Borderline personality disorder (BPD) is a serious mental illness characterized by unstable moods, behavior, and relationships. People with BPD often experience intense emotions and impulsive actions. They may struggle with a poor self-image and difficulty managing emotions. Suicidal behavior and self-harm are common among people with borderline personality disorder. This raises an important question: what is the mortality rate for BPD? Understanding the mortality data can provide insight into the prognosis and seriousness of this condition.
What is Borderline Personality Disorder?
Borderline personality disorder (BPD) is a condition marked by ongoing instability in moods, behavior, self-image, and functioning. These experiences often disrupt the person’s daily life and relationships. BPD affects how a person thinks and feels about themselves and others, causing problems in how they interact with the world. About 1.6% of adults in the United States have BPD. It is called “borderline” because it was originally thought to be on the border between psychosis and neurosis.
Some key symptoms of BPD include:
- Intense fear of abandonment, even going to extreme measures to avoid real or imagined separation or rejection
- Unstable and intense personal relationships, oscillating between idealization and devaluation
- Rapidly shifting moods lasting from a few hours to a few days
- Impulsive and risky behavior like unsafe sex, gambling, reckless driving, drug or alcohol abuse
- Suicidal behavior or self-harm
- Intense emotional reactions like irritability or anxiety lasting a few hours
- Chronic feelings of emptiness
- Explosive anger or difficulty controlling anger
- Temporary paranoid thoughts or severe dissociative symptoms
People with BPD often have other co-occurring mental health disorders like depression, anxiety, eating disorders, post-traumatic stress disorder (PTSD), and substance abuse problems. Childhood trauma, genetics, and brain changes may contribute to the development of BPD. While challenging to live with, borderline personality disorder is treatable through a combination of psychotherapy, medication, and self-care strategies. With appropriate treatment, many people with BPD experience remission of symptoms and can live happy, fulfilling lives.
Mortality Rate Statistics for BPD
Several studies have examined the mortality rates associated with borderline personality disorder. This data sheds light on the potential risk for premature death with BPD. Some key statistics on the mortality rate include:
- People with BPD have a suicide rate of 3-10%
- Around 75% of people with BPD have made at least one suicide attempt
- The mortality rate due to suicide among people with BPD is estimated to be around 4-9%
- One study found the mortality rate over 30 years was around 13% for people with BPD
- The average life expectancy among people with BPD may be reduced by 18-22 years
- Accidental death is another leading cause of mortality for people with BPD
- Death by homicide occurs in 2-5% of individuals with BPD
- Substance abuse significantly increases mortality risk among people with BPD
Overall, these statistics indicate that premature death, especially by suicide, is a real concern for individuals living with BPD. The mortality risk appears significantly higher compared to the general population. However, it’s important to note that these are averages. With proper treatment and support, many people with BPD can live a long and fulfilling life.
Causes of Early Mortality in BPD
There are several reasons why borderline personality disorder is associated with higher mortality rates:
Suicide
Suicide is one of the leading causes of death for people with BPD. Some key factors that contribute to the elevated suicide risk include:
- Difficulty regulating emotions – People with BPD often feel emotions very intensely. This can become overwhelming, leading to suicidal actions.
- Impulsiveness – Impulsive tendencies make it more likely to act on suicidal urges.
- Black and white thinking – People with BPD may view situations in extremes, feeling hopeless and like suicide is the only option.
- Difficulty maintaining relationships – Relationship conflicts can trigger suicidal behavior.
- Chronic emptiness or loneliness – Feelings of emptiness may lead to suicidal behavior.
- Anger issues – Rage or anger episodes that get out of control may end in suicide attempts.
Suicidal behavior in BPD often occurs in response to real or perceived abandonment and rejection from loved ones. Even minor separations can trigger suicide attempts. The chronic emptiness, intense emotions, and impulsiveness of BPD increase susceptibility to acting on suicidal urges.
Accidental Injury and Death
Accidental death is another leading cause of mortality for people with BPD. Some reasons for the elevated risk of accidental death include:
- Impulsive behavior – Impulsiveness leads to increased risk-taking behaviors like reckless driving, drug overdoses, and unsafe sexual practices.
- Self-harm tendencies – Sometimes self-harm acts can go too far and become fatal.
- Substance abuse – Alcohol and drug use increase the potential for overdoses and accidental deaths.
- Risky sex – Unsafe sexual behavior elevates the chance of dying from complications like HIV or hepatitis.
The impulsive nature of BPD contributes to people making poor, risky decisions that can have severe consequences. The self-destructive tendencies associated with BPD also lead to higher rates of accidental injury and death.
