Diminished Impulsivity in Older Patients With Borderline Personality Disorder

Stevenson J, Meares R, Comerford A
The American Journal of Psychiatry. 2003;160(1):165-166

Clinical lore indicates that patients with borderline personality "burn out" as they get older. The authors attempted to examine this hypothesis by looking at 123 individuals with a diagnosis of borderline personality disorder. By utilizing the Revised Diagnostic Interview for Borderlines (The DIB-R), they were able to assess these patients in terms of the core features of borderline personality disorder: affective disturbance, relationship problems, cognitive disturbance, and impulsivity. They discovered that the older patients showed significantly less impulsivity than the younger patients, but in terms of the other parameters, such as an affective instability, relationship problems, and cognitive disturbance, there appeared to be no changes in the varying age groups. The authors concluded that while impulsivity did seem to diminish as borderline patients became older, the other disturbances in the disorder continue to cause significant problems in the ability to interface with the world. Also, the authors noted that the popular notion that affective instability and impulsivity were connected did not seem to hold up in this study, and they felt that this relationship needed to be further explored and studied.

Abstract

Janine Stevenson, M.B., B.S., F.R.A.N.Z.C.P., Russell Meares, M.D., F.R.A.N.Z.C.P., F.R.C. Psych., and Anne Comerford, B.Sc., M.Sc., M. Clin. Psych. 

OBJECTIVE: The aim of this study was to test, in terms of impulsivity, the hypothesis that borderline personality disorder "burns out" with age. 

METHOD: Linear regression analyses, with age as a predictor variable, were conducted on subsection scores of the Revised Diagnostic Interview for Borderlines (DIB-R) for 123 individuals with a diagnosis of borderline personality disorder who were accepted into an outpatient-based psychotherapy program. The subsection scores of the DIB-R allow quantification of the core features of the disorder: affective disturbance, relationship disturbance, cognitive disturbance, and impulsive behavior. 

RESULTS: Older patients with borderline personality disorder showed less impulsivity than younger patients, but there was no difference in terms of affect disturbance, identity disturbance, and interpersonal problems. 

CONCLUSIONS: The view that borderline personality disorder burns out with age is supported in terms of impulsivity.