Time Heals Borderline PD Symptoms: New Research Shows that Many BPD Traits Improve Over the Years

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

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.

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

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.

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

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:

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

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.

Oct 11, 2007 4:17 PM

ghulkman :

This is an interesting concept (in relation to the article) that BPD symptoms (at least some) gradually "Fade" over time.
This has been written about before and that while I suppose "Some" symtoms of BPD might "Fade" as person grows older, I ratgher doubt that the disease (disorder) cures itself.

My EXBPD wife still exhibits the same traits/behaviours that she demonstrated over 7 years ago. I suspect her Impulsive beahviour in regard to eating, overspending & sex has actually gotten WORSE ..... NOT better!!!!!

As to which "Symptoms" fade over time ..... I believe would be very hard to tell ...... since it's apparent that a very SMALL percentage of BPD patients have actually been studied from the very beginning of their disorder up until the time they have actually grown "Old enough" to have possibly "Outgrown" some of the symptoms of the BPD.

"Hulk"

Oct 13, 2007 7:41 PM

Tami Port :

I wholeheartedly agree that BPD doesn't cure itself. The summarized article represents just one study with a sample size of less than 300.

It is still an interesting finding that at least a portion of the more acute symptoms do, according to this 10 year study, appear to lessen in severity over time.

Yet even with this hopeful finding, it is important to note that the more stable symptoms (those that did not show a reduction over time) are many of the same symptoms that current therapies are not designed to address.

This glimmer of hope is not any assurance that the difficulties associated with BPD fade away while patients and loved ones watch the clock.

If it were only that "easy"...

Oct 15, 2007 7:14 PM

redback :

There is evidence that problems plateau over time.

This may not be so much about the diagnosis nor impairment of personality disorder but its impact...what used to be called 'handicap'. People with disorders, through painful experience, limit themselves to (antisocial) jobs that create less conflict eg the interstate, overnight truck driver. They fade from the social limelight through unemployment or single living. The more volatile hormone raging teen years ease into more stability. ETC

Some of it is the person is less visible to certain social circles but they are effectively unchanged. And some of it is related to whether or not there is any reasonable accuracy to the rate of personality disorder to be confident about trends. It is likely to be under-diagnosed, misdiagnosed, under-treated through lack of access generally or lack of access to therapy that works...and availability of a therapist with skills and patient rapport. Inpatient treatment vs outpatient affect study results.

Oct 19, 2007 12:39 AM

Perry Patterson :

Well, from my experience . . . I'm 55 now and until a few years ago my life had consisted only of transitioning from one chaotic mess to the next. I also suffer from pretty bad PTSD and haven't been able to work now for about 5 years. I just finally got tired of trying to cope and have pretty much isolated myself. I have hobbies that keep me occupied and I do go to church (although I'm careful not to go beyond a nodding acquaintance with anyone) but aside from that, I have no contact with anyone except immediate family. My relationships with them now are very close and I talk to them everyday and see them often. But I haven't had so much as a phone call from anyone except them now for over two years. Am I lonely? Maybe. I'm not sure. But I am sure that if I had had to continue on for another 30+ years in that same frenzied, chaotic mode, I wouldn't have lasted. I have been in and out of therapy probably 6 times during my life and it has done all it can for me. I am on A LOT of medication; prescribed by my family doctor who also happens to be a specialist in psychopharmacology. So, I probably haven't answered the question, but for me, this is better. I can do this.

Oct 19, 2007 10:08 AM

ghulkman :

Hey Tami ....

I'm SO GLAD that you are here (Replacing Sam) so the discussion of BPD will be "rekindled" ...... so to speak.

Of course I can only speak of my experience with my EXBPD wife .... whom I met at 23 ..... Married at 25 ...... was dicorced when she was 33 ...... and she is now 38 (to be 39 in February of 2008).

I have access to information about her that she does NOT even know about and never will.

Her life is SUCH a mess ..... Yet she "Appears" to be "Perfect"
to friends and co-workers around her. Well ..... NOT quite !!!!!

Her Kindergarten "Co-Teachers" (They share the class during the day) BOTH either "Quit" or asked to be transfered OUT of her classroom because of her BPD behaviour.

Maybe symptoms of BPD do actually "Fade" over time.

But how much TIME.......

And .....

Who in the hell could endure them that long???????

"Hulk"

Feb 15, 2009 1:10 PM

Guest :

My late boyfriend committed suicide on the 7th of January, at age 39.
Needless to say, his borderline personality disorder symptoms (extremely anger, impossible impulsive control) was getting way worse. So, I don't know what this article is talking about.

Feb 15, 2009 1:38 PM

Tami Port :

To the Guest who posted an article on Feb 15th: I am very ,very sorry to hear about your boyfriend's suicide. The study discussed in this article is just that, one study. It showed that some BP symptoms, for some people, appear to decrease over time. Their findings certainly don't mean that this is the case for everyone diagnosed with borderline disorder. If only it were. There is so much still to be learned about how the mind works.

Mar 6, 2009 3:55 PM

Guest :

I do not believe that the symptons get better over time unless corrective nuturing release of past pains emotionally have been released. MOST OF US with BPD have too many other classifications on us to be treated correctly in the first place. I have been my own advocate always in some form or sliding fee or health insurance care. DID NOT HELP MUCH except to manage the outward CHAOS and continue to hide. MORE STUDIES MUST BE DONE TO CONCLUDE THIS FINDING !! I AGREE WITH THE BELOW.
for ME ___________GOD__________is the only help___________
Joi~ Oregon and still fighting the battle.