Physical Health Conditions
BPD itself does not directly reduce life expectancy. However, people with BPD engage in behaviors that increase the risk of developing health problems at a younger age. For example:
- Obesity – Binge eating and poor nutrition may lead to obesity.
- Smoking – High rates of smoking among people with BPD.
- Substance abuse – Alcohol and drug abuse strain physical health.
- Unsafe sex – Increased risk of sexually transmitted infections.
- Self-harm – Cutting and other forms of self-injury can cause infections or damage vital organs.
These unhealthy behaviors elevate the risk of conditions like heart disease, liver disease, cancer, lung disease, and infectious diseases. The strain on the body from long-term behavior patterns contributes to physical deterioration and disability at an earlier age. Accessing appropriate healthcare can also be a challenge for people with BPD due to unstable living situations, lack of insurance, and difficulty navigating care.
Risk Factors for Premature Mortality with BPD
While BPD itself carries an increased mortality risk, certain factors further elevate the chance of premature death:
Co-Occurring Disorders
Many people with BPD also live with other mental health conditions like depression, PTSD, anxiety disorders, and eating disorders. The combination of BPD with other disorders increases the mortality risk significantly. One study found that over 90% of people with BPD have one additional psychiatric disorder, while almost 75% have two or more additional diagnoses. The co-occurrence of multiple mental health issues compounds symptom severity and makes effective treatment more challenging.
Substance Abuse
Substance abuse is common among people with BPD. Estimates suggest anywhere from 38-65% of individuals with BPD also have issues with alcohol or drugs. Substance abuse is strongly correlated with increased mortality among people with BPD. It amplifies self-destructive tendencies and the likelihood of overdose or accidental death. Additionally, the lifestyle associated with addiction may lead to violence, incarceration, homelessness, and other factors that reduce life expectancy.
Treatment Noncompliance
Many people with BPD struggle to stay engaged in treatment over the long-term. They may stop taking prescribed medications or drop out of psychotherapy. Noncompliance with recommended treatments is associated with poorer outcomes. Without consistent treatment, people are more prone to suicide, accidental injury, victimization, and premature health decline.
Lack of Social Support
The instability of BPD can alienate friends and family members. People with underdeveloped support networks have higher mortality rates. Social isolation amplifies psychological distress and removes protective factors. Additionally, people with limited social resources are at greater risk of homelessness and being victims of violence.
Ways to Reduce Mortality Risk with BPD
While BPD does carry an increased risk of early death, there are many ways to improve the prognosis through proper treatment and support:
Comprehensive DBT
Dialectical behavior therapy (DBT) is the gold-standard psychosocial treatment for BPD. It addresses the emotion regulation, distress tolerance, and interpersonal effectiveness deficits associated with BPD. Comprehensive DBT programs that include individual therapy, group skills training, phone coaching, and therapist consultation lead to reduced suicide attempts, better well-being, and a more stable life.
Medication
Medications like mood stabilizers, antidepressants, and anti-anxiety drugs can help manage mood swings, depression, and anxiety. While meds don’t treat BPD itself, they alleviate associated symptoms for better day-to-day functioning. This leads to improved quality of life and lower suicide risk.
Treatment for Co-Occurring Disorders
Getting effective treatment for any co-existing mental health or substance abuse issues is crucial. Integrated treatment that addresses BPD and co-occurring disorders together leads to better outcomes. This holistic approach stabilizes symptoms and functioning across all conditions.
Self-Care and Coping Skills
Lifestyle changes like exercise, proper sleep, healthy eating, mindfulness practices, and social connection are all beneficial. Developing personal coping skills and self-care tools empowers individuals with BPD to better manage their symptoms day-to-day outside of formal treatment.
Support Groups
Support groups for people with BPD (like NEA-BPD) can provide invaluable understanding, advice, and connection from others facing the same struggles. This community support gives a sense of belonging that may help lower suicide risk.
Early Intervention
Getting assessed and treated as early as possible following the onset of BPD symptoms leads to better prognosis. The longer BPD goes unrecognized and untreated, the higher the risk for self-destructive behavior patterns to become entrenched.
Conclusion
Borderline personality disorder is associated with elevated mortality rates, especially due to suicide and accidental death. The emotional instability, impulsiveness, anger, emptiness, and relationship patterns of BPD contribute to greater risk-taking, self-harm, and vulnerability to suicide. Co-occurring mental health issues and substance abuse also increase the mortality risk. However, through comprehensive DBT programs, medication, treatment of co-occurring disorders, self-care practices, peer support groups, and early intervention, the prognosis for BPD can be significantly improved. Many people with BPD lead long, fulfilling lives with proper treatment and support systems. While BPD is a serious condition requiring intensive treatment, it does not have to be a death sentence. There is hope.
