What Happens When Teenagers with BPD traits Grow Up?

Borderline Personality Disorder (BPD) is often seen as a serious mental health condition that shows up in teenage years. It is marked by emotional pain, unstable relationships, and trouble with identity and self-worth. Many people believe that BPD is something you’re stuck with forever. But is that really true? What happens to teenagers who are diagnosed with BPD when they grow into young adults? Do they get better? Or do their difficulties follow them into adult life?

A recent study led by Stéphanie Bégin and colleagues helps answer these questions. It followed 192 adolescents with BPD for five years. The young people were between 13 and 18 years old when the study began. When the researchers caught up with them again five years later, most were in their early twenties. This study is one of the largest and most detailed of its kind. It gives us a rare look at how BPD develops over time — not just in terms of symptoms, but in how people function in daily life.

The results give a mixed picture. On the one hand, many participants were doing better. Most of them no longer met the full criteria for a BPD diagnosis. But on the other hand, not everyone had recovered. A large number still faced emotional struggles and difficulties in school, work, and relationships. The research shows that while symptoms can improve, BPD often leaves a lasting mark. Understanding these findings can help families, carers, and professionals provide better support.

When the study began, all 192 young people were diagnosed with BPD using structured interviews and recognised clinical tools. The research team made sure that every diagnosis was accurate and based on established criteria. Then, five years later, they reassessed 118 of the original participants. The researchers measured how the young adults were doing emotionally, how their symptoms had changed, and how well they were managing their lives overall.

One of the most striking findings was that just over 63% of those reassessed no longer met the criteria for BPD. This is a hopeful message: for many young people, BPD symptoms do not stay at the same level forever. Over time, they can fade. However, that still means more than one in three participants continued to experience enough difficulties to keep their diagnosis. For this group, the struggles had not gone away. They still dealt with intense emotions, unstable relationships, and problems with identity and self-image.

Recovery, however, meant more than simply no longer fitting a diagnosis. The study also looked at social and emotional functioning — that is, how well people were coping with daily life. Here, the story was more complicated. Many of those who no longer had BPD still had problems in their relationships or in managing school and work. In fact, the study found that only a small group — just 10% — had both lost their diagnosis and reached strong levels of functioning in multiple areas of life. That is a sobering figure. It suggests that even if symptoms fade, the impact of BPD can still be felt for years.

One of the most important parts of the study was its ability to compare those who had recovered with those who had not. The researchers found some clear patterns. Those who had ongoing BPD were more likely to report higher emotional suffering. They were also more likely to show signs of other mental health conditions, such as depression, anxiety, and substance use. Many also had lower self-esteem and more trouble trusting others.

The researchers also looked back at the original assessments to see what factors might have predicted who would still have BPD five years later. One major predictor was the level of distress the young person was feeling at the start. Those who had high levels of emotional pain and distress in adolescence were more likely to still have BPD symptoms in young adulthood. This shows the importance of recognising and treating intense suffering early on.

Interestingly, gender also played a role. While BPD is often diagnosed more in girls than boys, boys in this study were more likely to still have the disorder five years later. The reasons for this are not fully understood, but it may point to differences in how BPD is expressed or treated across genders.

The study also found that school and work functioning were closely tied to emotional health. Young adults who were still struggling emotionally were also more likely to have dropped out of school or to be unemployed. This highlights how mental health and real-life outcomes are deeply connected. Emotional pain can make it harder to succeed in school or work, and failure in these areas can in turn increase emotional distress.

One strength of the study was its use of multiple tools and methods. The researchers combined structured interviews with self-report questionnaires and functional assessments. This gave a well-rounded picture of how the participants were doing. It also helped confirm that the changes seen over five years were not simply due to changes in how the diagnosis is applied, but reflected real differences in symptoms and functioning.

Another key finding was that emotional dysregulation — the experience of being overwhelmed by emotion — remained a central feature of BPD over time. Even among those who had improved in other areas, many still struggled with this. Emotional dysregulation is often what makes BPD so hard to live with, and it may be the last symptom to improve. For clinicians and families, this means that emotional support and regulation skills remain crucial parts of recovery, even years after diagnosis.

The study does have some limitations. Not all the original participants could be reached for follow-up. This means that the results might not represent everyone with adolescent BPD. Also, the study did not look closely at the type or quality of treatment each person received, so it’s hard to say which therapies helped the most. Still, the size of the sample and the length of the follow-up make this study a very important contribution.

In practical terms, the research suggests that early diagnosis of BPD is not a sentence for life. Many adolescents do get better. But it also shows that recovery is not always complete. Many continue to struggle in important parts of life, even if they no longer meet the full diagnostic criteria. For carers and clinicians, this is a reminder that long-term support is often needed — not just for symptoms, but to help people build healthy, stable lives.

Finally, this research speaks directly to young people with BPD and their families. It tells them that change is possible, that pain does not have to last forever, and that there is real value in early care. But it also reminds us that BPD is complex, and that true recovery involves more than symptom relief. It requires support, understanding, and patience — sometimes over many years.

In sum, the study by Bégin and colleagues shows us a clear, scientifically grounded picture of what BPD looks like over time. It offers hope, but also realism. It confirms that many adolescents do grow out of the most intense symptoms. But it also shows that for others, the journey is longer — and that full recovery may mean addressing more than just a diagnosis.

Reference:
Bégin, S., et al. (2024). The course of borderline personality disorder from adolescence to young adulthood: A five-year follow-up study. Clinical Psychology. https://doi.org/10.1016/j.cpr.2024.102437