd8

What You'll Learn

- Why are so many more boys diagnosed with autism than girls?
- How can autism look different in girls?
- Why is it important for girls with autism to be diagnosed early?
- Quick Read
- Full Article
- Autistic girls don’t fit the “model”
- Another problem: misdiagnoses
- Autistic girls “pass”… at least for a while
- The cost of a missed diagnosis
- Safety risks for autistic girls 

Far more boys than girls are diagnosed with autism. But that might not be because more boys have autism. Often, autism in girls just looks different from the stereotype of autistic behavior, so some doctors might not diagnose it.

Repetitive behavior, like flapping their hands, is one sign of autism that most doctors recognize. But girls with autism might not have as many repetitive behaviors as boys, or they might be quieter about them. Having an intense interest in something specific is also common in people with autism. If that interest is something considered “girly,” like horses, a doctor might dismiss it as normal.

Autistic girls are sometimes better at controlling their behavior in public. They might have learned early on to smile or make eye contact. They might also be more interested in making friends than boys with autism are. All of this can make for a more subtle version of autism that a doctor might not recognize. Some girls with autism get diagnosed with ADHD instead, which can look similar on the surface.

When girls with autism don’t get diagnosed, they miss out on support that can help them understand their challenges, build skills and excel in school. They might get exhausted from trying so hard to fit in or be bullied because they miss social cues. That can lead to depression, anxiety, or low self-esteem. Therapists might not see that autism is the underlying cause. Getting diagnosed early on is important so girls can get the support they need as soon as possible.

Many more boys than girls are diagnosed on the autism spectrum: more than four boys for every autistic girl, according to the latest numbers from the Centers for Disease Control. Researchers point to genetic differences. But clinicians and researchers have also come to realize that many “higher functioning” autistic girls are simply missed. They’ve been termed the “lost girls” or “hiding in plain sight” because they’re overlooked or diagnosed late. They don’t fit the stereotypes or their symptoms are misinterpreted as something else. And they may be better at hiding the signs, at least when they’re young.

Even when girls’ presentation is clearer, they can be overlooked. Take Melissa’s two children. Both have an autism diagnosis. But while daughter Lisa’s symptoms were much more obvious than son Justin’s, the girl’s were waved off for three years by a variety of clinicians.

“On paper,” Melissa says, “she seemed to check all the boxes.” Lisa had a significant language delay — she didn’t speak in sentences until she was 4 — did no pretend play, and had several meltdowns each day. There were also other signs, like lining up her stuffed animals, spinning in circles, and constantly seeking sensory input. She was also unable to handle any change in routine.

Though Lisa’s challenges qualified her for Early Intervention at 18 months, it wasn’t until she was 6 that a developmental neurologist would diagnose her with autism.

Melissa’s son was also diagnosed at 6 — but by the first clinician who saw him,  despite the fact that his symptoms were far less obvious.

“The developmental pediatrician who saw Lisa didn’t believe autism was common in girls. He came up with excuses for her behavior and reasons why she couldn’t be on the spectrum,” Melissa says. “At one point, we were even told that my daughter just had low self-esteem and that’s why she didn’t speak. And, of course, that her issues were just a parenting problem. We were never told those things about our son.”

Autistic girls don’t fit the “model”

Autism is a developmental disorder that is marked by two unusual kinds of behaviors: deficits in communication and social skills, and restricted or repetitive behaviors. Children with autism also often have sensory processing issues. But here’s the hitch, according to Susan F. Epstein, PhD, a clinical neuropsychologist. “The model that we have for a classic autism diagnosis has really turned out to be a male model. That’s not to say that girls don’t ever fit it, but girls tend to have a quieter presentation, with not necessarily as much of the repetitive and restricted behavior, or it shows up in a different way.”

Stereo types may get in the way of recognition. “So where the boys are looking at train schedules, girls might have excessive interest in horses or unicorns, which is not unexpected for girls,” Dr. Epstein notes. “But the level of the interest might be missed and the level of oddity can be a little more damped down. It’s not quite as obvious to an untrained eye.” She adds that as the spectrum has grown, it’s gotten harder to diagnose less-affected boys as well.

In fact, according to a 2005 study at Stanford University, autistic girls exhibit less repetitive and restricted behavior than boys do. The study also found brain differences between autistic boys and girls help explain this discrepancy.

Wendy Nash, MD, a child and adolescent psychiatrist, adds that girls are more likely to control their behavior in public, so teachers don’t catch differences. “A lot of autistic girls get ruled out because they may share a smile or may have a bit better eye contact or they’re more socially motivated. It can be a more subtle presentation,” Dr. Nash explains. If girls are socially interested but odd, which is the case with the majority of these girls, she adds, “I think people give them a pass.”

