The Course of BPD

[MaybeSo]

Found this on the website for the National Education Alliance for BPD; the research think tank for this disorder.

It discusses stats for remission of symptoms, eg., stop self harming, visits to ER slow or stop. Those stats are pretty good with treatment. I've always wondered, though, about the less life threatening symptoms, like the daily social and relational issues we talk about here all the time that make partnering difficult. Not suicidality. Will my partner become a better partner? What are the stats with treatment on those symptoms? The item below seems to address that question, indicating even with treatment the outlook for social functioning ain't so good.

I would like those smarter than I am to comment on their impressions of this please.

The Course of Borderline Personality Disorder

www.borderlinepersonalitydisorder.com/understading-BPD/a-BPD-brief/

Borderline Personality Disorder usually manifests itself in early adulthood, but symptoms of it (e.g., self-harm) can be found in early adolescence. As individuals with BPD age, their symptoms and/or the severity of the illness usually diminish. Indeed, about 40-50% of borderline patients remit within two years and this rate rises to 85% by 10 years. Unlike most other major psychiatric disorders, those who do remit from BPD don’t usually relapse!  Studies of the course of BPD have indicated that the first five years of treatment are usually the most crisis-ridden. A series of intense, unstable relationships that end angrily with subsequent self-destructive or suicidal behaviors are characteristic. Although such crises may persist for years, a decrease in the frequency and seriousness of self-destructive behaviors and suicidal ideation and acts and a decline in both the number of hospitalizations and days in hospital are early indications of improvement. Whereas about 60% of hospitalized BPD patients are readmitted in the first six months, this rate declines to about 35% in the eighteen months to two-year period following an initial hospitalization.  In general, psychiatric care utilization gradually diminishes and increasingly involves briefer, less intensive interventions.


Improvements in social functioning proceed more slowly and less completely than do the symptom remissions. Only about 25% of the patients diagnosed with BPD eventually achieve relative stability through close relationships or successful work. Many more have lives that include only limited vocational success and become more avoidant of close relationships. While stabilization is common, and life satisfaction is usually improved, the persisting impairment of social role functioning of the patients is often disappointing.

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[patientandclear]

I'm not smarter than you, but yes, that's certainly how I would read that.

[LetItBe]

I'm not smarter than you, either, and that's how I interpret the article as well.  Thanks for posting that.  It sheds light on a statistic I've wondered about.

[MaybeSo]

Ya, only 25 per cent achieving "relative stability"... .WITH treatment

Wow, That just doesn't sound good.

Sigh.

[eeyore]

Well there are a lot of very serious illnesses in the world.  Mental illness is viewed by many as a taboo subject.  So that means limited money goes to medical research on the illness and it's cures.  I might not be picking the right words today.  But the point is it doesn't surprise me because there are limited resources.   

It really takes a special person to be able to navigate a relationship with a BPD partner.  I actually think with divorce rates at 50% relationships aren't easy or the statistics wouldn't be so bad.  Add to it something like BPD and the relationship is even more challenged.

[123Phoebe]

"Only about 25% of the patients diagnosed with BPD eventually achieve relative stability through close relationships or successful work."

Maybe that 25% would/wouldn't be across the board if every single person on the BPD spectrum were diagnosed?  I took it to mean more of the lower functioning sufferers. 

[MaybeSo]

Good point about lower functioning. The pop they are studying are low functioning visa vie hospital stays and medically treated suicidality, so of this pop the suicide symptoms remit quite well but only 25 per cent of that pop achieves relative stability in social functioning.

The high functioning folks remain a mystery in regards to treatment because they don't get tracked in research studies?

[123Phoebe]

The high functioning folks remain a mystery in regards to treatment because they don't get tracked in research studies?

They're probably the ones conducting them  (kidding)

I think it would be hard to get a good solid % of successfully treated high functioning folks, as a lot of them never set foot in a therapists office and go undiagnosed.  Might get a more accurate % from the loved ones who seek therapy

[waverider]

I think one of the issues to consider is that individuals who have been low functioning have missing "normal' life experiences, and hence maturity of thought. Even if the BPD wiring is rectified they still have missed out on a lot of development, that can only occur through experience, it can't be taught in therapy.

Even us nons are more mentally developed at 50 than we were at 30 and even more so than at 20. If someone goes from say 10 to 50 in emotional maturity due to therapy, their life experiences dont catch up proportionally. So they will always seem "not quite right"

[123Phoebe]

Even us nons are more mentally developed at 50 than we were at 30 and even more so than at 20. If someone goes from say 10 to 50 in emotional maturity due to therapy, their life experiences dont catch up proportionally. So they will always seem "not quite right"

This is something I've wondered about and then come to the conclusion of... .to whose standards? 

