A study recently appearing in The American Journal of Psychology reveals that many Borderline PD traits decline with age.

The suffering of those with severe BPD isn’t always a life sentence. According to new Harvard-based research by Zanarini et al (2007), 12 of the 24 symptoms typically associated with BPD showed a marked decline over the course of their 10-year study.

BPD Study Objective

Previous studies of BPD symptom remission have only followed the course patients' illness for 6 years at most (Shea 2002, Zanarini 2003, Grilo 2004). This is the first study to assess the time to remission of BPD symptoms over 10 years of follow-up.

The purpose of Zanarini’s research was to evaluate the course of 24 symptoms of Borderline Personality Disorder with respect to the time to remission of each symptom.

BPD Study Methods

Study Subjects

The researchers initially examined 362 patients with personality disorders, all recruited during inpatient stays. Of these, 290 patients met DSM-III-R criteria for BPD.

BPD Symptoms Studied

Of the twenty-four BPD symptoms studied, twelve were categorized as acute (less chronic) and 12 temperamental (more chronic).

Acute Symptoms Examined

• quasi-psychotic thought
• substance abuse/dependence
• sexual deviance (mostly promiscuity)
• self-mutilation
• manipulative suicide efforts
• stormy relationships
• devaluation/manipulation/sadism
• demandingness/entitlement
• treatment regressions
• countertransference problems/"special" treatment relationships
• affective instability
• serious identity disturbance

Chronic (Temperamental) Symptoms Examined

• chronic feelings of depression
• helplessness/hopelessness/worthlessness/guilt
• anger
• anxiety
• loneliness/emptiness
• odd thinking/ unusual perceptual experiences (overvalued ideas or depersonalization)
• nondelusional paranoia
• general impulsivity (eating binges, spending sprees, and reckless driving)
• intolerance of aloneness
• abandonment/engulfment/annihilation concerns
• counterdependency/serious conflict over help/care
• dependency/masochism

Assessment of BPD Symptoms

After initial assessment of the BPD-diagnosed study subjects, there were five follow-up evaluations, each 24 months apart. The 10-year study suffered very little attrition, with over 85% of the patients reinterviewed at each of the five 2-year follow-ups.

BPD Study Results

Among the Borderline patients studied, 12 of the 24 symptoms that were examined showed sharp decline over time, with less than 15% of patients who reported the symptom at the start of the study still showing the symptom at the 5th follow-up, 10 years later.

The 12 symptoms that did not show rapid decline still showed patterns of substantial but less dramatic reduction, with about 20-40% of Borderline subjects who exhibited them at baseline still exhibiting them at 10-year follow-up.

BPD Symptoms that More Quickly Resolved

All of the symptoms that the researchers had originally categorized as acute were those to most quickly subside, including:

Affective Symptoms

• affective instability

Cognitive Symptoms

• quasi-psychotic thought
• serious identity disturbance

Symptoms of Impulsivity

• substance abuse/ dependence
• promiscuity
• self-mutilation
• help-seeking suicide efforts

Interpersonal Symptoms

• stormy relationships
• devaluation /manipulation /sadism
• demandingness/entitlement
• serious treatment regressions
• countertransference problems/"special" treatment

Most Stable Symptoms

All of the BPD symptoms that the researchers originally categorized as temperamental, or more chronic, proved to be less prone to resolution over the course of the 10-year study, including:

Affective Symptoms of Chronic Dysphoria

• chronic feelings of depression
• helplessness/hopelessness/worthlessness/guilt
• anger
• anxiety
• loneliness/emptiness

Cognitive Symptoms

• odd thinking/ unusual perceptual experiences
• nondelusional paranoia

Symptoms of Impulsivity

• general impulsivity (typically disordered eating, spending sprees, or reckless driving)

Interpersonal Symptoms

• intolerance of aloneness
• abandonment/ engulftment/ annihilation concerns
• counterdependency
• dependency/masochism

BPD Study Conclusions

The results suggest that BPD may consist of two classes of symptoms, those that are manifestations of acute illness and those that represent more durable aspects of the disorder.

These results relate to current clinical care, in that two of the treatments for BPD that have demonstrated effectiveness, Dialectical Behavioral Therapy (DBT) (Linehan 1991) and mentalization-based therapy (Bateman 2001), primarily help with acute symptoms of the disorder.

However, temperamental symptoms, such as chronic anger and undue dependency, may seriously interfere with long-term psychosocial functioning, and, as of yet, no treatment has been specifically developed to address the temperamental symptoms of BPD.

More Information on BPD

There are numerous on-line and in print resources with additional information on the treatment of Borderline Personality Disorder, including: Psychology Prof Online, BPD Resource Center and the Suite101 article Borderline PD Information.

This Suite 101 article briefly summarizes the results of one study of BPD symptoms. The contents of this article are not meant to be used for diagnosis and are not a substitute for professional help and counseling.

Sources

Bateman A and Fonagy P (2001) Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry, 158.

Grilo C. M. et al (2004) Two-year stability and change in schizotypal. borderline, avoidant, and obsessive-compulsive personality disorders. J Consult Clin Psychol, 72.

Linehan M., et al (1991) Cognitive-behavioral treatment of chronically parasuicidat borderline patients. Arch Gen Psychiatry, 48.

Shea M. T. et al (2002) Short-term diagnostic stability of schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. Am J Psychiatry, 159.

Zanarini, M., Frankenburg, F., Reich, D. B., Silk, K. et al. (2007) The Subsyndromal Phenomenology of Borderline Personality Disorder: A 10-Year Follow-Up Study. Am J Psychiatry,164, 6.

Zanarini M., Frankenburg F., Hennen J., Silk K.(2003) The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. Am J Psychiatry,160.