Age: Do the symptoms of BPD improve/worsen with age?

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[Abigail]

And all of the other comorbidities must also be treated such as depression, anxiety, ADHD, etc.  BPD rarely stands alone.  It can also be more difficult to treat if the individual has other personality disorders such as Narcisstic Personality Disorder or Antisocial Personality disorder, or if the individual has a character disorder as well.  And with 9 criteria, of which only 5 are needed for a diagnosis, there is a lot of variance in each individual with the disorder.

[A.J. Mahari]

I think the answer to this is highly individual. Having said that, however, I do not believe that a diagnosis of BPD has to be for life at all. Is it more often than not, apparently, from all that we read on the internet. Perhaps once could even conclude, apparently, based on what a lot of the books written by professionals say.

It can also be argued BPD is for life given that professionals refuse (?) to outline or chart how some actually recover. They refuse, it seems, to define what recovery from BPD is or would look like. I will be addressing this in something I'm currently writing right now, but, I can only speak to it based upon my own experience. I have recovered. I know I am NOT the only one. However, I think it's fair to conclude, and sadly, very likely that many more have BPD for life than don't.

BPD is many things. For some it is more straightforward than for others. I think it is important for anyone with BPD to have hope and to believe in recovery. Hope and belief are the foundation of the road to recovery. Belief and hope in the possibility of recovery for those with BPD can make the difference between seeking the journey and deciding to take it even possible or continuing to live behind the maladpative (coping) defense mechanisms of the "borderline false self".

For anyone with BPD there has to be a willingness to enter into therapy. They have to take personal responsibility. They have to come to know that there are things they need to learn and change. Why do some with BPD get to these realizations and others don't? I am not sure that anyone really knows the answer to that question.

What I always stress to those who are non borderlines is how important it is to know where the person with BPD in your life  is. You can only make choices and decisions and invoke coping strategies based upon where the person with BPD in your life is at.

I guess there is a certain percentage with BPD who aside from some subsiding of some aspects of it after the age of 40 (so they say) do remain rather unchanged. In my experience recovery was a choice. It is a choice. If a person with BPD doesn't make that choice they will be unable to make all of the other choices that need to be made to support the initial choice to take personal responsibility, get into therapy and stick with therapy.

I have had tons of email from many with BPD though, who are well over 40 or 50 and even into their 60's and they are for whatever reasons mired in what I call the "active throes of BPD".

Whether or not someone is BPD for life, I believe, is the responsibility of each individual diagnosed with it. And given the reality that those with BPD can be blinded to personal responsibility - there's the main rub right there.

[JoannaK]

yoo referenced a study here:

As concerns (most probably) low functionning BP, there is a recent paper by Zanarini et al. A 10-year follow up of 362 BP initially contacted while they were in-patients. While impulsivity and severe difficulties in interpersonal management showed a reduction in some individuals, chronic disyphoria, abandonment and dependency issues tended to remain over time. Here the ref.

Zanarini, M. C., Frankenburg, F. R., Reich, D. B., Silk, K. R., Hudson, J. I., & McSweeney, L. B. (2007). The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study. American Journal of Psychiatry, 164(6), 929-935.

To my knowledge, there is no follow-up study on high functionning BP.
But no need to say that this type of investigation would be deeply needed :-)

- yoo

I think that the answer to this question would depend on many things... If the person with bpd is in treatment (voluntarily) and really wants to recover, I'd assume that you do see a decrease of symptoms with age.  If the person with bpd does not admit that he/she has any problems, I don't think you'd see much of a decrease, and age could exacerbate many of the symptoms.

[GENERAL ANNOUNCEMENT]

GENERAL ANNOUNCEMENT This board is intended for general questions about BPD and other personality disorders, trait definitions, and related therapies and diagnostics. Topics should be formatted as a question. Please do not host topics related to the specific pwBPD in your life - those discussions should be hosted on an appropraite [L1] - [L4] board. You will find indepth information provided by our senior members in our workshop board discussions (click here).

