Ten-Year Course of Borderline Personality Disorder

Abstract

Context Borderline personality disorder (BPD) is traditionally considered chronic and intractable. Objective To compare the course of BPD’s psychopathology and social function with that of other personality disorders and with major depressive disorder (MDD) over 10 years. Design A collaborative study of treatment-seeking, 18-to 45-year-old patients followed up with standardized, reliable, and repeated measures of diagnostic remission and relapse and of both global social functioning and subtypes of social functioning. Setting Nineteen clinical settings (hospital and outpatient) in 4 northeastern US cities. Participants Three study groups, including 175 patients with BPD, 312 with cluster C personality disorders, and 95 with MDD but no personality disorder. Main Outcome Measures The Diagnostic Interview for DSM-IV Personality Disorders and its follow-along version (the Diagnostic Interview for DSM-IV Personality Disorders–Follow-Along Version) were used to diagnose personality disorders and assess changes in them. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Longitudinal Interval Follow-up Evaluation were used to diagnose MDD and assess changes in MDD and in social function. Results Eighty-five percent of patients with BPD remitted. Remission of BPD was slower than for MDD (P<.001) and minimally slower than for other personality disorders (P<.03). Twelve percent of patients with BPD relapsed, a rate less frequent and slower than for patients with MDD (P<.001) and other personality disorders (P=.008). All BPD criteria declined at similar rates. Social function scores showed severe impairment with only modest albeit statistically significant improvement; patients with BPD remained persistently more dysfunctional than the other 2 groups (P<.001). Reductions in criteria predicted subsequent improvements in DSM-IV Axis V Global Assessment of Functioning scores (P<.001). Conclusions The 10-year course of BPD is characterized by high rates of remission, low rates of relapse, and severe and persistent impairment in social functioning. These results inform expectations of patients, families, and clinicians and document the severe public health burden of this disorder.

Favourable outcome of long-term combined psychotherapy for patients with borderline personality disorder: Six-year follow-up of a randomized study

“…Similar GAF levels have been found in six-and eight-year followup studies of other combination models (Bateman & Fonagy, 2009;Chiesa, Fonagy, & Holmes, 2006). The results are also consistent with findings from naturalistic follow-along studies of subjects with BPD, such as the Collaborative Longitudinal Personality Disorders Study (Gunderson et al, 2011) and the McLean Study of Adult Development (Zanarini, Frankenburg, Reich, & Fitzmaurice, 2010). There is increasing documentation that symptomatic and diagnostic remission does not necessarily coincide with social and functional improvement.…”

Borderline Personality Pathology, Polysomnography, and Self-Reported Sleep Problems: A Review

“…These maladaptive personality traits are relatively stable across the lifespan, occur in about 2.9 % of the population [2], and interfere with social, occupational, cognitive, and relational functioning [3][4][5]. Individuals with BPD focus on negative stimuli and have more pessimistic beliefs about themselves and about the world [3].…”

“…Individuals with BPD focus on negative stimuli and have more pessimistic beliefs about themselves and about the world [3]. They show severe levels of social dysfunction [5], and BPD is highly comorbid with substance use disorders [6]. People suffering from borderline personality pathology are at greater risk for suicide, mood disorders, anxiety disorders, and health problems [7][8][9][10].…”

Personality Disorders: A Burden in the Community, Neglected in the Clinic?

“…4,5 The persistence of impairment is understandable because personality pathology has usually been relatively longstanding and, therefore, has disrupted a person's work and social development over a period of time.…”