Borderline personality disorder (BPD) is a serious mental illness characterized by unstable moods, behavior, and relationships. BPD can significantly impact a person’s quality of life and lead to impulsive, risky behaviors. One question that often comes up is whether BPD shortens a person’s lifespan. Let’s take an in-depth look at the evidence.
What is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a condition marked by ongoing patterns of varying moods, self-image, and behavior. These patterns often result in unstable relationships and impulsiveness. Symptoms may include:
- Intense emotional swings and frequent mood changes
- Unstable self-image and sense of self
- Impulsive, risky behaviors like reckless spending, unsafe sex, substance abuse
- Intense but unstable relationships, alternating between idealization and devaluation
- Fear of abandonment and rejection
- Strong feelings of emptiness and loneliness
- Difficulty controlling anger
- Paranoid thoughts or dissociative episodes
BPD often begins in adolescence or early adulthood and occurs in around 1.6% of adults in the general population. It is more common among women than men. The exact causes are unknown, but research suggests a combination of genetic and environmental factors are at play. Brain abnormalities and traumatic childhood experiences like abuse or neglect may also contribute to BPD development.
People with BPD have intense, unstable emotions and behavior patterns that make life very challenging. Their relationships and sense of self are often chaotic. They may turn to risky behaviors like self-harm, substance abuse, or impulsive sex to cope with intense and frequently changing emotions. Frequent mood swings between depression, irritability, and anxiety are common. These unstable patterns lead to relationship conflicts, self-image issues, and impulsive actions that can have significant consequences.
Do people with BPD have higher mortality rates?
Given the unstable, risky behaviors associated with BPD, it is reasonable to ask whether the disorder shortens lifespan.
Research on this question shows mixed findings, but overall suggests that BPD may moderately increase mortality risk, at least among those with severe BPD symptoms. However, the life expectancy gap seems to be decreasing over time as treatment improves.
Here is an overview of the research:
Studies Finding Increased Mortality
- A 2020 study followed nearly 1,000 people with BPD over 30 years. It found they had 3.2 times higher mortality rates compared to the general population. The leading causes were suicide and accidental death from risky behavior.
- A Swedish study tracking over 700 patients for 15 years found 4.2 times higher mortality among BPD patients. 37% of the deaths were from suicide.
- A meta-analysis combining data from multiple studies estimated that individuals with BPD had a standardized mortality ratio of around 7 compared to the general public. Suicide was the leading cause.
Studies Finding No Increase or Only Slight Increase in Mortality
- A Danish study following 350 BPD patients over 18 years found no overall increase in mortality rates compared to the general public. However, suicide rates were 9 times higher.
- A 2021 study in the Netherlands tracked 623 BPD patients and found a standardized mortality rate of 1.7 compared to the general public. The higher death rate was attributed to increased natural causes rather than suicide.
- A study of Medicaid recipients in the U.S. found that BPD patients had a 28% increase in mortality risk over 10 years compared to the general population.
Factors Affecting Mortality Risk
Research has identified several factors that seem to affect mortality rates among BPD patients:
- Severity of symptoms – Patients with more severe BPD symptoms and behaviors have higher mortality rates.
- Suicidal behavior – Suicide is the leading single cause of premature death among BPD patients.
- Substance abuse – Co-occurring substance abuse disorders are linked to increased mortality.
- Treatment access – Lack of access to proper BPD treatment may increase risky behaviors.
- Co-occurring disorders – Other mental illnesses like major depression or PTSD further increase risk.
This indicates that mortality risk largely depends on the severity of each individual’s condition and their access to effective treatment.
Are mortality rates improving over time?
When looking at studies over the past few decades, there seems to be an improving trend in mortality rates for individuals with BPD. Some key findings:
- A meta-analysis found that mortality ratios compared to the general population decreased from around 9 in the 1990s to around 5 in 2010-2015 studies.
- A 30-year study in Norway found that the standardized mortality rate fell from around 9 in 1990 down to around 4 in 2017. Suicide rates also declined.
- Researchers attribute improving mortality rates to better recognition of BPD, improved access to targeted treatment approaches, and reduction in the social stigma associated with the disorder.
