Borderline personality disorder (BPD) is a serious mental health condition characterized by difficulties regulating emotions, impulsive behaviors, and unstable relationships. Many people with BPD struggle to function without treatment and support. So does BPD get worse over time if left untreated? Let’s examine the evidence.
What is Borderline Personality Disorder?
Borderline personality disorder is a pattern of instability in interpersonal relationships, self-image, emotions, and behavior. People with BPD often have intense emotions that can shift quickly from positive to negative. They may struggle with chronic feelings of emptiness, fear of abandonment, and lack of identity.
Common symptoms of BPD include:
- Intense but unstable relationships
- Impulsive, risky behaviors
- Unstable self-image
- Suicidal thoughts or behaviors
- Intense anger and mood swings
- Chronic feelings of emptiness
- Dissociation or detachment from reality
BPD typically begins in early adulthood and occurs in around 1.6% of the general population. Women are diagnosed at higher rates than men. BPD often occurs along with other mental health issues like depression, anxiety disorders, bipolar disorder, and substance abuse.
The Progression of Untreated BPD
Without proper treatment and support, BPD symptoms tend to get worse over time. As people age, they may develop more ingrained, inflexible patterns of thinking and relating to others. Impulsivity and risk-taking behaviors often decline with age, but relationship difficulties, emotional volatility, anger problems, and identity issues may persist or worsen.
Why BPD Tends to Worsen Without Treatment
There are several reasons why leaving BPD untreated may result in worsening of symptoms:
- Lack of coping skills – Therapy teaches crucial skills for managing BPD symptoms. Without these skills, symptoms spiral out of control.
- Invalidation – Lack of validation and support reinforces negative self-perception.
- Unstable relationships – Rocky relationships fuel fear of abandonment and emptiness.
- Negative reinforcement – Impulsive behaviors provide temporary relief but reinforce dysfunctional patterns.
- Biological factors – Changes in brain structure and function may occur.
- Co-occurring disorders – Untreated co-occurring conditions like addiction and depression worsen BPD.
Over time, the cycles of intense emotions, relationship conflicts, impulsive behaviors, and identity disturbances tend to become more fixed without treatment. People loses sense of identity, purpose, and hope for the future.
The Impact of Aging on BPD Symptoms
Aging and life stage affect how BPD manifests:
- Adolescence – mood swings, impulsivity, risky behaviors, and volatile relationships are common.
- Early adulthood – identity struggles, relationship problems, self-harm risks are often prominent.
- Middle age – impulsivity declines, but relationship and identity issues persist.
- Later life – loneliness, despair, and somatic symptoms may increase.
While certain symptoms may improve with age, core BPD issues around emotions, relationships, and identity tend to remain chronic without effective treatment.
Does Treatment Help Prevent Worsening of BPD?
Research strongly supports treating BPD as early as possible to prevent worsening of symptoms. While BPD is considered a life-long condition, the right treatment can help manage symptoms, increase stability, and improve quality of life.
Treatment Options for BPD
Recommended treatment options include:
- Psychotherapy – Talk therapy helps with coping skills, self-awareness, and relationships. Dialectical behavior therapy (DBT) is considered the most effective approach.
- Medications – No medications treat BPD specifically, but antidepressants, mood stabilizers, and antipsychotics can help manage symptoms.
- Self-help strategies – Stress management, journaling, mindfulness, and peer support groups can provide additional support.
A combination of psychotherapy and self-help strategies, along with medication if needed, generally provides the most comprehensive BPD treatment plan.
How Treatment Prevents Worsening of BPD
Treatment addresses factors that drive the worsening of untreated BPD:
- Teaches coping strategies to stabilize emotions and impulses.
- Improves self-awareness and identity.
- Enhances relationship skills.
- Provides validation to counter negative self-perception.
- Treats co-occurring disorders like depression and addiction.
- Provides structure and accountability.
With proper treatment, people gain tools and support to break destructive patterns and build a life worth living.
What Happens If BPD Goes Completely Untreated?
Without any form of treatment or support, BPD can severely damage a person’s quality of life. Potential consequences of untreated BPD include:
- Inability to maintain jobs or complete education
- Homelessness
- Financial instability
- Total isolation – loss of family and friends
- Addiction and substance abuse
- Self-harm behaviors
- Suicide
- Incarceration due to crimes or violent behavior
According to research, the suicide rate for people with untreated BPD is up to 10%. Additionally, around 9-30% of psychiatric hospitalizations are related to BPD.
Clearly, lack of treatment poses huge risks both psychologically and practically for individuals with BPD. It is crucial to seek professional help.
Are There Any Cases Where BPD Improves Without Treatment?
It is rare, but some people with mild to moderate symptoms of BPD may experience improvement over time without formal treatment. This is more likely when:
- Symptoms are relatively mild overall.
- The person has strong social supports and stable relationships.
- Co-occurring mental health disorders like addiction are avoided or addressed.
- The person learns to implement helpful coping strategies on their own.
- Significant life changes remove triggers and stressors.
However, most mental health experts warn against assuming BPD will get better on its own. Some symptoms may wax and wane, but core issues often remain or eventually return worse than ever without proper treatment.
Tips for Living with Untreated BPD
For those unable or unwilling to seek professional BPD treatment at this time, these self-help tips may help reduce symptoms:
- Find peer support groups for validation and accountability.
- Avoid drugs, alcohol, and other risky impulsive behaviors.
- Use exercise, journaling, art, or music to help relieve stress.
- Establish a daily routine and structure.
- Practice mindfulness and relaxation techniques.
- Focus on getting proper sleep, nutrition, and reducing stress.
While not a substitute for professional treatment, these strategies can help improve coping abilities and resilience. However, it is very difficult to manage untreated BPD completely alone in a healthy way.
The Takeaway – Get Professional Treatment for BPD
In summary, the evidence clearly shows that lack of treatment causes BPD to progressively worsen over time in most cases. While mild cases or certain symptoms may naturally improve in some people, BPD generally requires professional treatment to prevent a negative downward spiral.
Comprehensive therapy, self-help strategies, medication, and support can help manage BPD symptoms, increase stability, and greatly improve quality of life. Addressing co-occurring disorders like depression is also key. While BPD remains challenging to treat, the right interventions can make all the difference in the world.
So in answer to the main question – yes, BPD does tend to get worse without proper treatment and support. Seeking help as early as possible provides the best chance of gaining control over symptoms and living a fulfilling life. The potential consequences of leaving BPD untreated are simply too great. With the right treatment plan, people with BPD have hope for remission of symptoms and long-term wellbeing.