Long-Term Recovery From Borderline Personality Disorder Out of Reach for Many

Megan Brooks

April 15, 2010

April 15, 2010 — Recovery from borderline personality disorder, which includes symptom remission and good psychosocial functioning, seems difficult for most patients to attain, conclude study investigators in the April 15 online issue of the American Journal of Psychiatry.

However, "once attained, such a recovery is relatively stable over time," first study author Mary C. Zanarini, EdD, of McLean Hospital, Belmont, Massachusetts, and colleagues report.

These findings stem from a 10-year, prospective, follow-up study of 290 patients who met diagnostic criteria for borderline personality disorder. At baseline, the mean Global Assessment of Functioning scale score was 38.9, indicating major impairment in several areas, such as work or school, family relations, judgment, thinking, and mood, the researchers note.

The patients who were 80.3% female and 87.2% white, with a mean age of 26.9 years, were evaluated at baseline and every 2 years for 10 years via semistructured interviews and self-report measures. Attrition was relatively low, with 275 patients reinterviewed at 2 years, 269 at 4 years, 264 at 6 years, 255 at 8 years, and 249 at 10 years.

At 10 years, 93% of patients had attained a symptomatic remission lasting at least 2 years, and 86% had sustained remission lasting at least 4 years, the report states. However, only 50% of patients experienced a recovery from the disorder, which the researchers defined as a 2-year symptomatic remission and the attainment of good social and vocational functioning during the previous 2 years, as well as a Global Assessment of Functioning score of 61 or higher.

"It is sobering that only half of our study sample achieved a fully functioning adult adaptation with only mild symptoms of borderline personality disorder," the investigators note.

In addition, 34% of patients who recovered from borderline personality disorder lost their recovery. About 30% of those who achieved a 2-year remission of symptoms experienced a recurrence of symptoms, as did 15% of those who had achieved a 4-year sustained remission.

"This set of results is consistent with clinical experience," Dr. Zanarini and colleagues note in their report. The current study, they point out, is an extension of the National Institute of Mental Health (NIMH)–funded McLean Study of Adult Development, which found "steady, if modest, overall improvement over 6 years of prospective follow-up." Another NIHM-funded study — the Collaborative Longitudinal Personality Disorders Study — found that borderline patients continued to function in the fair range of global functioning during 2 years of prospective follow-up.

Joel Paris, MD, professor of psychiatry at McGill University, Montreal, Quebec, Canada, who was not involved in the study, told Medscape Psychiatry that the latest findings from the McLean study "are not unexpected; they do confirm what is already out there in the literature. On the other hand, this is a well-described sample, and it's the first time we've gotten this much detail."

Taken together, Dr. Paris said, the research suggests that patients with borderline personality disorder "do get better with time, but they don't get all better."

The long-term observations in the McLean study, Dr. Zanarini's team notes, also suggest that remissions are "far more common than the good psychosocial functioning needed to achieve a good global outcome."

"It would thus seem wise for those treating borderline patients to consider a rehabilitation model of treatment for these psychosocial deficits. Such a model would focus on helping patients become employed, make friends, take care of their physical health, and develop interests that would help fill their leisure time productively," the researchers suggest.

Dr. Zanarini and Dr. Paris have disclosed no relevant financial relationships.

Am J Psychiatry. Published online April 15, 2010.

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