title: Differences between older and younger adults with borderline personality disorder on clinical presentation and impairment.
abstract: BACKGROUND
  Borderline Personality Disorder (BPD) is well-known to be a clinically severe and impairing diagnosis. Research shows that BPD symptoms decrease in severity over time. However, a subset of patients with BPD continue to meet criteria for the disorder in older adulthood. Little is known about this subset. Perception of BPD as a young-person's diagnosis could lead to under recognition in older patients. As such, the objective of the present report is to provide the first direct comparison between older and younger adults with BPD on demographics, clinical presentation, and functional impairment.
  
  
  METHODS
  Over 3000 psychiatric outpatients were evaluated with semi-structured diagnostic interviews. Forty-six older adults (age 45-68) and 97 younger adults (age 18-25) met criteria for BPD.
  
  
  RESULTS
  Both groups reported high levels of functional impairment and Axis I comorbidity. Older adults were more likely to endorse chronic emptiness, and less likely to endorse impulsivity, self-harm, and affective instability. Older adults also reported fewer substance use disorders, more lifetime hospitalizations and higher social impairment.
  
  
  CONCLUSIONS
  Older adults with BPD had a significantly different clinical presentation from younger adults with BPD, including differences in likelihood of endorsing specific BPD criteria, social impairment, and comorbid substance use. It is important to assess less prototypic features of BPD to avoid overlooking borderline personality features in this population.
authors.affiliation: Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI 02904, USA.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Morgan
authors.forename: Iwona
authors.initials: I
authors.lastname: Chelminski
authors.forename: Diane
authors.initials: D
authors.lastname: Young
authors.forename: Kristy
authors.initials: K
authors.lastname: Dalrymple
authors.forename: Mark
authors.initials: M
authors.lastname: Zimmerman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016728:Self-Injurious Behavior / Q000209:etiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Borderline Personality Disorder; Comorbidity; Diagnosis; Functional impairment; Old age