Differential symptomatology and functioning in borderline personality disorder across age groups

Frías, Álvaro; Palma, C.; Solves, Laia; Martínez, Bárbara; Salvador, Ana Paula

doi:10.1016/j.psychres.2017.09.081

Cited by 22 publications

(29 citation statements)

References 37 publications

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“…Similarly, it would be useful to consider the age of onset and the duration of illness as specific moderators when studying the course of the disorder. In terms of functioning, cross-sectional research has reported, contrary to our findings, greater functional impairments in older age, when it is more likely to present worse physical health, poorer quality of life, and greater social assistance utilisation [56,57,58]. Nevertheless, this decline in functioning is more dramatically suffered in advanced age, whereas subjects comprising the study samples in our analysis were mostly in their 20 s and 30 s at baseline.…”

Section: Discussioncontrasting

confidence: 99%

“…Regarding patients’ age at baseline, we found that a diagnosis of BPD at a younger age was associated with higher percentages of remission in the long-term, whereas this moderator did not influence changes in depression and functioning. This is congruent with previous evidence indicating that BPD symptom severity may decline from adolescence to mid-adulthood, particularly in terms of the externalising manifestations of the disorder (i.e., impulsivity and suicidal behaviours) [55, 56, 57, 58]. Younger age has also been identified as a predictor of shorter time to remission [14].…”

Section: Discussionsupporting

confidence: 90%

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Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

et al. 2018

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Background:This meta-analytic review is the first to synthesise findings from prospective research on the long-term course of borderline personality disorder in adult clinical populations.Methods:Systematic searches were conducted in Medline, PsycINFO, PsycArticles, PubMed and Scopus within the period 1990-2017. Inclusion criteria were: (1) adult BPD sample diagnosed by a validated, semi-structured interview; (2) at least two prospective assessments of outcomes; and (3) follow-up period ≥ 5 years. Quality of evidence was rated with the Systematic Assessment of Quality in Observational Research (SAQOR). Four outcomes were meta-analysed using mixed-effect methods: remission from BPD diagnosis, completed suicide, depressive symptoms, and functioning. Potential moderators regarding the natural course and the initial treatment received were studied.Results:Eleven studies met the inclusion criteria, with 837 participants from nine countries being followed. Between 50% and 70% of the BPD patients achieved remission in the long-term. Significant reductions in depression and functional impairment were also found. Mean suicide rate ranged from 2% to 5%. Younger age was associated with higher likelihood for remission. Being female was correlated with lower functional improvement. Despite some positive trends, there were no significant associations between treatment moderators and the long-term outcome.Conclusions:Findings suggest that the course of BPD is characterised by symptomatic amelioration and a slight functional improvement in the long-term. Age and gender modulate the long-term prognosis and should be considered to adapt treatment resources. Further research is required to draw robust conclusions on the long-term effects of psychotherapeutic interventions.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 90%

Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

et al. 2018

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“…This suggests that growing older with any number of borderline personality traits is associated with a higher level of mental and physical health issues, which has a negative impact on the QoL. Our results are in line with a previous study reporting that among patients with borderline personality disorder age was associated with a lower level of mental and physical HR-QoL [14]. We found that among persons without borderline personality traits an increasing age is associated with a higher mental HR-QoL.…”

Section: Discussionsupporting

confidence: 91%

“…To the best of our knowledge, this is the first study presenting empirical findings on the impact of borderline personality traits on the relationship between age and HR-QoL in the general population [14], the physical component of HR-QoL [17], or typically lacked respondents with BPD or established borderline personality traits [15,17]. Furthermore, adults older than 65 years were entirely absent in most samples [7].…”

Section: Discussionmentioning

confidence: 88%

“…Nonetheless, empirical data on the bivariate association between borderline personality traits and QoL in older adults are particularly scarce [12,13]. For instance, among outpatients with borderline personality disorders, QoL was significantly lower among patients aged 46 years and older compared to younger patients [14]. Among older patients with depression, cluster B personality traits (including borderline traits) were found to be negatively associated with QoL [15].…”

Section: Introductionmentioning

confidence: 99%

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Impact of borderline personality disorder traits on the association between age and health-related quality of life: A cohort study in the general population

Botter

Have

Gerritsen³

et al. 2021

Eur. Psychiatr.

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Background Increasing age as well as borderline personality pathology are associated with a lower level of health-related quality of life (HR-QoL). Our objective was to investigate whether the presence of borderline personality traits modifies the association between age and HR-QoL in the general population. Methods Cross-sectional data from 5,303 respondents (aged 21–72 years) of the Netherlands Mental Health Survey and Incidence Study-2 were analyzed. Borderline personality traits were assessed with the International Personality Disorder Examination questionnaire. Mental and physical HR-QoL were measured with the Medical Outcomes Study Short Form Health Survey. Multiple linear regression analysis was used to examine the association of borderline personality traits, age and their interaction on mental as well as physical HR-QoL, adjusted for demographic variables as well as somatic and mental disorders. Results A total of 1,520 (28.7%) respondents reported one or more borderline personality traits of which 58 (1.1%) reported five or more indicative of a borderline personality disorder. A higher age was associated with lower physical HR-QoL. This negative association became significantly stronger in the presence of borderline personality traits. The association between increasing age and mental HR-QoL was positive in the absence of borderline personality traits and negative in the presence of borderline personality traits. Conclusion Borderline personality traits negatively interfere with the association between age and HR-QoL irrespective of somatic and mental disorders. Attention of clinicians and researchers for subthreshold borderline personality pathology is needed in middle-aged and older persons.

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The epidemiology and clinical features of personality disorders in later life; a study of secondary care data

Treagust

Sidhom

Lewis

et al. 2022

Int J Geriat Psychiatry

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Objectives: Personality disorders (PDs) are often conceptualised as impacting individuals throughout their life. However, there has been limited study of the disorders in those over the age of 65. We have used the psychiatric secondary care medical records of 21,971 individuals over the age of 65 from Cambridgeshire, UK, who received care between 2014 and 2021 to characterise older patients with a PD diagnosis. Methods:The data from all patients >65 with a diagnosis of personality disorder (PD) was extracted (n = 217) along with two comparison groups (n = 2170); patients <65 with a diagnosis of PD and patients >65 with a psychiatric diagnosis other than PD or dementia.Results: Compared to younger patients with PD, older patients were more likely to be male, married, suffering from a mixed PD and live in less deprived areas.Compared to patients >65 with diagnoses other than PD, older patients were more likely to be female, single or divorced and had a higher level of social deprivation.Our most striking finding was that older patients with PDs were more likely to experience polypharmacy. A mean of 18.48 different drugs had been prescribed over their lifetime, compared to 9.51 for patients >65 with other mental health diagnoses. Conclusion:Here we present the largest ever description of this group of patients and provide insights that could inform clinical practice and future research.

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Differential symptomatology and functioning in borderline personality disorder across age groups

Cited by 22 publications

References 37 publications

Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

Impact of borderline personality disorder traits on the association between age and health-related quality of life: A cohort study in the general population

The epidemiology and clinical features of personality disorders in later life; a study of secondary care data

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