Prediction of the 10-Year Course of BPD - Mary C. Zanarini, Ed.D.,

[blissful_camper]

I found it challenging to discuss the r/s on a deeper level with my ex. I couldn't stop the hater phase. I became a trigger. Being a trigger didn't reinforce his sense of wellness or mine.  The healthy option for us both was ending the r/s.

It seems natural to ask the question, "why didn't I leave sooner?"  I feel that I didn't exit earlier because I had neglected to put into motion my own inner work. I appreciate the r/s for pointing me in that direction.

[Tim300]

I became a trigger. Being a trigger didn't reinforce his sense of wellness or mine.  The healthy option for us both was ending the r/s.

I think this is one of the most important aspects of BPD awareness -- recognition that being in a close relationship with a pwBPD is not helping the pwBPD.  It might briefly be helpful for the pwBPD (and the pwBPD will certainly beg for it), but in due course you'll become a crippling trigger . . .

[Skip]

Thanks.  I just read both of the studies you posted.  I do not find them persuasive in refuting rotiroti's conclusion (that DBT "would only delay doomsday".

I think this is one of the most important aspects of BPD awareness -- recognition that being in a close relationship with a pwBPD is not helping the pwBPD.  It might briefly be helpful for the pwBPD (and the pwBPD will certainly beg for it), but in due course you'll become a crippling trigger . . .

I think the bigger question here is why are some of us obsessed with creating such a bleak image of BPD that we start attacking peer reviewed studies from Harvard of a protocol developed at the  University of Washington. Or that we need to openly declare treatment as ineffective. Or that we conclude that isolation (no close relationships) is helpful.

The first question I would ask is why is this rewarding to us? Researchers would say that it is to avoid personal responsibility.

Let's not do that.

Let's also keep matters in perspective - Face the Facts - if you will.

• Most of us did not have a relationship with a clinical borderline. We had relationships with subclinical borderlines or clinical and non-clinical bipolar, OCD, ACHD, addiction, etc.  This stuff largely presents the same way in failed relationships so we can help each other.

• The DSM describes BPD as a disorder of relationship instability - so, for the percent of our members with BPD-ex partners or subclinical BPD-ex partners, relationship instability is statistically likely. Its a given.

• A lot of us have our own bag of issues. Exiting the relationship and leaving the partner did not cure it.  Its important that we not become obsessed with blame shifting - if feels good - it perpetrates future failure. Its call co-rumination.

• Two things can happened when we pulled together a highly specialized group of people like we have on this board -  people who have recovered can reach back and help newer members with perspective and maturity to walk a path of recover (and everyone can be supportive) -  people with issues can band together and convince themselves that they have no issues.  Picking which pack you are in is the single most important decision you make here.

• The recovery statistics on BPD treatment are far higher than alcoholism, breast cancer at 10 years.  We all celebrate recovered alcoholic and breast cancer survivors. We should celebrate those that have battled back from BPD.

• Isolation is the single largest predictor of mental health failure.  Studies have show that those that have recovered from BPD had a trusted relationship - it may have been rocky - but it was important.  The same is true for us.  Having trusted relationships is extremely important part of our recovery.
  
  What is a trusted relationship?  Someone who cares, someone who is strong, someone who is mature enough to lead someone out of the "fog" of woundedness.  Everyone posting here, regardless of the number of posts, knows what this is first hand.

[Pretty Woman]

What I've heard is DBT is effective but it takes years of hard work... .like 8-10 years and getting a non-commital person to commit to that is not a very successful endeavor.

My ex BPD is 43. She knows something is horribly wrong with her. So she goes to "therapy" and convinces her therapist it's all me.

The therapist has no idea she could have BPD and enables her decision making thinking she is a rational person.

Getting a BPD into DBT is not an easy task.  BPD actually worsens if untreated. There is a lot of contradictory info out there that a woman can get "better" and outgrow BPD as they come into their late 30's-40's but one needs to realize... .there are many enviromental factors at play. My ex's entire family is f'd up. Even if she got treatment she is surrounded by un-supportive f'up people and many of these people are way over 40yrs of age!

There really is a low success rate overall.

