Borderline Personality Disorder has been thought to be a disorder with a poor prognosis. People with this diagnosis were thought to be noncompliant with treatment in many cases. It was assumed that this noncompliance resulted in continued poor adjustment to life. A recent study followed borderline patients for six years to discover what actually happened to them. Researchers found that they often did better than expected.
The study at McLean Hospital in Massachusetts followed 362 inpatients with personality disorders, conducting detailed interviews to establish that 290 of them fully met the DSM-III-R diagnostic criteria for borderline personality disorder. (The remaining 72 of the patients met criteria other personality disorders.) The average age of borderline patients was 27 years.Patients with concurrent organic, schizophrenic, schizoaffective, or bipolar I diagnoses were excluded from the study.
The patients were reassessed at 2, 4, and 6 year intervals using the same strict diagnostic interviews used to establish the original diagnosis. Interviewers were blind to the patient's original diagnosis when they conducted these follow-up interviews. After discharge, most patients continued some form of treatment for variable periods (75% of patients had some outpatient therapy, for example, and 71% received daily medications).
The authors summarized the results as follows:
- Of the subjects with borderline personality disorder, 34.5% met the criteria for remission at 2 years, 49.4% at 4 years, 68.6% at 6 years, and 73.5% over the entire follow-up.
- Only 5.9% of those with remissions experienced recurrences.
- None of the comparison subjects with other axis II disorders developed borderline personality disorder during follow-up.
- The patients with borderline personality disorder had declining rates of 24 symptom patterns but remained symptomatically distinct from the comparison subjects.
- Impulsive symptoms resolved the most quickly, affective symptoms were the most chronic, and cognitive and interpersonal symptoms were intermediate. (Zanarini, et.al., 2003)
Some symptoms persisted longer than others. Depression, chronic anger, and loneliness, boredom, or emptiness persisted in more than 70% of subjects at 6 years. Other symptoms were more likely to subside. Symptoms such as psychotic-like thinking, substance abuse, self-mutilation, manipulative suicide efforts, and serious identity disturbances persisted in fewer than 30% of subjects at 6 years.
This study suggest that persons diagnosed with borderline personality disorder do get better. It's important to remember that these patients were all hospitalized at the time that they joined the study. This suggests that their disorder was severe enough to interfere with their daily functioning at the time that they enrolled in the study. Almost 3/4 of the patients diagnosed with this disorder got better by six years later.
This study provides new information about the natural history of borderline personality disorder. The good news for persons with this diagnosis (and for mental health professionals) is that there is hope! The study may also help convince insurance companies and managed care companies to continue to pay for necessary treatment.
References:
- Zanarini MC et al. The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. Am J Psychiatry 2003 Feb; 160:274-83.
- Yager, J, Natural History of Borderline Personality Psychopathology. Journal Watch Psychiatry March 20, 2003
Last updated 12/27/05
