The Relationship Between Borderline Personality Disorder and Major Depression in Later Life: Acute Versus Temperamental Symptoms

Abstract

Objective A recent issue in the personality disorder field is the prevalence and course of Axis II symptoms in later life. Focusing on the presentation of personality disorder criteria over time may have some utility in exploring the relationship between borderline personality disorder (BPD) and major depression in older adults. Temperamental personality symptoms are relatively resistant to change but tend to be nonspecific to disorders, while acute symptoms remit relatively quickly. We predicted that temperamental BPD symptoms would be positively correlated with a history of depression and did not expect to find a relationship between major depression and acute BPD symptoms. Method One thousand six hundred and thirty participants between the ages of 55 and 64 were recruited to participate in a community-based longitudinal study representative of the St. Louis area. Participants completed a battery of assessments at baseline, including diagnostic interviews for all ten personality disorders and major depressive disorder. Results Temperamental and acute BPD symptoms were significantly correlated with a history of major depression. After adjustments were made for the effects of temperamental symptoms on depression, acute symptoms were no longer correlated with a history of depression. As predicted, temperamental symptoms remained significantly related to depression, even after controlling for the effects of acute symptoms. BPD acute symptoms showed a unique negative correlation with the amount of time following remission from a depressive episode. Conclusions Overall, this study supports associations between major depression and borderline personality in older adults. The findings indicate that a history of major depression is primarily related to stable BPD symptoms related to emotional distress, which are more prevalent in older adults compared to acute features.

Identifying Personality Pathology Associated With Major Depressive Episodes: Incremental Validity of Informant Reports

“…Thus, we found further support for using assessment methods uncommonly applied in practice as a resource to improve personality measurement. Our results are also consistent with previous reports indicating that self-report of maladaptive personality traits is associated with increased risk of experiencing major depression (Galione & Oltmanns, 2013; Gunderson et al, 2008). These results have practical implications for improving case conceptualization as well as detection and monitoring of personality pathology and related disorders.…”

Missed diagnosis: The emerging crisis of borderline personality disorder in older people

“…Thus, 'depressivity', whether expressed as MDD or dysthymia, appears to be associated with slower remission of BPD symptoms and, importantly, may be predictive of the persistence of BPD into older age. This is supported by a recent study by Galione and Oltmanns (2013), who evaluated a community-based population of 1630 people aged between 55 and 64 years. Their major finding was that a history of major depression was related to stable temperamental symptoms of 'depressivity' and distress even in those with sub-syndromal BPD.…”

Prevalence of Personality Disorders at Midlife in a Community Sample: Disorders and Symptoms Reflected in Interview, Self, and Informant Reports

“…This is, of course, exactly the kind of evidence that is needed to establish the validity of these diagnostic constructs (Kendell 2002). Our findings up to the present time indicate that symptoms of borderline PD are important in predicting various kinds of problems, including those associated with physical health (Powers and Oltmanns 2012), other mental disorders (Agrawal et al 2013; Galione and Oltmanns 2013), marital relationships (Weinstein et al 2012), and the onset of stressful life events (Gleason et al 2012). This is perhaps somewhat surprising in light of the fact that relatively few people in the study showed enough symptoms of borderline PD to meet a full diagnosis for that disorder, suggesting that these effects must hold for people who exhibit sub-threshold levels of symptoms.…”