[BorisAcusio]

• Isolation is the single largest predictor of mental health failure.  Studies have show that those that have recovered from BPD had a trusted relationship - it may have been rocky - but it was import.  The same is true for us.  Having trusted relationships is extremely important part of our recovery...
  
  What is a trusted relationship?  Someone who cares, someone who is strong, someone who is mature enough to lead someone out

Could you post a link to those studies?

[Loosestrife]

I agree with pretty woman the success rates for BpD recovery are abmissmal and the other addictions and illnesses you mentioned  have much higher success rates.

[Invictus01]

I agree with pretty woman the success rates for BpD recovery are abmissmal and the other addictions and illnesses you mentioned  have much higher success rates.

One more thing... .We are talking about treatment of personality disordered people who have committed to the treatment. According to psychologists, the vast majority of personality disordered people won't even go into an evaluation, let alone the treatment.

[Skip]

I agree with pretty woman the success rates for BpD recovery are abmissmal and the other addictions and illnesses you mentioned  have much higher success rates.

One more thing... .We are talking about treatment of personality disordered people who have committed to the treatment. According to psychologists, the vast majority of personality disordered people won't even go into an evaluation, let alone the treatment.

In answering this question, I don't want to dilute my point earlier that we should examine why it is so important to have these highly pessimistic beliefs. We don't loved ones with this disorder. We don't have loved ones in treatment.

Committed to the treatment You may want to read the study protocol. The only criteria was that these people were admitted to hospital - they were sick enough to do at least an overnighter.  Some were in structured treatment for some period. Some were in an out. Some took sophisticated treatment.  Some got local family therapist whatever.  Some got virtually nothing.

DBT is 8-10 year process It's not really the case. Most of the studies on DBT are on people with one year or less treatment year of treatment or less. DBT is often given as a course - 2.5 hour sessions, twice a week.

No other board has these beliefs. On the parenting board, virtually all the child (adult children) are diagnosed and there is a far more balanced perception of the recovery there.

The reality of impulse disorders is difficult enough with a balanced perspective - it doesn't help us to exaggerate.

Why it is so important to have these highly pessimistic beliefs?  

[Skip]

I agree with pretty woman the success rates for BpD recovery are abmissmal and the other addictions and illnesses you mentioned  have much higher success rates.

The equivalent study for alcoholism for people that had "any treatment" is

Alcoholism

Years ---------- 1-5 5-10 11-19

Abstain or Light Drinking ----------------------- 7.0% 31.5% 41.7%

2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, or NESARC

[LonelyChild]

Here is an abstract from part of the McLean study showing evidence of successful treatment and also additional factors related to treatment success. Note that this was an inpatient group, too.

Hi Mike. I, as well, have heard of these success stories. But I have never seen them or heard of anyone who have seen them in first-person. I've asked many Ps and Ts. They all say the same - the prognosis is that the chance for change is close to non-existent.

I only see these small studies of novely therapy methods that claim high success, but the fact of the matter is that change seems to be incredibly rare for pwBPD.

To me, it seems that saying that there's big hope for change is giving false hope to people. What about the persons on here who have been married and given EVERYTHING to "fix" their BPD SO? Years of therapy, counseling, what have you, for each of them separately, together, etc, etc. Still no change.

I'm sure some pwBPD get well and I'm sure there are great therapy methods out there, but on the whole, it seems like only a couple in a hundred change for the better. And even then, the change seems to be just barely enough to hold together.

[Skip]

To me, it seems that saying that there's big hope for change is giving false hope to people.

You are hitting the nail on the head here.  Over the years, this has been the single most cited reason for member concern about optimism - our own personal feelings of failure or weakness.  

When we opened the staying board back in 2007, some members accused the staff of "condoning abuse". When we dug into it, the answers we got were about feelings of failure with a partner and fears of being the at fault in the relationship.

Its easier to accept that nothing more can be done.  We had a newbie post these exact words today. "I'm a wreck still, cant understand it. Did I mess up in my frustrated comment? Was I used? I just want to believe its mental illness and use that as closure."

This is OK stuff for a newbie - get through the crisis - thats why we don't have hard and fast rules.  But at some point, we can get carried away.  

