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today in the review session for our abnormal psychology final, one of the teaching fellows mentioned that borderline personality disorder "fades" as its sufferers reach middle age and beyond. (by the way, i trust this teaching fellow as she has been studying clinical pscyhology in grad school here for six years!) i was curious whether anyone else had ever heard this or if any borderlines on this board are middle aged or older.

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there are some people (pychs i mean) who say this is true. 

the idea is that as you get older you get more secure, get in a stable safe relationship, outgrow your childhood trauma, stop having abandonment issues.

i know that there are also a lot of people with borderline mothers (the mothers being middle aged.)

and there are also docs who have found several biological differences in borderlines, relating to brain activity and the HPA axis. 

of course, my pdoc (and i beleive him) says that just as depression is genitics that are triggered, that you can sort-of un-trigger them.  so perhaps this is true with BPD.

i know that you can stop being borderline, that it is not a life-long diagnosis for many.

but i think the idea that you just outgrow it is absurd.  and not just because i've met a few borderline adult women, but becasue it's insulting to imply that a serious mental illness is just a phase that you can outgrow.

that belittles the pain of borderlines, and implies that therapists and patients who work their asses off in DBT are just wasting thier time because they'd just out grow it.

sorry if that was harsh.  i just think this theory is bs

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Penny Century,

The key word was "Fades" not obliterates or totally goes away, but fades.  And yes according to my abnormal psychology professor, my pdoc, my three different hospital pdocs, and about 20 other mental health care professionals including psychologists this is true... that the symptoms of BPD seem to lessen or fade as the individual enters middle age and the disease becomes more managable and in some cases even lose the BPD dx.  However, BPD isn't something that just magically goes away for most individuals with the disease, it takes hard work and dedication to quit the behaviors.... and begin  a new life

Kaylani

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Penny Century,

The key word was "Fades" not obliterates or totally goes away, but fades.  And yes according to my abnormal psychology professor, my pdoc, my three different hospital pdocs, and about 20 other mental health care professionals including psychologists this is true... that the symptoms of BPD seem to lessen or fade as the individual enters middle age and the disease becomes more managable and in some cases even lose the BPD dx.  However, BPD isn't something that just magically goes away for most individuals with the disease, it takes hard work and dedication to quit the behaviors.... and begin  a new life

Kaylani

I'm SO happy you took abnormal psych.

I never said that it wasn't a theory that some psychs hold.

I said that not all psychs think this, and in fact many think it is flat out wrong. 

Some psychs think this theory is true, and apparently so do you.

Some psychs think this theory is wrong, and so do i.

We'll just have to agree to disagree then, won't we.

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I have heard that some of the symptoms can lessen, but the most compelling evidence that I have seen in middle aged sufferers, men and women, stuck in habits set up by their BPD issues, that are destroying their lives!

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I got the BPD label once when I was 26, when I was having a major struggle with the dissolution of a 5 year relationship (my decision to end it). Looking back, it seems like a good fit for at least late adolescence/young adulthood, with at least a few remaining behaviors/symptoms into my 30s.

Some of the matching symptoms had begun to fade before the Dx was even brough to my attention, largely as an instinctive recognition that I was acting out inappropriately. I guess I performed my own DBT sort of thing, in which I imposed behavioral substitutions on myself.

Sexual acting out/promiscuity ended by decision when I was 21 (I decided it was WRONG, especially in terms of infidelity - but I also felt like dogshit after drunken casual sex, even if the sex itself was good). Last suicidal acting out, 19, during a PTSD type meltdown. Thrill-seeking, inappropriate flirting (precursor behaviors to sexual acting out/promiscuity) ended mid-thirties (somewhat reluctantly, but it was time). Occasional aggression/physical fights, when cornered physically during an argument (no escape), hasn't happened in a few years but remains possible (see below PTSD).

Black/white idealization/denigration was not prominent, but did exist to some degree, albeit quietly, until almost 30.

I have always been passive about relationships that didn't work, in the sense that I could end one abrubtly with "no hard feelings" on my part, unless hard feelings came back at me. Either way, I would have mini-meltdown abndonment problems, including disassiciative events, even if it was my decision.