[Unreal]

go back and look at  my marriage with my X. I met her in med school, lived with her for a few years, then married her. The severity of her symtoms seemed to get worse the longer we were together and finally culminated with our divorce after we had kids.

met early 20s...most mild
married mid 20's
kids early 30s...at her worst

I could answer this in a couple of ways. . . as a psychologist or as an ex spouse of a BPD.  I'm going to go with the latter, mostly.  Your time line is similar to mine, except I met her a little earlier (19) and jettisoned her in our early 30s before children.   It's hard to pinpoint to what to attribute changes. Your life circumstances changed substantially.  The opening phase of the relationship is more of an idealization period, so I'd expect the unpleasant symptoms to be somewhat restrained.  You probably had relatively limited life stressors, med school, etc. . . Medical school is, no doubt, stressful.  I didn't go through it, but I did go through graduate school.  It is stressful in a structured way.  There are definable limits and it also sucks a lot of time.  This sets limits on some things and also allows you to attribute anomalous behavior to the unusual stresses of medical school.  E.g., "Things will get better when we have more money and time."  I think my ex was always looking to get to the next screen (geeky video game analogy).  It was sort of frenetic.  Grad school, check. . . good job, check. . .cool car, check. . . nice house, check. . . Never calm.  She did best when we were removed from those things.  I would see the girl I started dating when we'd go on vacation to her parent's house.  That's pretty much it.  There would be glimpses elsewhere, but other than that, she was a pain in the ass. 

At the time, I saw it as. . . add a little stress and she decompensates.  But, I think the missing realization for me was the awareness of her BPD.  BPD is a disorder of intimacy.  Children would be a big trigger, I would think.  You have the stress that children bring to your schedule and lives.  You have shifting foci.  It can't be all about your ex anymore and she certainly realizes it's not about you (to an exponential degree, most likely).  The children I think become a serious destabilizing factor for whatever uneasy balance you may have had.  This is just speculation.  As I said, I didn't get to the children phase.  I had a close call that ended in a miscarriage and within that 10 week period, some of these things had already started to ramp up.  My ex developed this way of filling up our days with crap.  There was no way to turn it off.  There was always something major on the horizon, something that had to be done, something that occupied her mind and didn't allow either one of us to relax.  I think these were distractors and also a striving to achieve what she expected life to be.  She thought in images. . . white picket fences, roaring fireplaces, children running, laughing, and playing.  When reality deviated, she fell apart.  Life as an adult is very different than those college/medical school years.  So, does BPD get worse or change?  I don't think so, not without intervention.  I think personality is relatively stable.  What changes is what the personality is exposed to. . .   Might they mellow?  Sure, as stresses decline/shift, they may mellow.   But, I don't know that they're any different.    

You also mentioned your own perception of it.  Looking back, I think I overlooked many bad things in my relationship. . . things I would never put up with now.  I was young, it was the most serious relationship I'd been in, and I thought I understood love.  I'm betting you were blind in addition to variations of the above issues.   

[MomToOne]

I put this question to a psychotherapist from the Community Mental Health agency who came to evaluate my teen BPD d at the residential treatment center. She said that in her 20 years of practice, she had not seen BPD patients get better with age. Many stayed the same, but some got worse. She said the problem came from not being able to challenge or push them to improve. They cannot handle the challenge, and just wanted to come in and whine to her and seek justification and validation for their actions and emotions. Even when confronting them with this observation, they continued on with the same behavior. Often she would be the one to say "don't come back if you don't want to work on pathways to improvement." It amazed her to see patients in their 60s coming in and dealing with the exact same issues she read in their charts from 30-40 years earlier.

[Skip]

This is a very recent study (accepted for publication September 1, 2008) that my shed some light on this.

Improvement in borderline personality disorder in relationship to age
M. Tracie Shea 1,2 , M. O. Edelen 1 , A. Pinto 4 , S. Yen 1 , J. G. Gunderson 3 , A. E. Skodol 4 , J. Markowitz 4 , C. A. Sanislow 6 , C. M. Grilo 6 , E. Ansell 6 , M. T. Daversa 3 , M. C. Zanarini 3 , T. H. McGlashan 6 , L. C. Morey 5
 
1 Department of Psychiatry and Human Behavior, Brown University and   2 the Veterans Affairs Medical Center, Providence, RI ,   3 McLean Hospital, Belmont, MA ,   4 New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, NY ,   5 Texas A & M University, College Station, TX ,   6 Yale University School of Medicine, New Haven, CT, USA

Objective: It is commonly believed that some features of borderline personality disorder (BPD) improve as individuals reach their late 30s and 40s. This study examined age-related change in borderline criteria and functional impairment, testing the hypothesis that older age would be associated with relatively more improvement than younger age.