Does your experience seem inconsistent with:?

40% of patients with borderline personality disorder remit after 2 years, with 88% no longer meeting the criteria after 10 years   And if you read the studies, the self harm, suicide, reckless behaviors tend to resolve earlier in the cycles and the interpersonal traumas later.  

I remember reading someone criticizing this (interpersonal traumas later.) - but that is a little self centered when we do - if we were the ones with BPD, we would be most concerns about the suicide, and self harm. Researchers too.  The suicide rates is what really go the ball rolling here.

The studies are not about the social issue of hope.  It proof of principal of a method.  Science stuff. The studies with depression followed the same model - CBT.  Those numbers are very encouraging. But neither are social statements,

But what about the social issues?  Should we be optimistic or pessimistic?

The anti-stigma people will argue that the more hope there is (less hysteria), the more likely people will get treated.  We have seen that with mental issues like bipolar, we saw it with physical issues like HIV/AIDS.  When the stigmas lifted, many more people got tested/treated.

Here (bpdfamily), we aren't encouraging any social agenda - our charter says we are not to advocate (positive or negative).  

We want to provide perspective.  A lot of it is sobering.

[Randi Kreger]

I agree with your point about personal responsibility and many parts of your post. However, when people quote studies about treatment like those below  

"I think the bigger question here is why are some of us obsessed with creating such a bleak image of BPD that we start attacking peer reviewed studies from Harvard of a protocol developed at the  University of Washington. Or that we need to openly declare treatment as ineffective. Or that we conclude that isolation (no close relationships) is helpful.

To conduct a study with subjects who have BPD, BPD must be narrowly defined to ensure consistently. Before subjects are considered for the study, they are evaluated specifically for self-harm and suicidal thoughts.

The studies in Washington are about DBT, of course. DBT has two goals: reduction of  self-harm and suicidal thoughts. The results show reduction in those two areas. This is critical because insurance companies will pay to prevent more costly ER visits. And of course, you can't help a patient who isn't alive.

So it's not quite so simple to say that treatment works, when some treatments work for some people who are qualified for the treatment because they fit the narrow definition of BPD.

It's also wrong and a simplification to say people with BPD are untreatable and will never be cured.

Whatever the mental disorder is, a person can be helped if they have access to the proper treatment, are willing to go and work hard, and are willing to stick with it for years.

In addition, you can call treatment "successful" when it meets the goals you have set up; in DBT this involves those two principal traits/ Kiera Van Gelder, one recovered woman who wrote a memoir, has discussed "when has treatment really worked" and some clinical seminars.

Do we count treatment successful when a person is no longer self-harming? When they feel better? When they don't need meds? When family members don't feel burdened. Right now all we can quantify are things like emergency room visits and inpatient stays for those two main traits.

I believe that most people who enter DBT do feel better, but statistics do not bear this out. Someone can no longer be classified as having BPD now if they only have four out of 9 traits. And the drop out rate is incredible, the treatment is expensive, and clients are urged more than once.

So I think people split about this and think in black and white. For families, I think that "better" mostly means that they can live with the person in a reasonably happy way without abuse and hopefully with some closeness.

In terms of why people on the board are pessimistic, I believe that:

1. It's so much easier to complain than learn tools and techniques.

2. The initial change must come from the family member

3. Learned helplessness

4. Comorbidity with substance abuse and narcissism. About 30% of all people with BPD have NPD or NPD traits.

I think that happiness can't depend on treatment when the person refuses to go.

[Tyrwhitt1]

My experience of 22 years with my exBPDh who's now almost 60 years old, spent years in therapy and on meds is that whatever the research, BPD doesn't change with age, and as for therapy, my exBPDh accepted he wanted to change and sought prof help.  I thought he was doing it for himself and us but it was to keep me there, hoping our marriage would stabilize.

He told the therapist exactly what he wanted her to hear, promised all sorts of behavioural changes then walked away and carried on.  You see, it's not only you a person with BPD mirrors, it's everyone. 

And yes, the hater phase was inevitable, and in that stage, you can't do anything except part. The rage increases and it can get dangerous.

