Emergence of borderline personality features in the sixth decade of life

Late manifestation of borderline personality disorder: Characterization of an under‐recognized phenomenon

“…This likely reflects the well-known association between BPD and attachment trauma (Gunderson, 2009;Porter et al, 2020;Zanarini et al, 2002). This was also observed in the two case reports (Bernstein et al, 2002;Casher & Gih, 2009), which noted the loss of child by suicide and engaging in a legal battle to receive appropriate care for a child with special needs. Interpersonal problems as precipitants for BPD expression are consistent with our understanding of BPD; BPD symptoms often manifest when attachment difficulties are activated by rejection, invalidation, and loss of containing or protective factors (Fonagy et al, 2000;Zanarini et al, 2010).…”

“…Their presentation often appears to be sudden in onset with severe symptom expression (Bernstein et al, 2002;Casher & Gih, 2009). Anecdotally, these people experienced a reasonable level of functioning and psychosocial stability prior to a particular life crisis, which precipitated a clinical manifestation of BPD for the first time (Bernstein et al, 2002;Casher & Gih, 2009). Other precipitating factors include co-morbid mood disorders or substance misuse (Beatson et al, 2010), as well as hormonal changes (Eisenlohr-Moul et al, 2015;Eisenlohr-Moul et al, 2018).…”

Preliminary studies of the ICD-11 classification of personality disorder in practice

“…The most obvious is the time scale for the presentation of the disorder. It is now possible in ICD‐11 (Table ) to diagnose personality disorder at any age, and although there is general reluctance to make the diagnosis in childhood and choose alternative labels (Elliott, Tyrer, Horwood, & Fergusson, ; Rutter, ), this option is now possible, and the decision to make the diagnosis in adult life with the first manifestation after the age of 25 acknowledges that late onset of personality disorder exists (Casher & Gih, ). It may even be linked to what Owen has described as the hubris syndrome (Owen, ).…”

The rationale for the reclassification of personality disorder in the 11th revision of the International Classification of Diseases (ICD‐11)

“…conduct disorder/dissocial personality disorder, disruptive mood dysregulation disorder/borderline personality disorder) are artificially set by age. Clinicians should have the option of diagnosing personality disorder at any age, including later in life if the problems are sufficiently persistent (Balsis, Woods, Gleason & Oltmanns, ; Casher & Gih, ). Although this is now generally accepted—and is indeed necessary as the new classifications no longer include disorders that commonly begin in childhood in a separate section—there is bound to be some reluctance for clinicians to use the diagnosis of personality disorder in young people because of its stigmatizing implications.…”