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Author Topic: PROGNOSIS: Do the symptoms of BPD improve/worsen with age?  (Read 6633 times)
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« Reply #25 on: July 11, 2009, 08:38:01 AM »

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

Excerpt
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.

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« Reply #26 on: July 12, 2009, 10:00:11 AM »

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.

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« Reply #27 on: July 13, 2009, 05:53:38 PM »

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 ":)o 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).
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« Reply #28 on: July 14, 2009, 03:51:54 AM »

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.

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« Reply #29 on: December 24, 2009, 03:40:09 AM »

My doctor, who knows my ex-BPD 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 BPD 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).
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« Reply #30 on: February 05, 2010, 12:02:41 PM »

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.
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« Reply #31 on: June 27, 2010, 09:14:13 PM »

I'm not technically an expert but my experience is that it never gets better!
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« Reply #32 on: June 29, 2010, 02:47:28 AM »

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.
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« Reply #33 on: June 29, 2010, 08:04:39 AM »

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.
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« Reply #34 on: July 13, 2010, 03:49:13 PM »

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.
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« Reply #35 on: July 13, 2010, 10:05:25 PM »

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 ___." Oh, yeah.
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« Reply #36 on: October 30, 2010, 04:31:19 AM »

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.
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« Reply #37 on: January 15, 2011, 02:57:07 AM »

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.

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« Reply #38 on: January 16, 2011, 08:59:31 AM »

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.
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« Reply #39 on: January 16, 2011, 12:40:03 PM »

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.
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« Reply #40 on: January 13, 2012, 05:19:26 AM »

my mum is 70- and is definitely better! she is still a sick person but 300% better than she was.

she used to be one very- very sick and abusive lady. now shes just dotty and self obsessed. but the self obsession is harmless- as long as i dont need a two way conversation.

the abuse- blackmail- projection- fogging- needyness- demands- most of that has gone

what lingers now is the child like state of being stuck in that child like "my needs are the most important" narcissism. and thats ok to deal with- INTENSLY annoying but not damaging.

i never used to be able to see my mum withut being verbally abused- now i see her once a week- abuse free- and we chat quite happily. so long as she dominates the conversation and talks about herself and gets indulged.

its not fair- but its a better deal- and its also a genuine mental condition that one cant snap out of- or change easily. so apart from feeling intensly annoyed- and not being able to cope with vry much of it- its ok by and large.
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« Reply #41 on: January 13, 2012, 05:29:30 AM »

its me again..i keep readin past posts...i have to stop and break away..Laugh out loud (click to insert in post)

you dont break away from BPD at the age of 40, maturity or age doesnt cure a deep rooted/deep seated physchological condition which has arisen from childhood. it would be like learning to walk again but walking a different way- near on impossible. instead they learn coping strategies- how to deal with impulses for example

the impulses will always be there- but over time they wil learn how damaging they are and what to do INSTEAD,

althugh my mum - at the age of 70- will STILL do things wrong. Ive noticed that she has made a concious decision of what impuslses to follow- for example those that help and support her (me and my son) she will bit her lip and learn not to say things. those that she believe doesnt take the trouble to sympathise and understand her condition- she will let her impulses go and say the nasty thing...in between the nice things (which of course we all know is deeply confusing!)

it wont occur to my  mum that this is still making problems for herself- that those who dont support her- will support here even less. so shes not helpng HERSELF...so i think they make strides but stop short of a total cure!


right- i really am going now... Doing the right thing (click to insert in post)
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« Reply #42 on: April 23, 2012, 01:47:11 AM »

I have to agree with Alana.

Also,It depends on the enviroment they are in.  When you are young you feel more invincable and as the pressures of family life grow the added pressures seem to push the cycle along and jobs require more of you, they require more to bolster them up, and this complicates the whole thing they thought they had going.

When I accused my partner of compulsive lying and I told him he should google it, he did and we then progressed to BPD and he said he felt great relief to understand what he does and that he is unable to control and steer it.  He said "The lying is exhausting me"  I recognised some behaviors and he read some others and recognised them to.  He said he wanted to tell me lots of times but his dissociative behavior prevented him, he practised saying these things to me but couldn't get the words out.  He had always chatted with me on the phone but I was lucky to get a sentance out of him at home and of course this made him feel isolated which added to his need to feed on others for acceptance.  He is human you know! Laugh out loud (click to insert in post)

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« Reply #43 on: January 30, 2014, 09:18:15 PM »

I don't know of definitive studies on this topic.

But I have read that for many (that does not mean everyone) pwBPD the intensity of the behaviors tends to mellow out with age. So, that does not mean that their condition gets better. It means that the outer manifestations of it may get better.

The reasons given were two:

1. general mellowing out & loss of energy that everyone experiences with age

2. possibility that some pwBPD learn by repetition that some behaviors do not gain them the desired results and only hurt them.
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« Reply #44 on: January 30, 2014, 10:36:23 PM »

2. possibility that some pwBPD learn by repetition that some behaviors do not gain them the desired results and only hurt them.

I would have to agree with point 2 as this makes a lot of sense.

