How Stable Are Personality Disorders Over Time? A Look at New Research on Diagnostic and Symptom-Level Change
Living with a personality disorder (PD) can feel overwhelming—not just for the individual but for families, friends, and clinicians alike. At Philadelphia Integrative Psychiatry, Dr. David Danish and his team are committed to using the latest research to guide compassionate, individualized treatment. One common question we get from patients is, “Will this ever get better?” Historically, PDs have been considered stable, lifelong conditions. But a growing body of evidence is shifting that view—and we're paying attention. Understanding how PDs change over time is crucial for setting realistic goals and offering hope where it’s warranted.
That’s why our team reviewed a 2023 systematic review and meta-analysis titled “The Stability of Personality Disorders and Personality Disorder Criteria: A Systematic Review and Meta-Analysis” to better understand just how stable these diagnoses really are. The findings offer a more nuanced view of PDs—one that might surprise you.
How Stable Are Personality Disorders, Really?
The core question this meta-analysis explored was: Do people who are diagnosed with personality disorders stay diagnosed over time? The researchers examined 40 longitudinal studies involving over 38,000 participants to evaluate PDs from multiple angles, including:
Diagnostic stability (whether the diagnosis itself sticks)
Dimensional mean-level stability (whether symptom severity goes up or down)
Dimensional rank-order stability (whether individuals maintain their relative level of severity compared to others)
Let’s break down the results.
Diagnostic Stability: Only Half Remain Diagnosed Over Time
Across all personality disorders, only 56.7% of individuals retained their diagnosis at follow-up.
For borderline personality disorder (BPD) specifically, this number dropped to 45.2%.
Some studies showed even lower rates, with diagnostic stability for BPD as low as 10% in certain clinical settings [1].
This finding directly challenges the traditional view that PDs are “enduring” and “inflexible.” Instead, it appears that for many, these diagnoses shift over time—especially when viewed categorically.
Symptom-Level Change: Most PD Symptoms Decrease
The study also looked at dimensional mean-level stability, measuring how PD symptoms (not just diagnoses) changed over time.
Most PD criteria showed a significant decline over time.
The greatest improvements were seen in schizotypal (SMD = -0.46) and paranoid (SMD = -0.35) traits.
Borderline PD symptoms decreased moderately as well (SMD = -0.27).
Three disorders—antisocial, obsessive-compulsive, and schizoid—showed no significant change.
This suggests that while a formal diagnosis might remain, symptom severity often improves, especially when patients are receiving care or simply maturing through key life stages.
Rank-Order Stability: Some Traits Are More Persistent Than Others
Rank-order stability looks at whether someone who is high in PD traits relative to their peers stays high over time.
Antisocial PD had the highest rank-order stability (r = 0.56), meaning individuals with high antisocial traits tended to stay that way.
Borderline and narcissistic PD both had moderate rank-order stability (r = 0.46).
Obsessive-compulsive PD had the lowest stability (r = 0.31), suggesting more variability over time.
In plain terms, this means some traits—especially antisocial tendencies—may be more "stubborn" or persistent than others.
What Affects Stability? Several Factors Play a Role
The study found that several variables influenced how stable PDs appeared over time:
Assessment tools: SCID-II (Structured Clinical Interview) showed higher stability than others.
Setting: Psychiatric emergency and inpatient settings often reported greater change, likely due to treatment effects.
Comorbid conditions: Co-occurring disorders, like mood or substance use disorders, could also affect how PD symptoms evolve.
What Does This Mean for Patients and Clinicians?
The takeaway is clear: Personality disorders are not necessarily permanent. In fact, many people see substantial improvement over time, especially with proper treatment. At Philadelphia Integrative Psychiatry, we emphasize early intervention, evidence-based therapy, and regular re-evaluation—because we believe that change is possible.
For those struggling with PD symptoms, there’s no need to lose hope. These findings suggest that even long-standing personality traits can shift, adapt, and improve over time.
Getting in Touch with Dr. Danish and His Team
Whether you’re struggling with borderline personality disorder, avoidant traits, or another form of personality disturbance—or simply want a comprehensive, personalized evaluation—our team is here to help. We offer advanced diagnostic assessments, integrative treatments, and a compassionate approach that acknowledges the whole person, not just the diagnosis. Learn more or schedule a consultation by visiting Philadelphia Integrative Psychiatry.
For More on This Topic and Related Subjects, Check Out These Blogs by Dr. Danish:
https://phillyintegrative.com/blog/personality-and-coping-styles-in-depression
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Disclaimer: This guide is for informational purposes only and not a substitute for medical advice. Any treatment—whether a supplement, medication, procedure, injection, therapy, or device—carries potential risks, especially when used in excess or by individuals with certain medical conditions or genetic predispositions. Always consult a qualified healthcare provider before starting any treatment.
