Borderline Personality Disorder: Does It Get Better?

Recently I was hospitalized for depression. Another patient, who had just been diagnosed with borderline personality disorder (BPD), found out about this blog and asked me "Does it ever get any better?"

The answer is yes, but not quickly.

A common but difficult diagnosis

According to the National Alliance on Mental Illness, BPD is not as well-known as bipolar disorder or schizophrenia but is just as common, affecting 1 to 2 percent of the population. An estimated 10 percent of outpatients and 20 percent of inpatients have BPD. It commonly co-occurs with other psychiatric disorders; in my case, schizo-affective disorder depressive type, alcoholism, and post traumatic-stress disorder. The co-occurring diagnoses often make BPD complicated to treat.

In spite of this, BPD has a good prognosis when the patient is receiving proper treatment, such as dialectical behavior therapy (DBT) or schema therapy. It's worth noting that schema therapy can work even if DBT fails. I went through DBT and did not improve; I was in the hospital more often than I was out of it. I was eventually court-ordered to schema therapy at the borderline unit at Laure D. Carter Memorial Hospital in Indianapolis. I spent nine months at Laure Carter, and gradually improved. I now live in my own apartment (with some oversight by mental health technicians), work as a freelance writer and am rarely in an inpatient setting. I was a hopeless case that found a way out.

No quick fix

BPD does not, however, clear up quickly. I was in schema therapy for about two months before I started seeing improvement. A study by Farrell, Shaw and Webber is interesting; the study divided subjects with BPD into two groups. One group received treatment as usual (TAU); the other received TAU plus schema therapy. After 8 months, 94 percent of the schema therapy group no longer met criteria for BPD, versus 16 percent of the TAU group.

In other words, it is possible to get better if one stays in therapy and works long enough.

The problem is people with BPD tend to want an immediate cure. That's part of the nature of the illness. We have to learn to accept that treatment takes time. As the old saying goes, "Good things come to those who wait." Like it or not, there is no quick fix. The Serenity Prayer is helpful here; we must have both the serenity to accept that treatment takes time and the courage to stay with therapy even if we don't see results.

It is hard to wait, but worth it

The patient I mentioned earlier told me "The more I learn about BPD, the more I hate it." This feeling is understandable--BPD is a horrible illness that considerably affects one's ability to live life.

When I first started schema therapy, I was known for storming out of group therapy in a rage. With time, however, I was able to stop that and stay, even when upset. I learned how to speak up for myself when I was hurt or angry (the two often went hand-in-hand). I learned how to calm down when upset. Even if I hadn't learned anything else in schema therapy, these skills alone would have considerably affected how I dealt with my BPD diagnosis.

It is hard to wait. According to the Ferrall/Shaw/Webber study, 25 percent of the TAU group dropped out (versus 0 percent of the schema therapy group). Dropping out of therapy common for people with BPD, partly because of the difficulties of the therapeutic relationship, partly because therapy can seem painful and ineffective. But it is definitely worth staying with it. I recommend keeping a journal so you can look back and see how you used to be versus how you are now.

Borderline personality disorder does get better if you work at it. You are worth the wait.