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Does BPD Get Better or Worse with Age?

Borderline Personality Disorder (BPD) is a psychological condition often associated with intense emotions, unstable relationships, and impulsive behavior. While it's commonly discussed in the context of young adults, BPD can also affect the elderly population. The manifestation of BPD in older individuals comes with its unique challenges and considerations.

Old man sitting on bench

In this article, our main focus will be on older individuals who are dealing with BPD. We'll delve into the intricate aspects of BPD symptoms in this age group, explore the unique challenges associated with diagnosis, and reveal strategies that can provide essential support and guidance.

How to recognize older adults with BPD?

Identifying Borderline Personality Disorder (BPD) in older adults follows similar patterns as in any age group, but it requires keen observation. It involves observing signs such as intense and rapidly changing emotions, unstable relationships characterized by frequent conflicts, struggles with self-identity and purpose, impulsive behaviors, a deep fear of abandonment leading to clinginess, chronic feelings of inner emptiness, mood swings, and difficulties coping with life transitions like retirement or loss of loved ones.

However, as people age, the way they show their BPD symptoms might change. For example, where younger people with BPD might act out strongly, older folks might show their feelings in less obvious ways.

Studying these changes related to age gives us valuable insights into how BPD symptoms and behaviors transform as time goes on. As each year passes, life brings new experiences and emotions that lead to subtle shifts in how BPD symptoms show up. For example, the intense emotional ups and downs linked to BPD might become more balanced as emotional regulation improves with age. Even though impulsive choices and identity struggles are important parts of BPD, they might not be as noticeable in older adults due to the wisdom and personal growth gained from life's ups and downs. While these signs could indicate BPD, it's crucial to get a proper diagnosis from a mental health expert for an accurate assessment and proper support.

Key indicators to recognize elderly individuals with BPD

Unstable Relationships in Later Years: Older adults with BPD often continue to grapple with relationship instability. They may alternate between idealizing and devaluing those around them, finding it challenging to establish and maintain stable, lasting relationships. The fear of being abandoned remains a strong influence, impacting their capacity to nurture healthy relationships. In their later years, these relationship challenges can be compounded by issues such as retirement, loss of friends or family members, and changing social dynamics, which can intensify their emotional struggles.

Persistent Emotional Outbursts: Emotional outbursts, a hallmark of BPD, can persist into later life. If emotional regulation hasn't been effectively learned over the years, managing emotions becomes difficult. This can result in ongoing reliance on unhealthy coping mechanisms or escalation into more severe emotional distress. The intensity of emotional outbursts might lessen, making diagnosis complex. Moreover, older individuals with BPD might camouflage their symptoms, resembling other mental health conditions such as depression or anxiety. These emotional challenges can be magnified by the adjustments and losses that come with aging, making it essential to differentiate BPD-related symptoms from those rooted in the aging process itself.

Persistent Emptiness and Depression: The overwhelming feeling of emptiness characteristic of BPD can continue affecting the elderly. The instability of self-identity and their reliance on others may endure or even heighten with age. This emptiness could be expressed through a consistent sense of being misunderstood, lost, or disconnected from their environment. In the context of aging, this sense of emptiness might be intertwined with feelings of loneliness, nostalgia, and a reflection on life's changes.

"Time's passage reveals that even in later chapters, the echoes of BPD still whisper their complexities."

The feelings of hopelessness and emptiness that often affect elderly individuals with BPD can sometimes be reminiscent of symptoms seen in depression. This similarity can result in a misdiagnosis, leading to treatment efforts primarily centered around mood stabilization through medication. It's important to recognize that these experiences might be tied to underlying BPD instead. Gaining a comprehensive understanding of the individual's situation, considering the intricacies of both BPD and the challenges that come with aging, is crucial for delivering support and care that truly addresses their specific needs.

BPD Presentation in Elderly and Young Individuals

Onset and Development

BPD typically emerges during late adolescence or early adulthood. In elderly individuals, BPD diagnosed later in life may indicate lifelong symptoms unrecognized or attributed to other factors. Younger individuals face identity and relationship challenges, while elderly individuals might struggle with loss, isolation, and end-of-life concerns, influencing how BPD symptoms manifest.

Challenges in Diagnosis and Treatment

Co-occurring medical conditions, cognitive decline, and complex medication regimens can complicate BPD diagnosis and treatment in the elderly, demanding tailored approaches. Similarly, unique challenges arise in diagnosing and treating BPD in young individuals, driven by developmental factors and distinct life choices.

Treatment Considerations for Older Adults with BPD

Effective treatment for BPD in older adults requires a comprehensive perspective. Recognizing the unique circumstances, challenges, and preferences that come with aging is crucial. When considering the adaptation of therapies like Dialectical Behavior Therapy (DBT) for older individuals, it's essential to implement adjustments that align with their unique requirements, given that DBT is commonly applied to younger populations. These adaptations should consider factors such as their life experiences, physical well-being, and evolving emotional needs.

The following strategies can also be beneficial when considering treatments for older adults with BPD:

Holistic Approach: Taking a holistic approach involves addressing both mental and physical health. This encompasses treating mental health concerns, attending to physical ailments, ensuring medication adherence, and maintaining regular monitoring of mental well-being.

Life Review Therapy: Embracing life review therapy can be beneficial. This therapeutic method encourages older adults to reflect on their life journey, find significance in past experiences, and address any unresolved issues, promoting a sense of closure and self-understanding.

Family Therapy: Given that BPD can strain family relationships, integrating family therapy into treatment is valuable. Involving family members fosters an understanding of BPD's impact and fosters a supportive atmosphere for the individual receiving treatment.


BPD changes as people age. It's important to understand these changes so we can help people with BPD at all stages of life. Additionally, research on BPD in the elderly population might be more limited compared to younger age groups. For accurate diagnosis and effective treatment, mental health professionals need to consider the individual's unique circumstances and needs.

While there might be challenges, with the right approach and personal growth, the symptoms can improve over time. As individuals gain life experience, develop healthier coping skills, and learn to regulate emotions, their overall well-being can increase.

BPD Aging Frequently Asked Questions (FAQs)

Does BPD get worse with age?

The way BPD changes as people get older is different for each person. Some individuals might experience an improved ability to control impulsive actions over time and find it more manageable to handle the intense emotions often associated with BPD. Also, whether the struggle with forming a clear self-identity remains constant, becomes more intense, or takes on different qualities can differ from person to person. It's crucial to note that the improvement or exacerbation of specific BPD symptoms can be influenced by a range of factors, including the individual's environment, personal development, and other life circumstances. This is why giving them the proper treatment and support that's just for them is so crucial as they get older.

Is it common for older adults with BPD to experience loneliness?

Yes, the loneliness often associated with BPD can become more intense in later years due to changes in social connections and life circumstances. Seeking social engagement and support is important. Engaging in meaningful activities, pursuing hobbies, connecting with loved ones, and seeking support can help individuals with BPD maintain a sense of purpose and fulfillment as they age.

Is it harder to diagnose BPD in older adults?

Yes, it can be harder to diagnose BPD in older adults. The symptoms might look like other problems that come with age, or they might be seen as typical changes in personality for older people. Also, many older adults have found ways to cope over the years, which might hide some BPD symptoms.

How can older adults with BPD get help?

It's important to have people who can support you. This can be your family, friends, people who are experts in mental health, and groups that understand what you're going through. Talking to a therapist who knows about the challenges that come with getting older can also be helpful. They can give you advice and strategies that fit your age.


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