Purpose of Review To provide an update of a life span perspective on borderline personality disorder (BPD). We address the life span course of BPD, and discuss possible implications for assessment, treatment, and research. Recent Findings BPD first manifests itself in adolescence and can be distinguished reliably from normal adolescent development. The course of BPD from adolescence to late life is characterized by a symptomatic switch from affective dysregulation, impulsivity, and suicidality to maladaptive interpersonal functioning and enduring functional impairments, with subsequent remission and relapse. Dimensional models of BPD appear more age neutral and more useful across the entire life span. There is a need for age-specific interventions across the life span. Summary BPD symptoms and impairments tend to wax and wane from adolescence up to old age, and presentation depends on contextual factors. Our understanding of the onset and early course of BPD is growing, but knowledge of BPD in late life is limited. Although the categorical criteria of DSM allow for reliable diagnosis of BPD in adolescence, dimensional models appear both more age neutral, and useful up to late life. To account for the fluctuating expression of BPD, and to guide development and selection of treatment across the life span, a clinical staging model for BPD holds promise.

This proof of concept study shows that SCBT-g has potential to change EMS and to show significant effect at symptom level in older outpatients with PD features. A control condition in a randomized controlled trial is a necessary step for further research.

A specific instrument has been developed to diagnose personality disorders in older adults. However, further research is necessary to improve the diagnostic accuracy of the Gerontological Personality disorders Scale (GPS).

Empirical research focusing on personality disorders (PDs) among older adults is mainly limited to studies on psychometric properties of age-specific personality tests, the age neutrality of specific items/scales, and validation of personality inventories for older adults. We identified only two treatment studies-one on dialectical behavior therapy and one on schema therapy-both with promising results among older patients despite small and heterogeneous populations. More rigorous studies incorporating age-specific adaptations are needed. Furthermore, in contrast to increasing numbers of psychometric studies, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 pays little attention to the characteristics of older adults with PDs. Moreover, the constructs "personality change due to another medical condition" and "late-onset personality disorder" warrant further research among older adults. These needs will become even more pressing given the aging society worldwide.

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Schema therapy appears an effective treatment for cluster C personality disorders in older adults. This finding is highly innovative as this is the first study exploring the effectiveness of psychotherapy, in this case schema therapy, for personality disorders in older adults.

Personality disorders change phenomenologically throughout the life course, in interaction with biological, psychological, and social events. In this article, we present a life course perspective on borderline personality disorder (BPD), based on clinical staging (conditional stimulus [CS]) and health management (HM). CS is presented as an alternative to the traditional categorical classification, providing improved opportunities to assess the severity of borderline impairment throughout the life course. It is primarily proposed as a heuristic strategy to guide design and selection of appropriate treatment according to the stage of disease progression. In addition, we introduce the concept of HM in the field of BPD, to organize continuous and coordinated health care management for patients with (emerging) BPD. HM redirects the exclusive focus on curative treatment of late-stage disorders to the broad spectrum of preventive, curative, and care interventions necessary to respond to the various needs in the different stages of BPD throughout the life course. Combining clinical staging and HM could provide a more effective and efficient framework for organizing mental health care for BPD.