Method: A total of 216 male and female participants with BPD were followed prospectively with yearly assessments over 6 years.

Results: Participants showed similar rates of improvement in borderline features regardless of age. A significant age by study year interaction showed functioning in older subjects to reverse direction and begin to decline in the latter part of the follow-up, in contrast to younger subjects who maintained or continued improvement over the 6 years. Despite the decline, functioning for the older subjects was comparable with or slightly better at year 6 than at year 1.

Conclusion: Improvement in borderline features is not specific to the late 30s and 40s. There may be a reversal of improvement in functioning in some borderline patients in this older-age range.

[MaybeSo]

For a non...it would be important to know how 'improvement' is operationally defined in any study.

For example, one study might operatonally define and measure improvement as 'keeping a job for 5+ years"

Another study  might operationally define and measure improvment as 'no emergency room visits during the last two year period'

Clinical studies, either good or bad in terms of results, might be interesting...but what is the study measuring and does it apply to your situation?   

My guy, for example, is high functioning, he can keep a job and he's never been to the ER for a mental health issue. 

Many bpd studies are tracking low functioning aspects of the disorder, like did they cut less, was there less suicidal ideation, was there less hopspitalization...things like that.  If that's what your are dealing with, then studies reporting improvement on those issues would be important.

For myself, since my guy is high functioning, I would want to operationally define improvement as ' able to maintain a stable relationship with one partner/family members over a two year period, with no reports of severe verbal or emotional abuse as reported by the bpd individual and as confirmed based on interviews with partner and/or family members.'

that's the kind of study I would like to see more of...plus, we have to be careful...our borderline may actually be aspd or have other co-morbid issues...a study would control for that...you cannot control for that in your life...I think many here don't even know exactly what all they are dealing with in terms of a complete diagnostic picture.

[Skip]

Many bpd studies are tracking low functioning aspects of the disorder, like did they cut less, was there less suicidal ideation, was there less hopspitalization...things like that.  If that's what your are dealing with, then studies reporting improvement on those issues would be important.

Well stated.

The question here is "Do the symptoms of Borderline Personality Disorder improve with age?"

I believe the past literature suggests this may be true for very specific, dysfunctional behaviors (e.g., cutting, suicide, hospitalizations), as you say, but not necessarily true for relationship stability which, in my reading, is one of the most difficult aspects of the disorder to resolve. 

I believe this 2008 study suggests that, when measuring a broad array of symptoms among patients in treatment, there was no generalized improvement for patients in the 30's and 40's observed - if anything, there was some regression with the older patients (closer to 50's).

[boarderchic]

It's also important to consider that the people on this board are not necessarily a random sample of nons, so the fact that most of us have BPDs that seem to get worse with age is not evidence against the previous literature, which does seem to suggest that BPDs improve with age. 

I think you really have to read the studies to have a good picture of what is going on.  As MaybeSo points out, the definition of improvement is important, the "class" of BPD is important (low or high functioning), and there may be other factors that differ amongst studies that lead to seemingly contradictory conclusions that are actually consistent when the different study conditions are taken into account.  Unfortunately, when scientific studies are publicized outside their original publication source, the details that make the difference are usually left out in favor of broad generalizations like, "BPDs improve with age" or "BPDS don't improve with age."  The study authors are not typically the ones making such broad, sweeping claims.   

Google scholar is a good place to find the original sources for these studies.  Some are freely available.  If you're REALLY interested, head to your local college library as they'll have subscriptions to most of the mainstream journals.

[strongernow]

My doctor, who knows my ex-bdp partner who is 31 years old well advises that he won't start maturing out of it for another 10-15 years.  He advises that BPD suffers don't learn from there mistakes at the same rate that other people do.  The problem is, that by the time the bpd person reaches this stage- the bdp has caused damage that can be just as difficult, the BPD has knock on effects which you may wish to consider- for ex- alcoholism, anxiety/depression, unemployment/going from job to job (it can be tough for the average person to find a good job at the age of 45...), alienation and so forth.  In my situation, becoming alienated, confused and lost with my BPD didn't happen over night, it happened slowly so I didn't notice until after I left.  If you are with someone long term, you've really got to be concious of this.  Its funny now how invites to so much from friends that I thought were just living more quiet lives have started springing up all over the place (I left my BPD partner 3 months ago).