I might seem 'not quite right' to a lot of people, while others are very accepting of my idiosyncrasies; most importantly, that I accept myself.  I find 'normal' to be very subjective.

Does it boil down to acceptance of self?  Or is that too simplistic and idealistic?

Can high functioning/low functioning pwBPD accept themselves if they don't have a 'self' to accept?

[MaybeSo]

Well, I overlay this paper in terms of my ex ( we have contact, but aren't together)

Here's a guy that had some BPD issues showin up in childhood. In high school and college especially, he became the friendly clown that partied his a@@ off and barely graduated. The party lifestyle and mask was useful but there wasn't a lot of sophisticated social development going on. Married straight out of college cause everyone else was doing it and he had no idea what else to do with himself. Dated his wife through most of college but was known as the guy who could chat up ANY girl. With marriage, rage symptoms start to show up. He views it as totally about his wife's behavior, a very unempathetic "get over it" type. He also cuts way back on the partying lifestyle having grown tired of it, so no more booze and pot to self medicate. Married 16 years. Still chats up any attractive female, but reports he never physically cheated in the marriage. No real job first half of marriage; but then in the last half of marriage he starts reading some self help books, always felt something was wrong. He becomes very productive. Gets 2d degree in a profession and works for firm then starts his own firm. Starts another business with wife at same time. They finally split up. Marriage counselor has him working on rage, diagnosis of cyclothymia. Leaves 16 year marriage, dates like crazy for 2 years, meets me.

Major BPD love affair. I do the dysfunctional dance with him, all drama trauma.Push pull. Triangulates. Women women women. Clueless behavior about what would upset a gf or wife. Lots of work by both of us, lots of improvements. No suicidality ( one threat) but he's just... Borderline.

The mood swings and the fixation that he just needs to find the right one cycles for six years. His business has ups and downs, but he worked really hard to put people in place that can take care of the business when he's distracted or restless. He desperately wants (in cycles) to marry me and settle down but these mood episodes make him feel like crap and another woman will fix it. Has done that for two years with other women, it didn't fix anything. Same issues. Now he wants me again.

I don't do the dance anymore, no drama trauma.

So, huge improvements over time. A huge success story on paper. Eight years of therapy. Gone from unemployed to professional with 2 businesses. Remaining business doing very well, people in place to mitigate his weaknesses. Got healthier physically, got out of bad marriage, got control of anger/rage issues.

But the women.

Working hard on his "women" issues, but still a struggle. Can't be alone. Gets moody, and bolts. It sucks.

Will that ever change?

Cause that's pretty difficult "relative stability" to accept

[connect]

Hi Maybeso,

Yep you are right your ex has gone great guns to improve himself and he seems to be pretty self aware that he has issues to work on and has actioned on that awareness in the past. He is high functioning obviously - I also think this article may be statistically biased towards lower functioning individuals with BPD. But then again I could be in total denial about that 25% figure... .I suppose that group are easier to study as they may be in and out of the healthcare system and already being monitored. Harder with the higher functioning pwBPD as how can we always quantify social stability and subtle improvements in r/s's?

The frustration for you must be that his issues around women is almost the last piece of his puzzle that he needs to fix. Does he know that this is part of his issues? Or does he genuinely believe that a new woman will fix all his problems? What does he say when you have discussed it? I imagine he says that it will all stop and he will do better.

The moods / space stuff I can see you can deal with in a healthy way so it's not so much of a problem for you. It's just that last sticking point around women that is the real dealbreaker for you. Don't blame you. But so frustrating when all the other pieces have been fitting in so well.

[momtara]

Yes, they are talking about people who end up in the hospital a lot and make suicide attempts.  I don't think there's any way to tell how much the other symptoms will improve with treatment.  Seems to me that a year of weekly DBT would be a good start for some people.  Every case is different and it all depends on concurrent disorders, addictions, how badly the person wants to change, what's at stake, etc.

[eeyore]

Does his ex wife's story agree?  Were there no affairs?  At this point why is he mad at the ex and not mad at you?  Or did I misinterpret that?  And what happened to the business with the ex wife?  What's their relationship like now?

[MaybeSo]

Does his ex wife's story agree?  Were there no affairs?  At this point why is he mad at the ex and not mad at you?  Or did I misinterpret that?  And what happened to the business with the ex wife?  What's their relationship like now?

