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Thursday, May 17, 2012 Does Borderline Personality Disorder improve with Age?

Does BPD ever get better? Will everything always be the devastation and earth shattering crisis that it seemed to be in my teens and 20ís?   http://downwardspiralintothevortex.blogspot.com   ďHavenĒ 

Yes, it does/can get better. No, things do not always have to be this way. This is based entirely on the individual though.  Iíve received correspondence from many people in their 40ís, 50ís, and 60ís that still suffer with the more intense problems of Borderline Personality Disorder. These are often people that havenít received any help, sufficient treatment, or had trouble acquiring any kind of treatment or support at all.

From my experience I canít say that Borderline Personality Disorder will just spontaneously get better on its own. Over time the severity of symptoms is likely to diminish but they may not go away entirely. I think this is due, in part, to life experience. When a person reaches a certain age, by virtue of experience and having lived through so many situations they can recognize that all the traumatic feelings that they experience are feelings theyíve had before, and despite how they feel, see the pattern that things donít turn out as terribly as they feared, or that they are in fact, capable of coping with the results of what do happen.  

Then thereís also the fact that the human body and psyche can only handle so much. It can only deal with so much constant bombardment of adrenaline boosting anxiety and pain before it starts to wear down. Or build up a tolerance. When youíve been exposed to something for so long, the body adapts. Itís a basic principle of existence. Adapt or die.  

Constantly fighting the pain, tears, and trauma is exhausting. Eventually the body builds up a little tolerance to all the things that create such distress and while things may still cause anxiety and panic, the intensity of those emotions no longer reaches the same heights. The body, the mind, the spiritÖ gets tired. And tougher.  

Like scar tissue for the mind. Itís not to say that the pain wonít eventually come through, but it doesnít penetrate quite as easily. Which still doesnít sound incredibly encouraging.  

However!  Thatís the theory for those with BPD that have never accepted or found support or tried to work through the disordered thinking that we have to deal with. The odds of having your Borderline Personality Disorder improve rises drastically and dramatically when you are able to admit there is a problem, seek help, support, and/or therapy, and actively work to tame the wild beast that is the Borderline Personality.   

You donít have to tell me that this is easier said than done. You donít have to tell me that there are times when therapy feels futile and it seems like nothing will ever improve. Trust me, Iíve been there. I still have those days. But those feelings pass. Youíre kind of on this journey with me. I still have my bad days. I have a lot of my bad days. But I have many more good days as well. Days without panic, without anxiety, without depression. Days with happiness! Or just contentment. Those feelings are so foreign to me that itís hard for me to recognize them at first. By the simple fact that I have had days like that, days where my world wasnít shrouded in darkness, proves to me that even though things may not be perfect, things most certainly can get better.  

The choice is yours. Thatís the important thing to remember. Blaming our parents, blaming our exes, blaming the world around us, regardless of whether or not our circumstances are our fault, does not help. I certainly blamed my Evil-Ex for the years of trauma and unhappiness I had to deal with when I was with him. But blaming him isnít going to make my situation better. Blaming him isnít going to suddenly make him take it all back and try to fix my life for me. Thatís never going to happen. It wasnít fair, but life usually isnít. The only one that can decide to make my life better, is me. It sucks that things have to be so hard. Itís a shitty hand to be dealt, but itís the only hand we have. We can let the murk mire us in thoughts of self-pity, blame, and loathingÖ perpetuating a cycle of dismal depression and anxiety, or we can decide to make a change.  

In time, things may get a little better on their own, but frankly, Iím sick of waiting, and I donít have a lot of faith that the world is suddenly going to smile on me and decide that Iíve dealt with enough shit for one person already. Borderline Personality Disorder can absolutely improve with age, but the amount of improvement is directly proportional to the amount of effort you are willing to put forth.  