On the other hand, the few times I've been the recipient of a dumping, I have not pursued/chased or pleaded, but have had more severe abandonment-issue meltdowns as above, for the most part out of sight.

For the record, I had a highly verbally/emotionally abusive and moderately physically abusive upbringing (particularly mother who was a hair-trigger hair-puller-scratcher and extremely denigrating on a regular basis, dad's only thing was old-school belt-and-switch whippings), with no known sexual abuse, although I was hyper sexual as a child (very experimental, partly, I think, due to finding my grandfather's playboy and penthouse magazines as early as six years old - nothing harder until much, much later. Lots of ideas in those forum letters).

I have never been diagnosed as such, but I have and still do suffer periodically from PTSD sypmtoms under certain conditions, episodicaly lasting anywhere from years to hours.]

There is some good evidence to support the idea that many/most BPD cases are linked to what has been called "Complex PTSD", which allows that cumulative high stress yet non-life-threatening situations, especially if combined with a sensitive disposition, can lead to PTSD symptoms.

At any rate, this is just my experience. At 42, I no longer resemble BPD in any real sense.

I think the key word in Karuna's post is "habits". Cases in which the individual is not prepared/willing/able to look at themselves and their behavior with an open mind and accept that thier behavior should change (deflection/denial) will probably not show improvement.

Some of us just get sick of it - and realize we're just plain too old and tired to operate that way anymore. It is very tiring to live like that. Simply running out of steam probably helps many, although some cases may be too sever and/or some folks too tenacious to give in and call a spade a spade.

just my thoughts.

pigs.

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I know that BPD is a maladaptive way of coping, but it is often also quite instinctual and knee jerk, rather than a calculated way of behaving. Yes that still includes personal responsibility but it's worth noting that this is not a phase of acting out that people grow out of, like a spoilt toddler. Things like self harm, suicide ideations, intense emotional reactions to things, addictive tendencies, they're all features of other dx's that get taken seriously, somehow in BPD form it's seen as people being 'naughty' and that annoys me. If I could just 'grow up' I would, it's not that simple!

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That two-thirds of BPD patients remit from

BPD in a relatively short period of a few years (see,

for instance, Zanarini et al., this issue: 12), does

not seem to make these authors question their

basic premise of personality disorder. On the

contrary, they conclude that the concept of personality

disorder as a lifelong disorder must be

changed! Paradoxically, one of the major objections

of this school to the aective disorder thesis

of BPD has always been that the former is episodic,

the latter chronic. Are these authors prepared to

embrace the emerging paradigm of aective disorders

as chronically uctuating and relapsing disorders..........

more often than not

BPD is affective spectrum disorder in a youthful

patient with primitive defenses. Just as an affectively

ill individual with mature defenses along the

lines of intellectualization should not be diagnosed

as borderline obsessoid personality disorder, one

with primitive defenses should not be labeled BPD.

Indeed, current data indicate that the latter type of

defenses attenuate with maturation, and what

remains is the basic dysregulation in affect (54).

The claim that such attenuation of course occurs

only in BPD (55), but not in bipolar spectrum

disorder has no basis in fact: the bipolar spectrum

is less prevalent in older persons (56).

Hagop S. Akiskal

Invited Guest Editor

also on the subject.

http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=15514413

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I know that BPD is a maladaptive way of coping, but it is often also quite instinctual and knee jerk, rather than a calculated way of behaving. Yes that still includes personal responsibility but it's worth noting that this is not a phase of acting out that people grow out of, like a spoilt toddler. Things like self harm, suicide ideations, intense emotional reactions to things, addictive tendencies, they're all features of other dx's that get taken seriously, somehow in BPD form it's seen as people being 'naughty' and that annoys me. If I could just 'grow up' I would, it's not that simple!

Hope I didn't seem to imply this. It wasn't as simple as it sounds for me - we're talking years of screwups. But - a big part of it was executive decision-making and working like hell to resist impulses. Failed some along the way, with some things. Or came very close.

Did not really understand myself for a long time - until I accepted my knee-jerky maladaptiveness for what it was. That made things a little easier. Starting from a behavioral point of view also helped. My feelings took (still take) a very long, hard time to sort out - but at least I'm not adding to them anymore (the bad, self-loathing ones).

Adding fuel to the fire always escalated the bullshit.