[LonelyChild]

My experience of 22 years with my exBPDh who's now almost 60 years old, spent years in therapy and on meds is that whatever the research, BPD doesn't change with age, and as for therapy, my exBPDh accepted he wanted to change and sought prof help.  I thought he was doing it for himself and us but it was to keep me there, hoping our marriage would stabilize.

He told the therapist exactly what he wanted her to hear, promised all sorts of behavioural changes then walked away and carried on.  You see, it's not only you a person with BPD mirrors, it's everyone. 

And yes, the hater phase was inevitable, and in that stage, you can't do anything except part. The rage increases and it can get dangerous.

Having a uBPD father and uBPDxgf, I can only agree. It IS inevitable. They might stop the self-harm and suicide attempts, but they still do not function well in any kind of r/s, and reciprocity is literally impossible.

[Loosestrife]

I am appreciative of the honest and different opinions. I've met several Ps who say it the negative behaviours only ever get better for a short period of time and don't ever really settle down until the BpD person gets into their 50's... .

[LonelyChild]

I am appreciative of the honest and different opinions. I've met several Ps who say it the negative behaviours only ever get better for a short period of time and don't ever really settle down until the BpD person gets into their 50's... .

My dad calmed down somewhat in his 60's. The rages have actually stopped. He's still a wreck though. He's like an empty shell. He has no friends, his family don't really want contact with him, no interests, he can't sleep at night due to anxiety, he has no routine whatsoever, he doesn't know how to care for himself at all. He had 3 dogs and 2 cats (all are thankfully dead now). They all became mentally ill. Yes, I'm not kidding. Even his animals became crazy around him. The dogs lost extreme amounts of weight because of stress and we had to get rid of two (this was over 10 years ago). The last one, that he kept, was insane. He could come and cuddle with you, and when you cuddled back, he became super agressive. Dog form of push/pull. Even the cats couldn't relax and one died of some kind of heart attack. As I'm typing this, it sounds ridiculous, but I'm dead serious.

[BorisAcusio]

I am appreciative of the honest and different opinions. I've met several Ps who say it the negative behaviours only ever get better for a short period of time and don't ever really settle down until the BpD person gets into their 50's... .

My dad calmed down somewhat in his 60's. The rages have actually stopped. He's still a wreck though. He's like an empty shell. He has no friends, his family don't really want contact with him, no interests, he can't sleep at night due to anxiety, he has no routine whatsoever, he doesn't know how to care for himself at all. He had 3 dogs and 2 cats (all are thankfully dead now). They all became mentally ill. Yes, I'm not kidding. Even his animals became crazy around him. The dogs lost extreme amounts of weight because of stress and we had to get rid of two (this was over 10 years ago). The last one, that he kept, was insane. He could come and cuddle with you, and when you cuddled back, he became super agressive. Dog form of push/pull. Even the cats couldn't relax and one died of some kind of heart attack. As I'm typing this, it sounds ridiculous, but I'm dead serious.

I can relate to that as my father also mellowed out in his late 50s.  The extreme vicious rages paired verbal abuse halted and transformed into a child-like narcissistic regression, passive-aggression and dissociative detachment. My mother keeps him afloat but apart from that, almost completely isolated.

It took me a while to recognize why my ex's behaviour was so familiar.

[fromheeltoheal]

So what's the upside?  There's benefit in considering borderline behavior inevitable and treatment just a delay, or folks wouldn't do it.  The benefit is it makes it easier to let go of hope that the relationship could have worked or that it might work.  Going from a sliver of hope to no hope at all is a huge leap, and a painful one, but absolutely necessary for detachment, and in some sense the beginning of the real work.

And of course there's the piece that if it was them and it was inevitable then it wasn't me, so I don't need to feel guilty.  But that's secondary to letting go of that sliver of hope.

So whatever it takes.  If painting the borderline evil and doomed for a while helps us let go of that hope, then great, then on with the real work, addressing the challenges that show up once there's some time and distance, and once we do that, most likely our perceptions of our borderline exes will change too, some compassion might even show up.  It takes what it takes.

