Long-Term Outcomes in Borderline Psychopathology: Old Assumptions, Current Findings, and New Directions

Abstract

Borderline personality disorder (BPD) and historical variants of the diagnosis were long held to represent an intractable syndrome of psychopathology consisting of interpersonal, intrapsychic, and affective disturbances. For years, patients labeled "borderline" were regarded pejoratively due at least in part to the lack of effective treatments. Prospective data from recent naturalistic follow-along studies along with the development of treatments with empirically demonstrated efficacy have changed how BPD is viewed. It is now less common to hide the diagnosis from the patient, and BPD has become a useful label to guide the treatment process and help the patient make sense of his or her suffering. Although it is now accepted that BPD is a treatment-responsive disorder and that remission is the norm, more work is needed to help patients achieve a higher level of functioning, and targeting persistent trait-like features suggests new directions for future efforts in treatment development.

Sex differences in mortality of admitted patients with personality disorders in North Norway - a prospective register study

“…About 10% of all patients with borderline personality disorder diagnosis commit suicide [20,21], with higher rates in studies with longer follow-up [22]. Multiple suicide attempts and life-threatening self-harm behaviors are common [23] as 60 – 70% of the individuals with borderline personality disorder diagnosis attempt suicide during the course of their illness [24]. Even if the high level of suicide threats, attempts and self-injury is often seen in younger patients, the mean age of suicide completers is found to be as low as 30–37 years [8,20-22].…”

“…It is likely that this would have affected the validity of the diagnoses. The general construct validity of the personality disorder diagnoses has, however, been widely discussed [23,27,28]. Self-attributed personality traits seem to be more stable than symptoms assessed by clinicians, and diagnostic stability is generally found to be low [29].…”

Affective instability across the lifespan in borderline personality disorder – a cross‐sectional e‐diary study

“…Patients with BPD were diagnosed with a variety of comorbid axis I and axis II disorders. In BPD, comorbidity is the rule, rather than the exception and characteristic for both adolescent and adult patients with BPD. Therefore, a sample of BPD patients with high comorbidity rates constitutes a representative, non‐artificial sample, whereas BPD patients without comorbid disorders cannot be seen as representative of the BPD population .…”

Assessment and Treatment of Patients with Borderline Personality Disorder in the College and University Population

“…BPD most often presents in late adolescence, with patients most symptomatic in young adulthood (Paris, 2003). Recent prospective studies have found that a significant majority of patients diagnosed with BPD in young adulthood will have remission at surprisingly high rates (Gunderson et al, 2000;Gunderson, Stout, & McGlashan, 2011;Skodol et al, 2005;Zanarini et al, 2005;Zanarini et al, 2006), but they continue to have challenges in employment and relationships long thereafter (Sanislow, Marcus, & Reagan, 2012;Skodol et al, 2002). In recent years a number of evidence-based interventions for BPD have been developed and tested (Bateman & Fonagy, 1999;Black, Blum, Pfohl, & St. John, 2004;Clarkin, Yeomans, & Kernberg, 2007;Linehan, 1993;McMain, Links, & Gnam, 2009;Young, 1999); at the same time, a consensus has emerged about those strategies likely to be counterproductive for this population, that is, polypharmacy, recurrent extended hospitalizations, delay in addressing borderline pathology until co-occurring Axis I disorders have remitted (American Psychiatric Association, 2001;Gunderson & Links, 2008;Oldham, 2005).…”