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Better Prognosis for Borderline Personality Disorder Patients

Borderline Personality Disorder has traditionally been a disorder with a poor prognosis, usually because people with this diagnosis were thought to be “treatment-noncompliant” due to the nature of the disorder itself. It was assumed that this noncompliance resulted in the patient’s continued poor adjustment to life. However, a study done at McLean Hospital in Massachusetts has shown that there can be a better prognosis for Borderline Personality Disorder patients than traditionally predicted.

This study 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, with the remaining 72 of the patients meeting criteria for other personality disorders. The average age of patients with Borderline Personality Disorder was 27 years old.

These patients were reassessed at two, four, and six-year intervals, using the same strict diagnostic interviews that were used to establish their original diagnosis. When conducting these follow-up interviews, the study interviewers were blind to the patient's original diagnosis.

Post-discharge, most of the patients with Borderline Personality Disorder continued some form of treatment for variable periods – for example, 75% of the patients had some outpatient therapy, and 71% received daily medications.

The authors summarized the results of the study 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. 1

Some symptoms persisted longer than others. Depression, chronic anger, and loneliness, boredom, or emptiness persisted in more than 70% of subjects at six years post-discharge. 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 six years post-discharge.

This study suggests that people who are diagnosed with Borderline Personality Disorder have a better prognosis than traditionally predicted. In other words, those with the disorder can get better. However, it is important to note that the people in this study 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. More importantly, though, is that almost 3/4 of the patients diagnosed with this disorder got better six years later.

1. 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.

About the Author

David Oliver is the founder of BorderlineCentral.com a one stop source of information on how to cope and deal with borderline personality disorder.

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