[LonelyChild]

So what's the upside?  There's benefit in considering borderline behavior inevitable and treatment just a delay, or folks wouldn't do it.  The benefit is it makes it easier to let go of hope that the relationship could have worked or that it might work.  Going from a sliver of hope to no hope at all is a huge leap, and a painful one, but absolutely necessary for detachment, and in some sense the beginning of the real work.

And of course there's the piece that if it was them and it was inevitable then it wasn't me, so I don't need to feel guilty.  But that's secondary to letting go of that sliver of hope.

So whatever it takes.  If painting the borderline evil and doomed for a while helps us let go of that hope, then great, then on with the real work, addressing the challenges that show up once there's some time and distance, and once we do that, most likely our perceptions of our borderline exes will change too, some compassion might even show up.  It takes what it takes.

What is a more reasonable position to take? That a reciprocal r/s with a pwBPD is possible if you're not codependet or such?

I mean, in the end, isn't this binary? Either the problem is on both ends of the r/s, which means that your BPD SO just happened to not work well with you in particular. OR, they are damaged goods and do not work well with anyone, in which case the position of "the pwBPD is the problem" is correct. This, of course, does not mean that us nons do not have any issues.

[Skip]

So what's the upside?  There's benefit in considering borderline behavior inevitable and treatment just a delay, or folks wouldn't do it.  The benefit is it makes it easier to let go of hope that the relationship could have worked or that it might work.  Going from a sliver of hope to no hope at all is a huge leap, and a painful one, but absolutely necessary for detachment, and in some sense the beginning of the real work.

You know, heal', this is precisely why a person with BPD paints their partner black. Rather than feel disappointed or vulnerable, its "cleaner" to just pile in on someone else.

Is this dysfunctional when a person with BPD paint us black but "absolutely necessary" when we do it...

[rotiroti]

So what's the upside?  There's benefit in considering borderline behavior inevitable and treatment just a delay, or folks wouldn't do it.  The benefit is it makes it easier to let go of hope that the relationship could have worked or that it might work.  Going from a sliver of hope to no hope at all is a huge leap, and a painful one, but absolutely necessary for detachment, and in some sense the beginning of the real work.

You know, heal', this is precisely why a person with BPD paints their partner black. Rather than feel disappointed or vulnerable, its "cleaner" to just pile in on someone else.

Is this dysfunctional when a person with BPD paint us black but "absolutely necessary" when we do it...

I think nons can make an informed decision to walk away while someone with BPD might not be able to.

[fromheeltoheal]

So what's the upside?  There's benefit in considering borderline behavior inevitable and treatment just a delay, or folks wouldn't do it.  The benefit is it makes it easier to let go of hope that the relationship could have worked or that it might work.  Going from a sliver of hope to no hope at all is a huge leap, and a painful one, but absolutely necessary for detachment, and in some sense the beginning of the real work.

You know, heal', this is precisely why a person with BPD paints their partner black. Rather than feel disappointed or vulnerable, its "cleaner" to just pile in on someone else.

Is this dysfunctional when a person with BPD paint us black but "absolutely necessary" when we do it...

Yep, "it's them not me" works both ways.  It's not 'absolutely necessary' though, it's an option, I used it and it worked for me, and then as we hopefully transition from dysfunctional to functional, perceptions change.  Whatever it takes, on the way to a healthier future.

[Skip]

Yep, "it's them not me" works both ways.  It's not 'absolutely necessary' though, it's an option, I used it and it worked for me, and then as we hopefully transition from dysfunctional to functional, perceptions change.  Whatever it takes, on the way to a healthier future.

This gets into the whole "emotional equals" discussion.  

Spiting is self deception.  A person with BPD does it because they can't handle reality.  So, it would say we can handle the reality any better. We can't cope can't better.

And a person with BPD doesn't typically concern themselves with changing this.  Many of us don't either.

Some will talk endlessly about their partners pitiful weakness - but we get defensive when it come to them doing the same thing.

Just a reality check.  

Something to reflect on.

which means that your BPD SO just happened to not work well with you in particular. OR, they are damaged goods and do not work well with anyone, in which case the position of "the pwBPD is the problem" is correct. This, of course, does not mean that us nons do not have any issues.