Iíve seen  a lot of ďstudiesĒ and read a lot of testimony from therapists and social workers that say in X amount of years theyíve never seen improvement for BPD. There are a lot of reasons for this, including the fact that these people probably were not skilled or trained in the very recent developments that create real change for those with Borderline Personality Disorder. Therapists/clinicians are people too, and certain types of people are simply not equipped to deal with someone that can be more difficult to pinpoint their problems. Thatís why we have specialized therapy now. Major, MAJOR, strides have been made in therapy specifically meant for us. Donít let these limited perspectives discourage you. They usually donít have the kind of knowledge or experience to give an inclusive opinion.  

The other thing that Iíve noticed people focus on is the distinction between what improves. Many say the Ďsymptomsí of BPD often improve; the self-harm, the suicidal ideation, the paranoia, impulsivityÖ but how about the instability in relationships? Thatís a different kind of symptom. That first group of symptoms are internal to the one person suffering with BPD. However, relationships take two. It seems more broadly agreed upon while the individuals symptoms may improve, things like abandonment  and dependency issues are longer lasting. Again, this is all dependent on the individual, what kind of help they seek, and how much effort they put into their own recovery.  

I canít promise that all symptoms of BPD will eventually go away. I canít promise that everything will one day be healed and no longer any issue at all, even with therapy and dedication. I can say that I am entirely optimistic that these things can all become manageable and not the monsters we know them to be.  

BPD is not something that is going to get better in days, weeks or months. Hell, even years may be an estimate that is too conservative. Iím going on a year and a half of intense therapy and medication and Iím far from Ďrecoveredí, but my Therapist tells me every week that she can see improvements. Whatís more though, is I FEEL better.  

Without acknowledging the issue that is BPD there may be little to no improvement for decades. Even with active acknowledgement and intense effort improvement can take years. I donít mean to be discouraging, but I do mean to be realistic. You know me. I donít sugar coat anything. Thatís not why I do this. Think about this: In a world where it is now common to live into our 80ís and 90ís, isnít taking a year or two to really focus on ourselves, worth it? If we can have 40, 50, 60 years of living that is more content and happy than what we currently know, isnít the long term pay off worth the struggle and introspection?   

Taking care of our mental health is no different than taking care of our physical health. If you eat nothing but junk food, load up on soda, and smoke 2 packs of cigarettes a day your body is going to be pissed and reward you with a heart attack by the time youíre 40. If you eat healthy, exercise, get a good amount of sleep and donít abuse your bodyÖ in other words; work on taking care of yourself, your odds of living a long and productive life vastly improve.  

Whether Borderline Personality Disorder improves or worsens with age, is up to you.

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Recovery  probabilities in varying degrees from BPD.  5-13-12 reportings

From APA: Mary Zanariniís study shows social and work skills key to recovery; Andrew Skodol, MD Chairman of DSM 5 Task Force reports all personality disorders will be on Axis I.

Dr Zanarinís Key Points from her study (Psychiatric News, May 4, 2012):

ď1. Remission for symptoms is common for patients with borderline personality disorder but full recovery including good social and vocational functioning is less so.

2. Patients with BPD however fare worse in terms of remission, recovery and recurrence of illness than do patients with other personality disorders.

3. Cumulatives rates of remission for BPD patients ranged from 78 percent for those with an eight-year remission to 99% for those with a two-year reemission.  The corresponding rates for those with another personality disorder were 97 percent and 99 percent respectively.

4. Cumulative rates of recovery for BPD patients rangers from 40 percent for recoveries lasting eight years for 60 percent for recoveries lasting two years.  The corresponding rates for those with another personality disorder were 75 percent and 85 precent respectively.

5. Rates of recurrence of symptoms were higher for BPD patients at both time points as well, and patients with BPD also experiences recurrence of symptoms more quickly.Ē

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Roller-Coaster Relationship: Your Partner with Borderline Personality Disorder   By Kate Thieda

If you have a partner with borderline personality disorder (BPD), your relationship may look something like this:

ēYesterday, in the eyes of your partner, you could do no wrong. Today, everything you do is wrong.

ēTen minutes ago, your partner was smiling and happy. Now, they are screaming at the top of their lungs about a perceived snarky comment from you, which was not meant in the way it was interpreted, and household objects are being thrown. You hastily leave to go to work.

