Running head: BORDERLINE PERSONALITY DISORDER

Borderline Personality Disorder and Age

Cindy Vega
Salt Lake Community College Psych 1010

BORDERLINE PERSONALITY DISORDER

Borderline Personality Disorder and Age

Introduction
Borderline Personality Disorder; shorthanded as BPD; is a personality disorder that feeds
off of emotional stimuli and severely affects relationships through fears of abandonment. While
symptoms can interfere with their social lives, it seems that it diminishes with age. This paper
will look into that while also giving an example of someone with BPD and explores how they
saw the symptoms were affected with age and events.
Literature review
According to the DSM-5, a subject must show a pervasive pattern of instability of
interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early
adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1) Frantic efforts to avoid real or imagined abandonment
2) A pattern of unstable and intense interpersonal relationships characterized by alternating
between extremes of idealization and devaluation
3) Identity disturbance: markedly and persistently unstable self-image or sense of self
4) Impulsivity in at least two areas that are potentially self-damaging (e.g., substance abuse,
binge eating, and reckless driving)
5) Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6) Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria,
irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7) Chronic feelings of emptiness
8) Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical fights)

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9) Transient, stress-related paranoid ideation or severe dissociative symptoms (APA)

While specific genetic risks havent been found, it is known that Borderline personality
disorder is about five times more common among first-degree biological relatives of those with
the disorder than in the general population. (APA) Fortunately, it is also known that aging may
diminish the severity of symptoms.
In NGs study of Recovery, 585 people with BPD were placed in a study to see if symptoms
of BPD would change with age. It was found that people who had follow-up period of 10 years
or more had higher rates of remission, (Ng), remission being patients who had previously met
the specific diagnostic criteria for BPD but did not meet criteria at follow-up(Ng), signaling that
BDP symptoms may lessen with age.
Another study supports this, although adding a twist. In Sheas study, participants were
evaluated for a period of 6 years in order to see how age would affect symptoms. Results were
that, Older subjects change direction from improvement to worsening in functioning midway
through the 6 years of follow-up, in contrast to the younger aged cohorts. While those in their
30s to early 40s were functioning the best, some in their mid-40s to 50s showed poorer
functioning, suggesting a reappearance of difficulties with advancing age. (Shea). Since most
subjects had received some form of treatment outside of the study, they acknowledged that that
may be a factor to consider, seeing as aging would equal more treatment sessions, yet cannot
explain why improvement declined in the mid 40s to 50s (Shea).
There are several risks that come to the physical well-being of someone with BPD.
Completed suicide occurs in 8%10% of such individuals, and self-mutilative acts (e.g., cutting
or burning) and suicide threats and attempts are very common. (APA). These suicidal
tendencies may arise from of abandonment, real or imagined. Self-mutilation may not be done in

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full-awareness of the individual, as explained in the DSM-5. Self-mutilation may occur during
dissociative experiences and often brings relief by reaffirming the ability to feel or by expiating
the individuals sense of being evil. (APA). It doesnt help that individuals with BPD have
lower pain sensitivity during dissociation (Winter).
Their sensitivity to emotional stimuli may help us understand why negative stimuli can be so
harmful. This has been proven through Functional neuroimaging studies, which found that there
was higher brain activity in areas which affected emotional processing when shown negative
images compared to individuals that didnt have any mental illness (Winter).
Borderline Personality Disorder greatly affects relationships as well. Intimacy is usually
expected to occur early on in relationships, with an expectation of receiving affection on
demand. While demanding affection and attention, these individuals do the same, offering
affection and attention back. Because of this, the intimacy early on, the affection and attention,
any drastic changes in the relationship can affect how someone with BPD sees someone. They
may feel like they were abandoned, or feel like the other is not there as much as they used to.
Idealization can turn to devaluation. Sudden changes in mood may also lead to the individual
with BPD to lash out at others, leading to feelings of being evil and regret (APA).
Application
I have a friend who I will call Megan. She has been attending therapy for BPD for about
two years now, and has been going to therapy in general for about six years. During her time
there she has learned how to handle her anger effectively, avoiding taking it out on others. She
had been doing well for some time, effectively reducing the symptoms of BPD, but has recently
retracted, having been abandoned by her friends. She has gone back to cutting and has
occasionally shown much more sarcastic behavior towards her old friends, and has become much

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more dependent of me. She blames herself for having been abandoned, and believes that she is
evil. She believes that she can compensate through cutting. She has even attempted suicide by
crashing her car, hoping to gain the attention of her boyfriend, who seemed to have been losing
interest. While she used to idealize her friend and boyfriend, she now sees them as literal
demons, and will bring up her hatred of them whenever she cuts again. After the incident, she has
reported a greater sense of emptiness.
Our relationship seems to be dependent on each other emotionally, as shown in the DSM5. An individual with BPD will expect to be given affection and attention when demanded and
they will also give it back. If this stops, the fear of abandonment grows (APA). She has
occasionally shown a fear of abandonment, texting me about her worries after I do not contact
her in a day. She has grown to know that I will give her attention if I find that she is upset, so she
occasionally takes that to her advantage. Meanwhile, we both tend to speak a lot, telling each
other funny stories and she relies on me when she needs emotional support. She hopes that by
forming that bond with me and a couple of other friends, she can find support and eventually
start to reduce the symptoms once more.
Conclusion
I learned more about BPD that I was not explicitly told or shown by my friend. It is
comforting knowing that the symptoms seem to decrease with age. I would like to eventually see
more studies finding why it is that the symptoms worsen at older age since that would be helpful
in treating that age group with BPD who may be distressed and confused as to why they
regressed. This topic has personally helped me in understanding my friend more, and I know that
if more people knew more about BPD then people may be more understanding as to why
attachment is so difficult to them.

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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders : DSM-5. (5th ed.).http://dx.doi.org/10.1176/appi.books.9780890425596

Ng, F. Y. Y., Bourke, M. E., & Grenyer, B. F. S. (2016). Recovery from Borderline
Personality Disorder: A Systematic Review of the Perspectives of Consumers, Clinicians, Family
and Carers. PLoS ONE, 11(8), e0160515. http://doi.org/10.1371/journal.pone.0160515

Shea, M. T., Edelen, M. O., Pinto, A., Yen, S., Gunderson, J. G., Skodol, A. E., Morey,
L. C. (2009). Improvement in Borderline Personality Disorder in Relationship to Age. Acta
Psychiatrica Scandinavica, 119(2), 143148. http://doi.org/10.1111/j.1600-0447.2008.01274.x

Winter, D. (2016). Attention to emotional stimuli in borderline personality disorder a

review of the influence of dissociation, self-reference, and psychotherapeutic interventions.
Borderline Personality Disorder and Emotion Dysregulation, 3, 11.
http://doi.org/10.1186/s40479-016-0047-z