As far as I know wife and his story agree. I have not personally asked wife about any of this, but, I was in a couple of sessions with him and the same T that he and wife use to go to when they were trying to do couples counseling before I met him, before the split. I was concerned about his weird behavior with women, it was like he was hitting on them all the time or taking friendship way too far... .  I asked kind of incredulously to him and the T... .was this an issue that came up in the past in marriage counseling?  The T and he said, OH, ex wife knew he had a way with women, would glom onto them at parties etc., But in T, the exwife would say "OH, that's just (insert name)"... . and roll her eyes.  Like, she wasn't thrilled about it but it was like, not the number one thing on her plate.  She just kept saying in T all the time "somethings wrong with him, he needs to be medicated"... .I guess mostly in response to his moodiness and rage-fests.  You know, If he was raging all the time with me, I'd probably be less focused on the women thing, too. But, he'd done a lot of work on that already by the time I met him. It seems like the rage stuff decreased and the 'working it with women' thing increased or took it's place.  Wife and  ex were talking with me one day about an issues that came up where my ex had withheld something from her concerning the kids... .and ex-wife said to him, in front of me... .'come on, you aren't a liar"... .I thought that was rather interesting.   Here his ex wife of 16 years who thought he needed meds because something was so wrong with him... .said straight faced... .'you aren't a liar'... .as though his withholding of information from her was not a typical experience for her.  Whereas... .MY experience is that he DID lie and shave the truth a lot with me... .but mostly out of desperation to keep me.  Their dynamics were obviously quite different... .I think I set the bar much higher than she did.  They were like roommates for years... .tolerated each other. No major romance going on whatsoever between them, no one ever said "I love you", no affection, no real shared interests, and I think she would say there were no affairs to her knowledge. He felt certain that if he cheated on her, she'd divorce him and really take him to the cleaners.  But I think wife would say that he would work a room with women. Today, he paints ex wife black.  Can't stand her.  He can't stand her because she has not ONE once of empathy or concern for ANY THING having to do with him. So, this does not go over well, as you can imagine.  She is not very nice to him, frankly. The worse communication style you could ever have with a person with borderline features... .just very curt and NOT interested in any part of a persons emotions AT ALL.  And of course, he is very triggered by that style... .and so it's a no brainer for him to paint her black.  My style is much different with him than hers.  I actually use a lot of the tools on this site, I always try to use a lot of emotional validation when I speak with him etc., so of course he's is going to feel more warmly toward me, even when we are broken up or not together. 

[sm15000]

They're probably the ones conducting them  (kidding)

I'm not sure if you're that far off the mark!

My ex mentioned once that when he was an older teenager someone advised him that his behaviours could be managed within a certain philosophy, if you like.

As a young man he was a lead singer in a punk band, toured, didn't have an 'official' job for years, squatted and aligned himself to anarchist politics.  Totally the opposite, I should imagine, of his police detective father's ideals.

He took a Philosophy and Politics degree and became a University lecturer. . .and a very, very popular one - he was an excellent teacher I have to give him that.

But I can see how he has managed his PD by using this. . .he has blown off steam over the years when going to demonstrations - got arrested once but I think his Dad aided his getting off.  If people think he 'thinks' differently or acts 'strangely', he puts it down to his beliefs and values are different from yours. . .and can argue it like a champion.

If he gets angry, he's angry at the world (it's not him)

If he cheats, it's because he's a free spirit (it's not him)

If he gets involved with other women (usually students), they take it the wrong way, he's just trying to guide them and do his job well (it's not him)

He's VERY, VERY good at it but is nearly 55 now and - as far as I know - still repeating the pattern

AS with Maybeso's partner. . .the women thing is something I don't think will ever change.  He needs it, the attention, the thrill. . .and in a way, it's the aspect he seems in denial about the most.  Some of his other behaviours I think he is quite aware of.

The HF BPDs are very different beings 

[eeyore]

I could see the the ex wife's style might be better for moving on.  She doesn't have to keep a string to him with the kids she's always got one.   I suspect that's a major difference.  Has she remarried? 

[MaybeSo]

I could see the the ex wife's style might be better for moving on.  She doesn't have to keep a string to him with the kids she's always got one.   I suspect that's a major difference.  Has she remarried?

 

His ex wife is not married but has a bf she has been living with for about two years now. She wants no attachment to her ex H... .other than the money he pays in support.  She can't stand him. They both can't stand each other.  They both don't understand each other at all. The divorce was final years ago... .she is not a major player in his life AT ALL... .I wish they DID get along better so they could co-parent the kids more effectively, but they just cannot communicate without triggering eachother... .not in like a failed romance kind of way, but in a rolled eye, you are a jerk kind of way.  They both do it. If anything, my ex works much harder to TRY to use good communications skills with her... .whereas the exwife just thinks his efforts at therapy and his efforts toward self imporvement are stupid.  She is EXTREMELY invalidating.

[eeyore]

I could see the the ex wife's style might be better for moving on.  She doesn't have to keep a string to him with the kids she's always got one.   I suspect that's a major difference.  Has she remarried?