Letting shame lead to denial/deflection always got in the way - so much so that for a long time I could not see some of my feelings/behavior for what they were.

Again, I got the label once. From a pdoc I had not seen for long and didn't for long. HE gave me some other, very excellent advioce - and accurately predicted I would just vanish from his care in the BPD way. I did, ultimately, just as he said I would, and as I had done in many other situations in life prior.

So I give him a little credence.

pigs

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Maybe the traumas get dealt with and our loved ones reassure us again and again, and we can feel somewhat relieved of the pain we endure. Time can heal.

But the newer theories pin BPD WITH BP Spectrum. I can attest that as a DXed BP1 that I share so many of the BPD symptoms, I can't tell if they are the same or if I have 2 different things going on.

I don't know if a name matters. Just that we know we  have maladaptive ways of dealing with our pain and these can be handled somewhat by our therapy efforts, and with time too.

Melinda

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Actually, I'm here today reading up on borderline personality because I think it describes my mom to a tee--and she's 63.  It's definitely a disorder I thought of as being the domain of the young, but she had her first child at the age of 14, so in many ways she hasn't had the opportunity to develop emotionally.  There is definitely a cyclic component to her behaviors and they're definitely exacerbated by stress.  She's unemployed, uninsured and recently lost vision in one eye due to cataract.  Initially I offered to help financially with the surgery, but once she started talking about the big S, I suggested a better use of my limited resources might be getting her some mental health care. 

Now I've been accused of using my money to play God with her health.  And what's more, I've used my evil powers to affect all her relationships (I'm the only one of her kids who speaks to her).  There's your black/white idealization/denigration.  Yesterday I got this long email from her outlining all the important people in my life--my husband, my son, my siblings, my friends and all the ways in which they secretly hate me behind my back and how I'm going to end up all alone.  I think that probably speaks to her abandonment issues.  And, of course, there's the relationship she's recently been trying to cultivate with her married landlord.

I've got my own issues to deal with, but I'm trying to look at this objectively, not take her lashing out at me personally.  And I honestly don't know what to do and how to get her some help especially if she doesn't think she needs it.  She's lived this way all her life, burned a lot of bridges and had a husband (my dad) who coddled her and protected her from herself all through their marriage.  He's been dead for 4 1/2 years.  I'd love nothing better than for her to have someone to talk to, get on some medication and start pulling a life together for herself with a job and friends and activities.

Anyhow, I think the point of this frustrated rambling would be that I disagree that borderline personality fades with age.

RC

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I think it depends on a lot of factors whether BPD fades or not: access to good mental health services, proper diagnosis, the sufferer's insight into the illness and how well they co-operate etc.

Looking at my book "Borderline Personality Disorder: The Latest Assessment and Treatment Strategies":

FACTORS ASSOCIATED WITH COMPLETED SUICIDES IN PEOPLE WITH BPD:

* Mean age of those completing suicide is 32

* Mean time for suicide is four years after hopitalisation

* Those who completed suicide successfully generally:

- Attempted suicide in the past

- Were more highly educated than survivors

- Had fewer psychotic symptoms than survivors

- Reported fewer problems with their mothers than survivors

- Suffer fewer separations and losses before the age of five

* No difference exists between people who commit suicide and survivors in terms of age, sex, marital status, conflict with fathers, and substance abuse

Factors associated with completed suicides indicate that those with less severe BPD symptomotology and traumatic history have higher suicide rates. Those who completed suicide were more functional in reality testing, more able to form relationships, and more hopeful about the future (as a result of more education). This higher level of functioning mat make the emotional struggles related to BPD seem intolerable. Lower functioning people with BPD, that experienced more trauma and difficulty earlier in life, may have adapted and thus have a higher level of tolerance

PREDICTORS OF A POSITIVE PROGNOSIS INCLUDE:

* Shorter hospitalizations

* Presence of distractability

* Presence of self-destructive acts during hospitalizations (not self-destructive acts prior to hospitalizations)

* Absence of:  affective instability, parental divorce, feelings of entitlement, feelings of boredom

PREDICTORS OF A NEGATIVE PROGNOSIS INCLUDE:

* Substance abuse

* Prominent anti-social traits

* Dysphoria (mild chronic depression)

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