Another problem: misdiagnoses

Dr. Epstein says there’s another reason autistic girls are misdiagnosed, or diagnosed later than boys. Girls struggling with undiagnosed autism often develop depression, anxiety or poor self-esteem, and clinicians may not “really dig underneath to see the social dysfunction” caused by autism.

Dr. Nash adds that these girls can also be misdiagnosed with ADHD. “I see a lot of girls who are diagnosed with ADHD when they’re young who actually meet the criteria for autism,” she says. “There’s hyperactivity without as much social impairment or a different kind of social impairment, so the autism is missed.”

Autistic girls “pass”… at least for a while

Another reason girls may not be diagnosed is because they’re able to “pass.”

“Girls tend to get by,” Dr. Epstein says. “They might not understand what’s going on but they’ll try to just go along and imitate what they see. And they may get away with it to third grade or fifth grade, but once they get to junior high and high school, it shows as a problem.”

This has been the case for Lisa, now 13. Melissa says of her daughter, “She is less mature than her typical peers, and girls are so intricate in how they behave socially. It’s very difficult for her to maintain friendships because of this and, let me tell you, 13-year-old girls are not very accepting of someone different.”

The cost of a missed diagnosis

Dr. Epstein says undiagnosed autistic girls end up wondering “what’s wrong” with them, which can lead to depression, anxiety and loss of self-esteem. They work so hard to fit in that it wears them out. “That’s the thing about imitating,” she says. “You don’t necessarily ‘get’ it so you’re just trying to do what people do. If you’re just trying to mimic and you don’t really understand, it makes it pretty rough.”

Dr. Nash says less severe autism in girls is often first flagged because of these social issues, or the depression they generate. “In people we call mildly autistic, there are adolescent social problems or they’re seeming hyperfocused on a topic and not participating in school to their potential or abilities,” she says. “Depression can be more common among high-functioning kids on the spectrum. So they’ll come in for something like depression or poor school performance. Then it becomes more clear to me that they have a restricted interest and social communication issues.”

Another cost of being overlooked is missing out on early support for skill-building. “We talk about early intervention,” Dr. Epstein says. “When the girls are identified late, they’ve missed out on a lot of social interventions that are much harder later. That’s the danger for anybody who gets a late diagnosis.”

Dr. Nash concurs, adding that they’ve missed opportunities to get the proper support in school as well as socially: “Academically, it’s harder for them to focus on topics that are not of interest. That’s true for people who have ADHD and even to a greater degree for kids who are on the autism spectrum.”

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

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Safety risks for autistic girls 

Autistic girls may be bullied simply because they’re “different.” Also, Dr. Epstein says, because these girls miss social cues and want to be liked, their autism can leave them more naïve. This makes them easy prey for someone trying to take advantage of them, be it a bully or a sexual predator. “The girls may be wanting the interaction but not understanding what it’s about, what the cues are,” Dr. Epstein says. “It can be very easy for them to follow their hormones without an understanding of what the dangers are. And sometimes even if they have been taught, they need ongoing support to be able to maintain safety.”

Melissa says this has been true with Lisa. “I’ve had to think about female issues at a much earlier age than I expected,” she says. “We’ve already had an incident of her being inappropriately touched by a boy, for whom the excuse was made that because he’s also disabled, he ‘didn’t understand what he was doing was wrong.’”

One of her daughter’s greatest strengths is how accepting she is of others, Melissa adds. “She always finds the good in people, even when they are mean to her,” she says. “But because she is so accepting and kind, others can easily take advantage of her, or bully her, and she won’t say anything.”

Dr. Nash notes that there’s an area of study that’s rethinking how to help girls on the spectrum: “There’s expanding research on how boys and girls present differently and how our treatments may need to be specified a bit more for a girl’s presentation vs. a boy’s presentation.”

But first the girls need to be identified — and accepted. This will require more awareness and sensitivity on the part of parents, teachers and clinicians.

Frequently Asked Questions

How does autism present in girls?

Autism in girls often presents as deficits in social skills and communication. Girls with autism may also have repetitive behaviors, but they tend to be better at boys than hiding them and fitting in with peers. Girls may be hyper-focused on a specific topic and not participate in school to their potential.

Why are so many more boys diagnosed with autism than girls?

https://standingabovethecrowd.com/james-donaldson-on-mental-health-why-many-autistic-girls-are-overlooked/

They often go undiagnosed because they don’t fit autism stereotypes and they mask symptoms better than boys do

Writer: Beth Arky

Clinical Experts: Wendy Nash, MD , Susan F. Epstein, PhD

https://www.youtube.com/watch?v=bPOUMxBnwd8

What You'll Learn

- Why are so many more boys diagnosed with autism than girls?