 

His ex wife is not married but has a bf she has been living with for about two years now. She wants no attachment to him, other than the money he pays in support.  She can't stand him. They both can't stand each other.  They both don't understand each other at all. The divorce was final years ago... .she is not a major player in his life AT ALL... .I wish they DID get along better so they could co-parent the kids more effectively, but they just cannot communicate without triggering eachother... .no in like a failed romance kind of way, but in a rolled eye, you are a jerk kind of way.  They both do it. If anything, my ex works much harder to TRY to use good communications skills with her... .wife just thinks his efforts at therapy and his efforts toward self imporvement are stupid.

Sounds like she has moved on with her life after all those years with him.  I guess the thing is your ex/bf is still isn't in the 25% that have reached stability in a relationship.  Of course he is  undiagnosed.  It's all very interesting.  He doesn't keep trying to engage with her because he doesn't like the result.  You are understanding so he keeps being engaged in a life with you.  Seems like he causes (may not be the best choice of words) you to be in an unhealthy dynamic.  Although it is also your choice.  So what do you do knowing he's always got these other women?  How do you move on?  But that's another subject.

[MaybeSo]

Ya, if I threw some invalidation his way consistently he'd go away!  

Anyhoo... .ya, I'm not with him right now. He's wanting me to be, though. But that's pretty standard in his cycle, I don't get too worked-up about it either way anymore. Been there. Done that.   And have given all of this a lot of thought, even from a very clinical, more detached point of view because I'm not invested in it much either way anymore, other than, he's person who has been in my life, I do love him, and I wish him well and hope he can be happy. It doesn't HAVE to be with me.  It would be nice, but with this last one big remaining ISSUE... .I truly wonder if he can ever really modify that behavior long term.  When I see a paper like the one above... .it makes me think the odds aren't good.  

[123Phoebe]

I could see the the ex wife's style might be better for moving on.  She doesn't have to keep a string to him with the kids she's always got one.   I suspect that's a major difference.  Has she remarried?

 

His ex wife is not married but has a bf she has been living with for about two years now. She wants no attachment to her ex H... .other than the money he pays in support.  She can't stand him. They both can't stand each other.  They both don't understand each other at all. The divorce was final years ago... .she is not a major player in his life AT ALL... .I wish they DID get along better so they could co-parent the kids more effectively, but they just cannot communicate without triggering eachother... .not in like a failed romance kind of way, but in a rolled eye, you are a jerk kind of way.  They both do it. If anything, my ex works much harder to TRY to use good communications skills with her... .whereas the exwife just thinks his efforts at therapy and his efforts toward self imporvement are stupid.  She is EXTREMELY invalidating.

Are you sure there isn't more (unfinished business) going on beneath the surface with the ex?  The reason I ask is because of the high-trigger component.  Not that it's romantic, I'm not saying that at all (I have no idea).  But that he even tries using good communication skills with someone he can't stand.  Is she more like his mother/father than you are in the invalidating department?  And screw the kids when it comes down to this stuff?

This stuff is so d@mn deep and you can just keep going deeper.  To even be thinking about it at that level (without going for a degree), as I have with so many people in my life... .  If I took 25% of the time that I've devoted to other people's suspected mental illness issues (as my own ), into my own health, wealth and well-being... .  I'd be 125% further ahead in my life than I am now.

I definitely have my own issues.  Focusing on other people has not been the answer

MaybeSo, do you feel better not being with him?  Do you feel like you're on the right track with yourself?

[MaybeSo]

Are you sure there isn't more (unfinished business) going on beneath the surface with the ex?  The reason I ask is because of the high-trigger component.  Not that it's romantic, I'm not saying that at all (I have no idea).  But that he even tries using good communication skills with someone he can't stand.  Is she more like his mother/father than you are in the invalidating department?  And screw the kids when it comes down to this stuff?

Of course there is deep stuff there between them. There always is when there is hatred there.  So, it's triggery for both of them, both are likely dealing with projections and echoes from the past. It's been that way for the 8 years I've known him. Read The Narcisstic Borderline couple ... .they are poster children for that dynamic.  His mom is narcisstic, ridged, and cold, her father was a big shot who had affairs for years while her mother looked the other way. They are both living out childhood trauma through eachother. They chose what felt familiar from childhood and recreated that in their own relationship.  That's what all that fighting and acrimony is almost always about ... .

He and I were heading down that path, but not anymore. Not for a long time now.

I have both personal and professional interest in this disorder.

I don't focus on it to the exclusion of myself. Not anymore. A lot has changed in the last two years. The progression of this disorder with treatment is of great interest to me, for a lot of reasons.