What is the prognosis of borderline personality disorder (BPD)?

Updated: Nov 05, 2018
  • Author: Roy H Lubit, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Short-term follow-up studies indicate that BPD is a chronic condition, though many patients improve over time. In a 1998 prospective follow-up study, Links et al reported that almost 50% of their former inpatients with BPD continued to meet diagnostic criteria at 7 years. [20] Furthermore, these patients have significantly more comorbid personality psychopathology; this finding supported the assertion that the level of pathology at the initial assessment primarily predicts the level of borderline psychopathology.

The long-term outcome is variable. The initial diagnosis of BPD is rarely made in patients older than 40 years. Children with borderline pathology tend to develop a wide range of personality disorders, not necessarily BPD. Andrulonis has suggested that BPD traits in girls are more likely to evolve toward affective disorders, whereas BPD traits in boys evolve toward episodic dyscontrol syndromes and substance abuse. [21]

Premature death among patients with BPD may be due to the increased risk of suicide in this population. Approximately 70-75% of patients with BPD have a history of at least 1 deliberate act of self-harm. According to Linehan et al, the mean estimated rate of completed suicides is 9%. [1, 2]

BPD is associated with significant morbidity. The individual’s relationships are generally unstable. Marked changes in feelings about people, high levels of anger, and impulsivity compromise social and work activities. There are high rates of depression and substance abuse. Psychosis occasionally occurs. In a study of 409 patients, Zimmerman et al found that in comparison with patients who did not have BPD, patients with BPD were twice as likely to receive a diagnosis of 3 or more current axis-I disorders (eg, mood disorders, anxiety, substance abuse, eating disorders, or somatoform disorders) and nearly 4 times as likely to have a diagnosis of 4 or more such disorders. [22]

Morbidity in this population includes failure in social relationships, developmental delay, and occupational impairment. Healthcare costs in patients with borderline pathology are enormous, and treatment dropout rates are high.

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