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

[BPDFamily.com]

I have often heard a theory that many BPD's began to realize how childish they have been behaving between the ages of 30-35. I do not agreee with this. I think BPD stay the same or get worse.

[Triple H]

I have often heard a theory that many BPD's began to realize how childish they have been behaving between the ages of 30-35. I do not agreee with this. I think BPD stay the same or get worse.

[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).

[Mousse]

This is probably most relevant to the long-term partners on the board:   I felt some relief when I read that BP's  often get better with age, but I've read some of your posts stating that your partners have gotten worse.  What was your experience?  Mine is 39, we've been together almost 7 years.  He's gotten more willing to listen to my concerns after an argument, and really does seem to be trying to control himself and change.  I've noticed subtle changes for the better in terms of attitudes toward my feelings, but my overall impression is of 2  steps up, 1 and a half back over the last four years when I finally started to stand up for myself.  I'm at a tranisiton point with this marriage where I am starting to build a foundation to leave on, but I could use some input from you.

[comanche]

I think I heard once, and it makes sense, that as we age, and get physically weaker and lose our confidence, our fears bother us more. If a person has a problem in their youth, age will make it worse and any quirk a person has when young gets magnified as they get older.

The idea that people mellow out in their old age is baloney. They get more fearful, more irrititable, especially when they get sick. IN fact everybody tends to get like that BP or not.

Growing old gracefully is not the norm, I am afraid.

[Alana]

I believe that a high functioning BPD could improve over time in the right environment. The keys being that the BPD is surrounded by others who are very psychologically healthy and behave in emotionally mature ways AND the BPD is open to at least some self-examination. That's a lot of 'if's. I don't mean to imply that worsening behavior by a BPD is a Non's fault, but I definitely believe that a BPD can get worse if surrounded by the unhealthy behavior of other people.

Hope this helps someone.

Alana

[tired]

My limited observations of 2 emotionally healthy older people who recently passed away is that growing older gracefully is possible.

My observation of elderly people (and I have had quite a bit of experience with them) is that they become more of whatever they are.  If they are emotionally unstable, unhappy, mean, whatever, you will see more of that as they age.  Those that are happy, grounded, willing to accept help when they need it and emotionally healthy will be happy.  I have seen both sides, and really, just as in the rest of life, we all determine what we are like.  One of my motivations to figure out my own issues and fix them has been to see people age.  We need to fix stuff before we hit those years!

[StressedinCleveland]

I think the "getting better with age" observation comes from psychiatrists who mainly see BPD as self-harm (cutting) and suicide attempts. These specific symptoms do "mellow" with age. Also the promiscuity often gets better, simply because there are fewer partners that a 60-year-old hussy or lothario can attract. Also, the classic picture of a young BPD having their flaws overlooked because of their great looks and sexual prowess will definitely fade over time.

[sonomanona]

I am approaching this issue from the perspective of a spouse rather than as a child of a person with BPD.  And we are perhaps older (53) than some of the other spouses who have responded to this question. 

In my case, I think that some things are better with age, possibly because the young male testosterone issues have decreased.  In the earlier years, my husband tended to react to every perceived threat, insult, challenge, etc., in a physically aggressive way.  He's still not really caught up to his actual status physically (meaning that he still has a rather inflated idea of his ability to kick butt) but he is less inclined to let his rages spill over into risky physical conflicts.  So that part's easier for me.

He's still awesomely self-centered and clueless about how he impacts on his family.  And as I get older and want support through the inevitable trials of life, I find myself feeling sadder about how incapable he is of letting someone other than himself be the focus of attention, and how much I long for a partner who is actually capable of empathy. 

But at least I find myself less anxious about him letting his rages turn into public conflicts.  I guess that's better(?)... .

[Abigail]

  I don't believe the aging affects the disorder so much as the situations they are in.  Our doctor told us that borderlines are highly allergic to stress.  Perhaps that is why so many don't show the symptoms in the early stages of a romantic relationship, provided there is no stress in their lives.  In the first 23 yrs. of our marriage (before we knew about BPD) there were some okay times but stress did make it worse.  So did holidays!  He could be doing fine but on Thanksgiving or Christmas Day, you could count on the day being ruined in one way or another.

  Fortunately, he has received treatment in the past two and a half years and has made a dramatic turnaround.  He is on maintenance medications and also has a medication to take in times of high stress.  Works great!

  Abigail

[tired]

Our doctor told us that borderlines are highly allergic to stress. 