[Randi Kreger]

As concerns (most probably) low functionning BP, there is a recent paper by Zanarini et al. A 10-year follow up of 362 BP initially contacted while they were in-patients. While impulsivity and severe difficulties in interpersonal management showed a reduction in some individuals, chronic disyphoria, abandonment and dependency issues tended to remain over time. Here the ref.

Zanarini, M. C., Frankenburg, F. R., Reich, D. B., Silk, K. R., Hudson, J. I., & McSweeney, L. B. (2007). The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study. American Journal of Psychiatry, 164(6), 929-935.

To my knowledge, there is no follow-up study on high functionning BP.
But no need to say that this type of investigation would be deeply needed :-)

- yoo

There is no research on higher-functioning BPs. It doesn't exist. This population is invisible to 90% of the clinical world, and as they get higher and higher up the food chain there is less and less awareness of this population.

In a phone seminar conducted by Robert Friedel, MD (who is on the board of the National Education Alliance for Borderline Personality Disorder, NEABPD.com) echoed the fact that while this population is "invisible to the clinicial population," every else knows about them.

[sailman]

I'm not technically an expert but my experience is that it never gets better!

[bpdfriend]

I'm not technically an expert but my experience is that it never gets better!

You are making a generalized statement about the illness, based upon your experience which is guaranteed to represent the smallest of slices of miniscule percentile of the BPDs in the world. I'm not comfortable with someone saying "it never gets better." That seems like an incredibly irresponsible thing to say, in my opinion.

[Skip]

There is a lot of conflicting information on this question... so it is probably fair not to generalize.

The first question is - "which behaviors?".   The second questions is "what time period"?

I think the general consensus is that self injury and suicidal ideation often (not always) become less problematic as a person matures (reaches into 30-40s).  There is some consensus that people, in general,  get more difficult to interface with as they age (reach into the 70-80s) and that this is more problematic with people suffering from a PD.  Stress or trauma can makes things worse.

In between these extremes, it most likely varies by the person and the situation.

[Fuzzy Bunny]

I am wondering if this is just a natural part of all of us when we age. Several older relatives, who I dont believe have PD's, became more ridgid in thinking as they age.

There is also the trait of scepticism increasing in some of us as we age. I know I am guilty of this.

Understand they dont deal with death well (who does?), its a big emotional time for us, for our PD partners, tough, as we age, more of our friends and relatives pass on.

[Jemima]

I have read that BPD tends to get better with age --- that some people gain emotional maturity over the course of adulthood that most people gain by age 18 --- but truthfully I haven't seen that. My mother "came out of the closet" after my father died five years ago. My mother and father as a unit always drove me crazy ... triangulation, thy name is [Jemima's parents] ... but I think my dad probably tamped down her rages. I never saw her just lose it before he died although she could be unexpectedly mean and nasty, and she definitely always has had a sense of entitlement, and is rigid and hyper-concerned with appearances.

My MIL is about the same as she always was with us ... has quiet periods punctuated by flares of rage and border-lion drama. And always, always, the lying, manipulation, and maliciousness. But if I could get my SILs to be honest, I'm thinking they would say she is worse.

A psychologist friend once told me that my MIL would just get worse with age, "because she will just stop giving a sh*t." Oh, yeah.

[Blossom]

What are the studies otherwise showing, though? If you're talking about a young adult who gets diagnosed at the 'right' time and receives appropriate treatment, then i can see how by age 30 or 40, the diagnosis may no longer apply. But like you, i don't see that it's as simple as growing through a phase of some sort. However, it's a reminder of how young people (especially) who have issues (IE self harm) can be mis-diagnosed with BPD and that their own issues may resolve within that time frame. I don't know, i'm rambling, but i am interested to see how others are reaching that conclusion.

[Mr R]

All the reading I've done recently tends to indicate that from about 40 years onwards you can start to 'grow out of BPD'.
Although they all state, and this is VERY important that Therapy is a total must if you really want to get over it at this age totally.

[Randi Kreger]

All the reading I've done recently tends to indicate that from about 40 years onwards you can start to 'grow out of BPD'.
Although they all state, and this is VERY important that Therapy is a total must if you really want to get over it at this age totally.

If you talk to adult children of BPs--the best place to hear examples of this--they will tell you they don't see much of a lessening.

[Mr R]

Wouldn't that be a biased population?

My Ex Wife is very high functioning, and is quite normal at times (a mask) but I can see that she is learning to regulate her emotions , at the age she is in life.