I think it is healthier to look at all breakups the first way and at the same time add in some of second. Get the balance that fits your ex accurately.

[myself]

Facing the facts = Some of it was them, some of it was us.

It's usually not 50/50 though. Disordered or not. Good, bad, whatever.

It's inevitable that balance helps with acceptance, which helps with balance... .

[LonelyChild]

Yep, "it's them not me" works both ways.  It's not 'absolutely necessary' though, it's an option, I used it and it worked for me, and then as we hopefully transition from dysfunctional to functional, perceptions change.  Whatever it takes, on the way to a healthier future.

This gets into the whole "emotional equals" discussion.  

Spiting is self deception.  A person with BPD does it because they can't handle reality.  So, it would say we can handle the reality any better. We can't cope can't better.

And a person with BPD doesn't typically concern themselves with changing this.  Many of us don't either.

Some will talk endlessly about their partners pitiful weakness - but we get defensive when it come to them doing the same thing.

Just a reality check.  

Something to reflect on.

which means that your BPD SO just happened to not work well with you in particular. OR, they are damaged goods and do not work well with anyone, in which case the position of "the pwBPD is the problem" is correct. This, of course, does not mean that us nons do not have any issues.

I think it is healthier to look at all breakups the first way and at the same time add in some of second. Get the balance that fits your ex accurately.

Either they work with some people - which means that you two just happened to not work out. Or they don't work out with anyone (in the long term) which automatically puts the blame on her. Because that means that even if you HAD done everything right, it still wouldn't have worked out. That's my take on it.

[antelope]

what exactly does remission mean?  does this mean that the most severe, impulsive behavior is quelled? 

they studied inpatients... .people who had reached a severe breaking point and had to be hospitalized... .what about the supposed 'quiet' borderlines, so steeped in denial and façade... .what does their 'remission' entail?

how is remission calculated?  by interview, like with recovering alcoholics?  I have worked in a few rehabs, and know first hand the lies a recovering addict will tell to make themselves 'look good'... .the same can be said for a BPD

as far as why their symptoms lessen with age? bridge burning and feelings of shame eventually drown their outward behavior, and they may become involved in other dysfunctional endeavors (hoarding, emotional or financial dependence on children, etc)

I'm not saying that BPD is a death sentence.  In fact, I def. believe that recovery, no matter how big or small, is possible... .

but studies, esp. psychological ones regarding aspects of temperament, personality, and character are extremely difficult to assess when the main instrument used is interview and questionnaire

[boatman]

Going from a sliver of hope to no hope at all is a huge leap, and a painful one, but absolutely necessary for detachment, and in some sense the beginning of the real work.

I absolutely agree. People do not change, they gain awareness of who they are. An alcoholic does not become a non-alcoholic, rather he/she becomes aware of what he/she is and chooses to change his/her behavior accordingly. Someone with BPD or BPD traits is not going to change and is quite likely NOT going to gain much awareness either.

In any situation one has three choices:

1) Surrender to the situation as it is.

2) Leave the situation.

3) Take action to change the situation.

It took two years for my last therapist to drill into my head that my parents with BPD traits are not attached to me and are not going to change and that my exBPDgf is not going to change. Letting go of the false, completely unrealistic hope that the people in my life will change, as heeltoheal said, was a huge painful leap. It IS however absolutely necessary and NOTHING like the abusive projecting/splitting that someone with BPD does.

One side note, I chose option #2. Maybe one day I will have the spiritual fortitude to employ option #1 but I am not there yet.

[Sunfl0wer]

I hope my comment is not in poor taste... .

There is one situation where the hater/painted black phase does not happen... .

If the non dies during the idealization phase, they will forever remain white.

The pwBPD can remain the perpetual victim through the loss of the r/s by death.

However, I cannot think of a more favorable circumstance for the non to not enter a black phase.

[myself]

^^ Could be painted black for dying on them... .Talk about abandonment.

[Sunfl0wer]

^^ Could be painted black for dying on them... .Talk about abandonment.

Holy Cow!

I'm having my first good belly laugh in a LONG time!

Hysterical!

I soo Needed that!