So while BPD appears to increase mortality risk overall, especially suicide risk, the gap seems to be lessening over the past few decades likely due to improvements in diagnosis and treatment. Continued focus on evidence-based care and suicide prevention for these patients remains important.
Leading causes of death among BPD patients
We’ve touched on the leading causes of premature death in BPD, but let’s summarize the main findings:
Suicide
Numerous studies identify suicide as the leading single cause of early mortality among BPD patients, accounting for between 30-40% of deaths in some research.
Factors that contribute to the substantially increased suicide risk include:
- Extreme emotional instability and impulsivity
- Frequent, severe mood swings and depression
- Feelings of emptiness and loneliness
- High sensitivity to rejection and failure
- Substance abuse as a coping mechanism
- Previous suicide attempts or self-harm behaviors
Effective psychotherapy and appropriate medications can help reduce BPD patients’ suicide risk. Teaching coping skills, addressing comorbid disorders like depression, and providing a strong support system are also important protective factors.
Accidents and Risky Behavior
After suicide, accidents and consequences of dangerous behavior account for a significant portion of deaths among BPD patients.
Examples include:
- Drug overdoses
- Reckless driving and automobile accidents
- Unsafe promiscuous sex leading to violence or disease
- Injuries related to extreme behavioral outbursts
The impulsivity, risk-taking, anger issues, and substance abuse that characterize BPD may contribute to higher rates of accidental mortality.
Natural Causes
While suicide and accidents account for most premature deaths, later mortality tends to be from natural causes like cardiovascular disease, cancer, respiratory diseases, etc.
Factors contributing to increased risk of natural mortality include:
- High rates of smoking and substance abuse
- Poor self-care and nutrition
- Lack of access to medical care
- High stress levels
- Medication side effects
Managing lifestyle factors through diet, exercise, smoking cessation, and appropriate medical care can help reduce mortality from natural causes among BPD patients.
How does effective treatment impact mortality?
As discussed previously, access to proper diagnosis and effective treatment appears to be improving mortality outlooks for individuals with BPD. But how exactly does treatment help?
Psychotherapy
There are several psychotherapy approaches with good evidence of effectiveness for treating BPD:
- Dialectical Behavior Therapy (DBT) – Focus on emotion regulation, distress tolerance, and interpersonal skills.
- Mentalization-based therapy – Focus on improving ability to understand oneself and others.
- Transference-focused psychotherapy– Focus on managing problematic relationship patterns.
These therapies can:
- Teach coping strategies to better manage BPD symptoms
- Reduce impulsive, risky, and suicidal behaviors
- Improve ability to have stable relationships
- Provide ongoing support system and accountability
Data shows DBT, for example, reduces suicide attempts, self-harm behaviors, substance abuse, depression, and even psychiatric hospitalizations.
Medications
While no medications treat BPD itself, certain drugs can help manage specific symptoms:
- Antidepressants for depression and anxiety
- Mood stabilizers for emotional instability
- Antipsychotics for dissociation, paranoia, aggression
Medications often need to be combined with ongoing psychotherapy. But appropriate pharmacotherapy provides additional tools for stabilizing moods and risky behaviors.
Overall Benefits of Treatment
In total, a multifaceted approach of psychotherapy, medications, lifestyle changes, social support system, and coordinated care from a multidisciplinary treatment team provides the best mortality outlook for individuals with BPD.
Research clearly shows that involvement in comprehensive BPD treatment programs reduces premature deaths, especially those related to suicide, overdoses, and accidents.
Conclusion
Borderline personality disorder is a complex mental health condition associated with unstable emotions, behaviors, relationships, and identity. This instability and impulsivity appears to contribute to moderately higher mortality rates among BPD patients compared to the general population.
However, suicide accounts for a large portion of early deaths in BPD, and improved access to evidence-based treatments seems to be steadily reducing mortality gaps. Comprehensive psychotherapy, appropriate medications, lifestyle changes, social support, and integrated care promote longer life expectancy.
While BPD certainly increases risks that require careful management, effective modern treatments are providing these patients better mortality outcomes and hope for living a normal lifespan. Continued progress relies on reducing stigma around BPD, training providers, early diagnosis, affordable access to care, and suicide prevention.