Many Zanarini of McLean Hospital in Massachusetts [an expert researcher in the field] studied 290 hospitalized patients with BPD over 10 years. Half of the patients (50%) recovered from the disorder after 10 years of follow-up. Recovery was defined as at least two years without symptoms and both social and vocational functioning. Overall, 93% of patients achieved a remission of symptoms lasting at least two years and 86% for at least four years. The LA Times says
, âA new study offers hope that recovery, although challenging, can be long-lasting.â The LA Times article continues, âThe research suggests that while it may be difficult to achieve recovery, once recovery has been attained it appears to last. While many treatments focus on symptoms, therapy should include work on improving relationships and functioning in the workplace, areas that vastly boost the odds of long-term recovery.â
for the whole article. A Medscape article
had a different slant.
âRecovery from borderline personality disorder, which includes symptom remission and good psychosocial functioning, seems difficult for most patients to attain,â 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 person0ality disorder. The patients were overwhelmingly female and white; the mean age was 27. These were lower-functioning, âconventionalâ BPs interested in working in treatment.
At the beginning of treatment, the mean Global Assessment of Functioning (used to rate the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living) was 38.9. This means the patients had major impairment in several areas, such as work or school, family relations, judgment, thinking, and mood.
Then, researchers interviewed the patients every two years for 10 years. The assessment included both semistructured interviews and self-report measures. Attrition was relatively low. Of the original 290 patients, 275 patients were reinterviewed at two years, 269 at four years, 264 at six years, 255 at eight years, and 249 at 10 years.
(This attrition rate is low. According to Joel Paris, M.D., because of their impulsivity, about two thirds of borderline patients drop out of treatment within a few months. See http://www.jwoodphd.com/borderline_personality_disorder.htm
. My guess would be that these patients were either more highly motivated at the beginning, or participating in the study gave them higher motivation.)
The report states that at 10 years, 93% of patients had attained a symptomatic remission lasting at least two years, and 86% had sustained remission lasting at least four years. However, only 50% of patients experienced a recovery from the disorder (which the researchers defined as a two-year symptomatic remission and the attainment of good social and vocational functioning during the previous two years, as well as a Global Assessment of Functioning score of 61 or higher).
The investigators said that, "It is sobering that only half of our study sample achieved a fully functioning adult adaptation with only mild symptoms of borderline personality disorder.â Sadly, 34% of patients who recovered from borderline personality disorder lost their recovery. About 30% of those who achieved a two-year remission of symptoms experienced a recurrence of symptoms, as did 15% of those who had achieved a four-year sustained remission.
In part, the Medscape Psychiatry article http://www.medscape.com/viewarticle/720303
(but you must register) written by Megan Brooks reads:
"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)âfunded McLean Study of Adult Development, which found âsteady, if modest, overall improvement over six years of prospective follow-up.â
âAnother NIHM-funded study â the Collaborative Longitudinal Personality Disorders Study â found that borderline patients continued to function in the fair range of global functioning during two years of prospective follow-up.
âJoel 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.â
âTaken together, Dr. Paris said, the research suggests that patients with borderline personality disorder âdo get better with time, but they don't get all better.â The long-term observations in the McLean study, Dr. Zanarini's team notes, also suggest that remissions are âfar more common than the good psychosocial functioning needed to achieve a good global outcome.â
"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.ââ