- How can autism look different in girls?

- Why is it important for girls with autism to be diagnosed early?

- Quick Read

- Full Article

- Autistic girls don’t fit the “model”

- Another problem: misdiagnoses

- Autistic girls “pass”… at least for a while

- The cost of a missed diagnosis

- Safety risks for autistic girls 

Far more boys than girls are diagnosed with autism. But that might not be because more boys have autism. Often, autism in girls just looks different from the stereotype of autistic behavior, so some doctors might not diagnose it.

Repetitive behavior, like flapping their hands, is one sign of autism that most doctors recognize. But girls with autism might not have as many repetitive behaviors as boys, or they might be quieter about them. Having an intense interest in something specific is also common in people with autism. If that interest is something considered “girly,” like horses, a doctor might dismiss it as normal.

Autistic girls are sometimes better at controlling their behavior in public. They might have learned early on to smile or make eye contact. They might also be more interested in making friends than boys with autism are. All of this can make for a more subtle version of autism that a doctor might not recognize. Some girls with autism get diagnosed with ADHD instead, which can look similar on the surface.

When girls with autism don’t get diagnosed, they miss out on support that can help them understand their challenges, build skills and excel in school. They might get exhausted from trying so hard to fit in or be bullied because they miss social cues. That can lead to depression, anxiety, or low self-esteem. Therapists might not see that autism is the underlying cause. Getting diagnosed early on is important so girls can get the support they need as soon as possible.

Many more boys than girls are diagnosed on the autism spectrum: more than four boys for every autistic girl, according to the latest numbers from the Centers for Disease Control. Researchers point to genetic differences. But clinicians and researchers have also come to realize that many “higher functioning” autistic girls are simply missed. They’ve been termed the “lost girls” or “hiding in plain sight” because they’re overlooked or diagnosed late. They don’t fit the stereotypes or their symptoms are misinterpreted as something else. And they may be better at hiding the signs, at least when they’re young.

Even when girls’ presentation is clearer, they can be overlooked. Take Melissa’s two children. Both have an autism diagnosis. But while daughter Lisa’s symptoms were much more obvious than son Justin’s, the girl’s were waved off for three years by a variety of clinicians.

“On paper,” Melissa says, “she seemed to check all the boxes.” Lisa had a significant language delay — she didn’t speak in sentences until she was 4 — did no pretend play, and had several meltdowns each day. There were also other signs, like lining up her stuffed animals, spinning in circles, and constantly seeking sensory input. She was also unable to handle any change in routine.

Though Lisa’s challenges qualified her for Early Intervention at 18 months, it wasn’t until she was 6 that a developmental neurologist would diagnose her with autism.

Melissa’s son was also diagnosed at 6 — but by the first clinician who saw him,  despite the fact that his symptoms were far less obvious.

“The developmental pediatrician who saw Lisa didn’t believe autism was common in girls. He came up with excuses for her behavior and reasons why she couldn’t be on the spectrum,” Melissa says. “At one point, we were even told that my daughter just had low self-esteem and that’s why she didn’t speak. And, of course, that her issues were just a parenting problem. We were never told those things about our son.”

Autistic girls don’t fit the “model”

Autism is a developmental disorder that is marked by two unusual kinds of behaviors: deficits in communication and social skills, and restricted or repetitive behaviors. Children with autism also often have sensory processing issues. But here’s the hitch, according to Susan F. Epstein, PhD, a clinical neuropsychologist. “The model that we have for a classic autism diagnosis has really turned out to be a male model. That’s not to say that girls don’t ever fit it, but girls tend to have a quieter presentation, with not necessarily as much of the repetitive and restricted behavior, or it shows up in a different way.”

Stereo types may get in the way of recognition. “So where the boys are looking at train schedules, girls might have excessive interest in horses or unicorns, which is not unexpected for girls,” Dr. Epstein notes. “But the level of the interest might be missed and the level of oddity can be a little more damped down. It’s not quite as obvious to an untrained eye.” She adds that as the spectrum has grown, it’s gotten harder to diagnose less-affected boys as well.

In fact, according to a 2005 study at Stanford University, autistic girls exhibit less repetitive and restricted behavior than boys do. The study also found brain differences between autistic boys and girls help explain this discrepancy.

