Are there people with BPD who do not get better despite treatment

[Family Court Strategies: When Your Partner Has BPD OR NPD Traits.]

While I appreciate all the hopeful posts, I am wondering if anyone else experienced a BPD who never improved despite over 20 years of psychiatric care.

[snowwhite]

While I appreciate all the hopeful posts, I am wondering if anyone else experienced a BPD who never improved despite over 20 years of psychiatric care.

[Notwendy]

The one I know of is my BPD mother who has had decades of therapy off an on.

I don't think it is possible to predict if someone can get better. This is in retrospect and with several possible reasons:

She's elderly and grew up in an era where mental illness was not discussed and there was little information on BPD so some of the therapy may not have been what she needed.

Denial- she believes there is nothing wrong with her and issues are due to someone else.

Severity- BPD is on a spectrum and she is severe and low functioning. She's very intelligent but BPD impacts her function.

She's got some NPD component. When she has been in any kind of group therapy she thinks she's "better than those people".

Dishonesty- she lies to the therapists ( she lies constantly ) and seems to get some satisfaction out of "fooling" them ( and others). They can't help her if they don't see the larger picture.

Her public persona is amazing- attractive, intelligent, people don't believe what she's like at home.


I think for any therapy to be successful, the person needs to have some motivation to work with it.

[Sunfl0wer]

A previous friend of mine has had therapy for over a decade.  She is definitely much more functioning and manages her outward behaviors better, is raising her child, participating in her education, etc.

She however, has not fully internalized the emotional regulation skills.  She still uses other people to regulate her feelings that she cannot tolerate... she is simply more skilled at how she goes about this now.  I cannot for certain say she has internalized any self soothing more than she used to... she simply is more skillful at hiding her lack of emotional regulation abilities so goes about getting what she needs from people in a more covert manner than before.

[Notwendy]

I think if your friend is more skilled at being a mother, that's a success. I don't think this disorder is easy to "cure"  in the sense that they learn to control it well in every aspect. I think there are some people who have succeeded but I think we also have to consider that any improvement is a positive step.

One more "reason" for why therapy was not effective with my mother. My father met her needs almost immediately. He enabled her. On his part, it was a way for him to have a little bit of peace but it also reinforced her ways of getting her emotional needs met.

[flourdust]

It is an extremely difficult disorder to treat.

Sufferers have maladaptive strategies to fend off excessive feelings of shame and inadequacy ... that can include having difficulty acknowledging that their thoughts, emotions, and behaviors are harmful and need to be changed. Being unable to accept the illness is a major obstacle in accepting treatment for it.

My ex-wife had a BPD diagnosis, which she came in time to accept, but she still viewed therapy as something that she was doing under duress. Or she would manipulate it to serve her own needs and ego.

The literature on effective treatment for BPD tends to focus on improvement in extremely severe cases -- high risk of suicide, inability to function in society. Improvement to a more functional level for people who would otherwise be institutionalized is significant, but it may not translate to the typical circumstance we see here, where the BPD sufferer is more or less functional on a day to day basis but creates a lot of interpersonal conflict.

[Doughboy]

My Ex has been going to a Counselor for over 5 years and as of 2 weeks ago the Counselor still feels her issues are from ADHD and being a Highly Sensitive Person.

She spent 4 days on the Psych floor end of December because she could not be calmed down and was talking suicide.  The Psychiatrist there gave her "I hate you, Don't leave me".  She then did 6 weeks of DBT, 6.5 hers a day.  Transitioned to group once a week for 3 hrs and and back to her longtime Counselor.  This is when the Counselor said BPD was not correct.  About this time I was also incredibly devalued, blamed, a shoved away. 

Will the Therapy work for her. I have no idea.  Maybe they get worse before they get better.  Maybe it takes a period before acceptance.  My hope is that she was upfront and Honest and did not try and spin her life so she looked better.

I wonder if it is possible that the Therapy made a lot of the issues very clear to her and that created a level of sadness and shame that would not allow her to have me around. 

I think everything hinges on them accepting the Diagnosis, accepting the Therapy, and working hard to be truthful.  If I go off of what I experienced then I would say no but I was jettisoned before a real evaluation could be determined.

YMMV

[Cat Familiar]

My husband, who I label as BPD-lite, in that he has traits and has had moments of major dysregulation (before I learned how not to make things worse), has been voluntarily seeing a psychologist for several months.

He previously saw this guy when he was more symptomatic, but he stopped treatment and told me that it was a joint decision (which I doubted). His presenting issue then was feeling unaccepted by his sisters, who live on the opposite coast and have adult children. He thought that they didn't think he was a "real person" because he didn't have children.

Needless to say, I was really disappointed when he stopped therapy a couple of years ago, as I saw progress starting to happen. When he originally saw this psychologist, I even called him up and gave him a heads up that I thought my husband had borderline traits and I specifically mentioned what I had observed. I told him that he is very good at having a polished presenting personality due to years of being a lawyer, and it could take a while for him to truly disclose feelings.

Much to my surprise, he started back seeing this therapist and I haven't asked him any questions. He told me that he was planning on doing that one night when we were out for dinner and I merely said, "Yeah, I remember you liked that guy."

I think he's doing incrementally better, but recently he's had some minor health issues that have triggered some mild almost-dysregulations, but I haven't fed the fire, so they simply faded away.

A friend, who is a chaplain and has worked with this psychologist, thinks he does "therapy-lite" and isn't impressed. But that he may work slowly and non-confrontationally might just be a perfect fit for my husband.