ēBy the end of today, you will get 15 text messages, eight phone calls, and 10 emails from your partner that ask if you still love them, and threatening suicide if you end the relationship.

According to the National Institute for Mental Health, two percent of Americans are diagnosed with BPD, which equates to about six million people, although some estimates are as high as six percent, or eighteen million people. Women are more frequently given the diagnosis, but that may be because they present for psychiatric services more often than men, or because of provider bias, with men being diagnosed with antisocial personality disorder instead of BPD.

Obviously, having a relationship with someone who experiences BPD is a challenge. At the beginning of your relationship, there may have been a honeymoon period where you were idealized by your partner. But now you may be experiencing the darker side of BPD: fears of abandonment, impulsive behaviors (gambling, unsafe sex, spending sprees, binge eating, drug use), emotional instability, and suicidal gestures or attempts.

What does the partner of someone with BPD do?

Helping your partner find the right treatment is crucial. Convincing them to first try treatment, and then stick with it, however, is a whole other issue. BPD clients are frequently considered the ďtoughest to treatĒ by mental health professionals because of the instability they present. Remember, what happens in the ďreal worldĒ also happens in therapy offices: the same patterns your partner with BPD does at home happen with the therapist, too.

But there is hope. Dialectical behavioral therapy (DBT) is considered the most effective treatment for BPD. There are a ton of resources online about DBT, including the blog Dialectical Behavior Therapy Understood here on PsychCentral, so I invite you to check them out to learn more. There are other treatments that are beginning to receive more attention as well, such as mentalization-based therapy (MBT), transference-focused psychotherapy (TFP), schema therapy (ST), and cognitive behavioral therapy (CBT) tailored specifically to BPD.

Next, finding a therapist to help you is vitally important as well. Even if your partner is in treatment, the instability and uncertainty around their mood and behavior will not resolve overnight. Treatment for BPD is a long process, and if you and your partner are going to get to the other side with your relationship intact, you are going to need professional support.

It is important for you to learn about DBT as well so that you can participate in your partnerís recovery. One way to do this is through DBT Family Skills training.

As for day-to-day ways to support your partner during the recovery process, some tips include:

ēDo not ignore your partnerís threats to harm themselves. After a while, family and friends can become desensitized to the threats of the person with BPD. However, it is common, especially when someone is in treatment, for things to actually get worse before they get better. Statistically, around 9-10% of people with BPD complete suicide, and it is often by accident. Donít take chances: call 911 or bring your partner to the emergency room if they are threatening suicide. Let the mental health professionals decide the level of actual threat.

ēLearn how to validate your partnerís experience. One of the theories behind DBT is that the person with BPD grew up in an invalidating environment, which means they were consistently told that their feelings were bad or wrong, or may have even been physically punished for showing emotion, even if their reaction to the situation was perfectly appropriate.

ēUse good communication skills to set boundaries with your partner. Another hallmark of the experience of people who have BPD is that their lives have always been unstable. Having boundaries in place in their adult relationship, and especially having those boundaries remain in place when tested, helps to provide your partner with a safe environment that they know will not fail them.

ēTake care of yourself. I say this in practically every post: if you are not caring for yourself, you are not in a position to help your partner get better.

 
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What is the prognosis of people with borderline personality disorder?  from MedicineNet.com website

As with any illness, an appropriate question about BPD is if it is curable. While improvement in any personality disorder is not synonymous with being cured, the symptoms of BPD do tend to diminish with time. How well or poorly people with BPD progress over time seems to be influenced by how severe the disorder is at the time that treatment starts, the state of the individual's current personal relationships, whether or not the sufferer has a history of being abused as a child, as well as whether or not the person receives appropriate treatment. Simultaneously suffering from depression, other emotional problems, or a low level of conscientiousness have been found to be associated with a greater likelihood of symptoms of BPD returning (relapse). Conversely, having steady employment or school status once symptoms of BPD subside (remit) tends to protect BPD sufferers from experiencing a future relapse.