At the age of 7, I was diagnosed with Aspergers. It stood out to many that I was on the AS that I was referred for testing. Many years later, it takes people by surprise when I tell them, it has even caught close friends by surprise too. The only people that seem to notice immediately are people who have family members on the AS and can identify the micro signs. It has been a lifetime of learning by repetition, self analysing what works and what doesn't, intense reading, making changes to my personal being, therapy. There is no cure and it won't ever go away but I have made changes to improvise, adapt and overcome personally.

I would be certain that in the same way, pwBPD can and will do the same thing too. At the end of the day it is an illness they never asked for and it causes them intense pain too. I guess it would depend on the individual but if the same pattern follows you all the way through life, and you are aware it is doing it, then you would look to make those changes. The key difference would be down to projection and how much a pwBPD is willing to take responsibility. With Aspergers we tend to take on and own everything, pwBPD tend to project everything so it is much easier for us to make those changes than pwBPD but it doesn't mean they can't or won't.

As well as the individual, it would also depend on the partner too and how they approach the situation too. For someone like me who takes on responsibility that isn't mine, I'm certainly in no position to help improve a pwBPD because we would leave the r/s with me thinking I was at fault for everything and them believing I was at fault too. So in answer to the question, my belief would be that a) it depends on the individual and b) would depend on their support network. A good balance there, I cannot see why a pwBPD could not improve with age. On the other hand, someone who cannot take any responsibility and a bad support network will forever believe others are at fault, will be abandoned many times over, may be angry and frustrated and therefore worsen with each abandonment cycle.
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« Reply #45 on: April 09, 2014, 12:14:43 PM »

Well, I've read and heard various things, and I think it ultimately depends on the pwBPD.  I can relate a couple of experiences, though.  First, my GF was diagnosed BPD over a decade ago.  She's gone through DBT, and is now 38.  Have her symptoms lessened?  Dunno.  She no longer cuts, has not attempted suicide in 10 years, and has been clean from drugs and alcohol for 11 years.  On one hand, that's major progress.  Yet, she still has violent outbursts, still rages, still has unstable relationships, still self harms in other ways (overeating, overspending, risky relationships), still can't manage her own life, still is mostly depressed and can't keep a job.  So in her case, symptoms have definitely changed to ones that are at least less life-threatening, but lessened?  Not really.  She still meets all criteria for BPD on a weekly basis.

On the other hand - my mother.  She's not diagnosed BPD, and never has met the criteria, but many of her behaviors are similar to BPD.  And I can attest to major changes in her moods and behaviors since she turned 60.  She doesn't worry about my dad as much. She's happier.  Things that used to bother her she's able to deal with better. 

I really think it depends on the person, and what kind of challenges that must be overcome in order to truly tackle the BPD.
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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.

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« Reply #46 on: December 31, 2014, 02:34:59 PM »

Based on my experience in observing my ex-fiancee's mother (both have BPD), I would definitely say that BPD does not get better with age.  She was in her early 50s.  Nobody would date her now, but it became easy to see her BPD traits in other areas (except cutting -- I don't think she ever did that).  

I read somewhere that an aged, single, unattractive pwBPD will seek non-relationship activities to stir up drama -- such as making unnecessary ER visits.  I did in fact see her make such hospital visits.

In any event, from a theoretical perspective, I don't understand how or why BPD would fizzle out with age.  I would be just as quick to assume that BPD would worsen as negative life experiences accumulate and the person becomes less attractive and thus potentially more prone to abandonment/rejection.  I suspect that any sources suggesting that BPD fizzles out with age are overly optimistic, erroneous, and are based off of poor methodology (e.g., only relying on cutting observations).  Most BPD traits would likely be impossible to observe and measure on a broad scale for the purposes of conducting a study.  BPD traits seem to be hardwired into certain peoples brains, for the long haul.  
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« Reply #47 on: December 31, 2014, 04:18:50 PM »

Ive read on sites for pwBPD that some have mentioned their symptoms improving post menopause. Othrrs stated that hysterectomy and HRT improved their condition with some stating they were no longer meeting the criteria for BPD.

I would not say this is the norm as the change in hormone levels effects everyone differently. Some have stated here that their female partners improved when pregnant while othrrs changed up a gear and got worse.
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« Reply #48 on: January 31, 2015, 02:37:34 PM »

After 31 Years of marriage I would have to say my BPD wife has gotten worse. She sailed through menopause early, but then about age 45-47, coincident with a big move out of state and my retirement, things began to get worse--and the move and my retirement were of course blamed. Now that she's 55, and after three separations of six weeks, three months, and eight months, we are on the brink of ending it. She has never been suicidal or addictive, but does engage in some risky behavior for someone with a seizure disorder. All the other symptoms have gotten worse, though in the last year there has been some improvement which she credits to AlAnon (her father and a brother are her qualifiers). She has seen a therapist on her own and with me, but lately her defenses have gotten so high she refuses to seek help, even though her neurologist said she had to see a psychiatrist because of her insomnia.
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YaYaGirl
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« Reply #49 on: September 25, 2016, 12:35:46 AM »

There is no cure for BPD, but people can go into recovery. Just because you go into recovery doesn't mean you no longer have BPD. I've had BPD now for over 30 years and I've had 3 recoveries. I'm still in my 3rd one and I'm better then ever and off all medication.
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