Wendy Nash, MD, a child and adolescent psychiatrist, adds that girls are more likely to control their behavior in public, so teachers don’t catch differences. “A lot of autistic girls get ruled out because they may share a smile or may have a bit better eye contact or they’re more socially motivated. It can be a more subtle presentation,” Dr. Nash explains. If girls are socially interested but odd, which is the case with the majority of these girls, she adds, “I think people give them a pass.”

Another problem: misdiagnoses

Dr. Epstein says there’s another reason autistic girls are misdiagnosed, or diagnosed later than boys. Girls struggling with undiagnosed autism often develop depression, anxiety or poor self-esteem, and clinicians may not “really dig underneath to see the social dysfunction” caused by autism.

Dr. Nash adds that these girls can also be misdiagnosed with ADHD. “I see a lot of girls who are diagnosed with ADHD when they’re young who actually meet the criteria for autism,” she says. “There’s hyperactivity without as much social impairment or a different kind of social impairment, so the autism is missed.”

Autistic girls “pass”… at least for a while

Another reason girls may not be diagnosed is because they’re able to “pass.”

“Girls tend to get by,” Dr. Epstein says. “They might not understand what’s going on but they’ll try to just go along and imitate what they see. And they may get away with it to third grade or fifth grade, but once they get to junior high and high school, it shows as a problem.”

This has been the case for Lisa, now 13. Melissa says of her daughter, “She is less mature than her typical peers, and girls are so intricate in how they behave socially. It’s very difficult for her to maintain friendships because of this and, let me tell you, 13-year-old girls are not very accepting of someone different.”

The cost of a missed diagnosis

Dr. Epstein says undiagnosed autistic girls end up wondering “what’s wrong” with them, which can lead to depression, anxiety and loss of self-esteem. They work so hard to fit in that it wears them out. “That’s the thing about imitating,” she says. “You don’t necessarily ‘get’ it so you’re just trying to do what people do. If you’re just trying to mimic and you don’t really understand, it makes it pretty rough.”

Dr. Nash says less severe autism in girls is often first flagged because of these social issues, or the depression they generate. “In people we call mildly autistic, there are adolescent social problems or they’re seeming hyperfocused on a topic and not participating in school to their potential or abilities,” she says. “Depression can be more common among high-functioning kids on the spectrum. So they’ll come in for something like depression or poor school performance. Then it becomes more clear to me that they have a restricted interest and social communication issues.”

Another cost of being overlooked is missing out on early support for skill-building. “We talk about early intervention,” Dr. Epstein says. “When the girls are identified late, they’ve missed out on a lot of social interventions that are much harder later. That’s the danger for anybody who gets a late diagnosis.”

Dr. Nash concurs, adding that they’ve missed opportunities to get the proper support in school as well as socially: “Academically, it’s harder for them to focus on topics that are not of interest. That’s true for people who have ADHD and even to a greater degree for kids who are on the autism spectrum.”

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

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Safety risks for autistic girls 

Autistic girls may be bullied simply because they’re “different.” Also, Dr. Epstein says, because these girls miss social cues and want to be liked, their autism can leave them more naïve. This makes them easy prey for someone trying to take advantage of them, be it a bully or a sexual predator. “The girls may be wanting the interaction but not understanding what it’s about, what the cues are,” Dr. Epstein says. “It can be very easy for them to follow their hormones without an understanding of what the dangers are. And sometimes even if they have been taught, they need ongoing support to be able to maintain safety.”

Melissa says this has been true with Lisa. “I’ve had to think about female issues at a much earlier age than I expected,” she says. “We’ve already had an incident of her being inappropriately touched by a boy, for whom the excuse was made that because he’s also disabled, he ‘didn’t understand what he was doing was wrong.’”

One of her daughter’s greatest strengths is how accepting she is of others, Melissa adds. “She always finds the good in people, even when they are mean to her,” she says. “But because she is so accepting and kind, others can easily take advantage of her, or bully her, and she won’t say anything.”

Dr. Nash notes that there’s an area of study that’s rethinking how to help girls on the spectrum: “There’s expanding research on how boys and girls present differently and how our treatments may need to be specified a bit more for a girl’s presentation vs. a boy’s presentation.”

But first the girls need to be identified — and accepted. This will require more awareness and sensitivity on the part of parents, teachers and clinicians.

Frequently Asked Questions

How does autism present in girls?

Autism in girls often presents as deficits in social skills and communication. Girls with autism may also have repetitive behaviors, but they tend to be better at boys than hiding them and fitting in with peers. Girls may be hyper-focused on a specific topic and not participate in school to their potential.

Why are so many more boys diagnosed with autism than girls? https://standingabovethecrowd.com/?p=16047