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Living with BPD  By Kristalyn Salters-Pedneault, PhD

How Does Living with Borderline Personality Disorder Affect You?

Relationships
BPD can have a major impact on your relationships. In fact, having difficulties in relationships is one of the primary symptoms of BPD. People with BPD have lots of arguments and conflict with loved ones, or a lot of relationships that break up repeatedly. The way that they feel about their family, friends, or partner can change dramatically from day-to-day or hour-to-hour. These patterns can be very difficult both for the person with BPD and those who care about him or her.

Work
Work, school, or other productive pursuits can give us a sense of purpose in life. Unfortunately, BPD can interfere with success at work or school. Because BPD has such an impact on relationships, people with BPD may find themselves in trouble with co-workers, bosses, teachers, or other authority figures. The intense emotional changes may also impact work or school; people with BPD may have to be absent more often due to emotional concerns or hospitalization. Some of the symptoms of BPD (e.g., dissociation) can also interfere with concentration, making task completion very difficult.

Physical Health
Unfortunately, BPD can also have a major impact on physical health. BPD is associated with a variety of serious health conditions, including chronic pain disorders such as fibromyalgia and chronic fatigue syndrome, arthritis, obesity, diabetes, and serious health problems. BPD is also associated with less healthy lifestyle choices (e.g., smoking, alcohol use, lack of regular exercise).

BPD and the Law
Some of the behaviors associated with BPD can lead to legal problems. The anger associated with BPD can lead to aggression (e.g., assaulting others, throwing objects, or acting out against others' personal property). Impulsive behaviors, such as driving recklessly, abusing substances, shoplifting, or engaging in other illegal acts, can also lead to trouble.

Coping with the Symptoms of BPD
People with BPD do not have to resign themselves to a life of emotional pain. Below are some things you can do that can help. These are just the beginning. Getting help from a licensed mental health professional, and learning more about how to manage the symptoms of BPD, can alleviate the impact of BPD on your life.

Get Help
BPD is a very serious disorder. The intense experiences associated with BPD are not something that one person should face alone. Fortunately, there are a number of effective treatments for BPD. Finding a professional you feel comfortable with is one of the most important steps you can take for your health.

Have a Safety Plan
BPD causes very painful emotions, and as a result, it is not uncommon for mental health emergencies (for example, active suicidality) to arise. For this reason, it is critical you to have a safety plan in place before a crisis happens. If you are in danger of harming yourself or others, what will you do? Can you call 911? Is there a hospital nearby with an emergency room that you can go to? If you have a therapist, counselor, psychiatrist, or social worker, talk this plan over with them. Learn more about what to do in a crisis so that you can keep yourself (and others) safe.

Get Support
Having the support of your family, friends, or partner can be a big help. But, not everyone has someone to turn to when things get difficult. You may need to find ways to connect with others, and to build a support network for yourself. BPD is not an uncommon disorder; it occurs in about 1.4% of the population...that that percentage is reported to be truly much higher. That means that there are roughly four million plus people with BPD in the U.S. alone. Many of those people are looking for support, just like you.

Take Care of Yourself
It is important that individuals with BPD take good care of themselves. Good self-care can reduce emotional pain, increase positive emotions, and help reduce the emotional ups and downs experienced by people with BPD. Good self-care includes eating nutritious and regular meals, practicing good sleep hygiene, getting regular exercise, taking time for relaxation and stress-reduction, and scheduling enjoyable activities.

Learn More
When it comes to your mental health, knowledge is power. Educate yourself about the symptoms, causes, and treatments of BPD. Learn about ways to manage your symptoms. Share what you have learned with the people in your life who are affected by it. Amy:  That is what I am doing by actively researching this disorder, and uploading it to this website.  There is so much to grasp about this disorder.  I am amazed by all that I have continued to see that is written about this mental health disorder.  Continuing to live with a dedication and determination to conquer this disorder is enough to keep me putting one foot in front of the other.  Once again, I ask you to forward this site on to anyone, I mean anyone  who could possibly benefit from it, as a BPD or Non-BPD.

Blessings to You,

Amy Allison, owner and author of this website.

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