Wish they had a vaccine for that 

How we behave when we are under stress tells a lot about all of us.  Sure, things go well during the dating phase of any relationship.  What happens when finances are tight?  When a family member dies?  When teenagers have problems?  We all see what we are made of during those times, us as well as our BPD's.

[nevergiveup]

I think it depends what the question means - does it mean ":)oes the person get worse in general?" or ":)oes the person get worse inside a specific relationship?" I don't have a clue about the first question, but I think for the second question the answer is yes, because they treat people with kid gloves at first, seeing how much abuse they will take, how far they can push it, and then if the other person looks like they will take it and they stick around then the BPD will see that as a green light to treat them as badly as they like. My ex certainly got worse over the years - at first she worried I would leave her, then later she didn't care, and finally I think she kind of despised me because I DID put up with her crap.

[longtime]

I had the same question so I asked my T.

He said that many eventually burn out. It takes a lot of energy to sustain the levels of emotionally intensity that they experience and as they age they find that this level of intensity it is not possible to maintain.

Hence, with age they "Mellow" (My word not his)

Longtime

[Almost_Nobody]

Perosnality disorders tends to increase at age 50+ and tends to decrease at 60+

[another_guyD]

As a person ages 50+ it seems they mellow (though my observations are purely anecdotal evidence).

My mother is a nurse who deals with a lot of geriatric patients for a week to a month at a time.

She says that attitudes of these type of patients are usually angry or very nice, rarely any middle grounders.

I am not sure this matters but interesting info none the less.

I am curious about the study. What symptoms were they gaging this by? Medical studies are some the most

ambiguous studies and are often as flawed as their subject; humanity is hard to quantify, much less the human with BPD.     

[yoo]

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

[smerdonsh]

Thanks Yoo, that information is very interesting.  And I do wish there were more studies conducted with high functioning, but it also may be dangerous to do that since they can be so manipulative and the data could be scewed as well.

[beachgirl]

I think it is different for everyone. However... .from my research and my experiance. BPD is at it's very worst from age 17 to about 30. 

[Raven Valley]

I first found out about what exactly the disorder is on wikipedia, but on there it says it lasts for about a decade, that it lessens in severity over time. But a lot of the threads I've been reading here seem to be by people who have known sufferers for a lot longer than 10 years without any dissipation of the disorder.

Is wikipedia wrong?

[Skip]

This may be a definitional thing... .often the technical literature refers to low functioning BP.  These individuals have difficulties holding jobs, self harm, and often spend time as inpatients in hospitals.  These severe symptoms often reduce in time.  They learn to adapt.

The majority of the BP discussed on this sit are either high functioning, sub-clinical (traits as opposed to clinically disordered), or past this "severe" symptom period. What we discuss here is the difficulty of maintaining a relationship with a BP or person with BPD traits... .and that level of difficulty can persist for many years - even a lifetime - if a significant effort is not made to address it.

Hope that helps.

Skippy

[RainbowGirl]

I dont think that slipping will necesarily put you back to the start, its a two steps forward, one step back process from what i've seen. I think the major difficulty with BPD is that every patient is different, there are different vices, different coping mechanisms, different drugs and therapies that may help one, but not another, and thats why its such a difficult disorder to diagnose, treat and live with; because there are no 'right' answers, because each patient is individual. I have a friend of a friend, who went through two years of therapy, and now leads a full and healthy life, although she does sometimes feel like she has bad days when she thinks about the past and feels like it may be creeping back. So she is not 'cured' as such, but has been given a chance to deal with the issues, and has learnt to live with, and cope with her feelings. In 2 years, she has had 2 days off sick, and they were genuine... .Now of course the same therapy wont work for everyone, but it shows that things can be done, but perhaps not to get rid of BPD, but to learn to cope. Hope that makes some kind of sense... .!

Rainbow x

[Abigail]

It is a disorder, similar to something like diabetes, in that it can be managed with the proper treatment of medication, therapy and changing one's way of thinking with some form of cognitive behavioral therapy which can include DBT (has been shown to reduce self-harming behavior).

Symptoms may wax and wane depending on the amount of stress they are under, when they first fall in love and certain traits may lessen in severity with some individuals.  There is no cure at this point but it can be properly managed, if the individual is willing and is able to receive the right treatment.

As Skip mentioned, there is a difference between low functioning and high functioning borderlines and most of the research has been based on low functioning types which are more often seen in clinical settings.

[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.

[AJMahari]

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.

[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 ":)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).

[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-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).