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Author Topic: Prediction of the 10-Year Course of BPD - Mary C. Zanarini, Ed.D.,  (Read 5160 times)
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« on: May 29, 2006, 07:21:31 PM »

Am J Psychiatry 163:827-832, May 2006

doi: 10.1176/appi.ajp.163.5.827

© 2006 American Psychiatric Association

Prediction of the 10-Year Course of Borderline Personality Disorder

Mary C. Zanarini, Ed.D., Frances R. Frankenburg, M.D., John Hennen, Ph.D., D. Bradford Reich, M.D., and Kenneth R. Silk, M.D.

OBJECTIVE: The purpose of this study was to determine the most clinically relevant baseline predictors of time to remission for patients with borderline personality disorder.

METHOD: A total of 290 inpatients meeting criteria for both the Revised Diagnostic Interview for Borderlines and DSM-III-R for borderline personality disorder were assessed during their index admission with a series of semistructured interviews and self-report measures. Diagnostic status was reassessed at five contiguous 2-year time periods. Discrete survival analytic methods, which controlled for baseline severity of borderline psychopathology and time, were used to estimate hazard ratios.

RESULTS: Eighty-eight percent of the patients with borderline personality disorder studied achieved remission. In terms of time to remission, 39.3% of the 242 patients who experienced a remission of their disorder first remitted by their 2-year follow-up, an additional 22.3% first remitted by their 4-year follow-up, an additional 21.9% by their 6-year follow-up, an additional 12.8% by their 8-year follow-up, and another 3.7% by their 10-year follow-up. Sixteen variables were found to be significant bivariate predictors of earlier time to remission. Seven of these remained significant in multivariate analyses: younger age, absence of childhood sexual abuse, no family history of substance use disorder, good vocational record, absence of an anxious cluster personality disorder, low neuroticism, and high agreeableness.

CONCLUSIONS: The results of this study suggest that prediction of time to remission from borderline personality disorder is multifactorial in nature, involving factors that are routinely assessed in clinical practice and factors, particularly aspects of temperament, that are not.



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« Reply #1 on: April 16, 2010, 10:27:02 AM »

Am J Psychiatry Published April 15, 2010

doi: 10.1176/appi.ajp.2009.09081130

© 2010 American Psychiatric Association

Time to Attainment of Recovery From Borderline Personality Disorder and Stability of Recovery: A 10-year Prospective Follow-Up Study

Mary C. Zanarini, Ed.D., Frances R. Frankenburg, M.D., D. Bradford Reich, M.D., and Garrett Fitzmaurice, Sc.D.

Objective: The purposes of this study were to determine time to attainment of recovery from borderline personality disorder and to assess the stability of recovery.

Method: A total of 290 inpatients who met both DSM-III-R and Revised Diagnostic Interview for Borderlines criteria for borderline personality disorder were assessed during their index admission using a series of semistructured interviews and self-report measures. The same instruments were readministered every 2 years for 10 years.

Results: Over the study period, 50% of participants achieved recovery from borderline personality disorder, which was defined as remission of symptoms and having good social and vocational functioning during the previous 2 years. Overall, 93% of participants attained a remission of symptoms lasting at least 2 years, and 86% attained a sustained remission lasting at least 4 years. Of those who achieved recovery, 34% lost their recovery. Of those who achieved a 2-year remission of symptoms, 30% had a symptomatic recurrence, and of those who achieved a sustained remission, only 15% experienced a recurrence.

Conclusions: Taken together, the results of this study suggest that recovery from borderline personality disorder, with both symptomatic remission and good psychosocial functioning, seems difficult for many patients to attain. The results also suggest that once attained, such a recovery is relatively stable over time.
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« Reply #2 on: April 21, 2010, 07:06:29 AM »

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, “A new study offers hope that recovery, although challenging, can be long-lasting.” The LA Times article continues, “The 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.” See www.latimesblogs.latimes.com/booster_shots/2010/04/borderline-personality-disorder-recovery.html for the whole article. A Medscape article had a different slant. “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 person0ality disorder. The patients were overwhelmingly female and white; the mean age was 27. These were lower-functioning, “conventional” 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 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.” 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 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)–funded McLean Study of Adult Development, which found ‘steady, if modest, overall improvement over six 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 two 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.’”
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« Reply #3 on: April 21, 2010, 07:48:14 AM »

Well, it's interesting to see Mary Zanarini's  distinction in the use of the terms recovery and remission.

Extended Recovery=remission of symptoms and having good social and vocational functioning during the previous 4 years.

Recovery=remission of symptoms and having good social and vocational functioning during the previous 2 years.

Remission=remission of symptoms
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« Reply #4 on: April 21, 2010, 10:05:16 AM »

Well, it's interesting to see Mary Zanarini's  distinction in the use of the terms recovery and remission.

Extended Recovery=remission of symptoms and having good social and vocational functioning during the previous 4 years.

Recovery=remission of symptoms and having good social and vocational functioning during the previous 2 years.

Remission=remission of symptoms

   Interesting...

So my H would be in "recovery" and odds are good he will stay there, headed to "extended recovery".

Any idea what treatments were used to get there?

I wonder what studies of older folks might look like? And men?  In my Hs case, he was always very high functioning, had no other mental illness issues or addictions and Ive felt that was always a big asset to his recovery.
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« Reply #5 on: April 21, 2010, 10:24:54 AM »

I had the same questions as Steph. I'm assuming these patients were under some type of treatment or they wouldn't be able to get the data on them for the study? Am curious as to whether they all were under treatment and what type of treatment was used.

Thanks Skip and Randi for posting the info. Interesting!
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« Reply #6 on: April 22, 2010, 04:16:47 PM »

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 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.)

www.borderlinepersonalitydisorder.com/audio-pres.shtml

Scroll down to:

  Ten-year Course: Longitudinal Study

  Mary Zanarini, EdD

She specifically discusses this aspect in this conference presentation, this is roughly what I remember she said: The adherence to the study was exceptional and quite possibly higher than for normal or any other mental illness. Patients got even upset when they did not get their follow-up call in time and called in.

I think we must never underestimate the attachment of a BPD sufferer once it is formed. I remember also have heard that marriages tend to last longer with BPD than between healthy people. They may marry less often but once they do it endures - for better or worse... .

While not all results where in at that time the conference was a lot of data was almost there and I suspect it is worth listening for anyone interested in this study and at little time.
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« Reply #7 on: May 01, 2010, 12:42:01 AM »

I'm not a professional in the field but I've been informally studying it (BPD) for five years and been married to one for twentyfour years. I've seen various others with differing manifestations of it all in the same family. My perspective is that the root cause is so deep that remission is not an appropriate term. Either it gets cured or it isn't. I liken it to a flaw in the basic operating system of the mind (faulty logic code installed during initial programming). Humans are extremely adaptable and can find creative workarounds and/or ways to mask it but the flaw will resurface unless it is truly overwritten. Behavior modification therapy may manage the expression of symptoms but a truly sound sense of self is the ultimate cure. The real problem is that there are a lot of well-built defence mechanisms to get past in order to reprogram code in the deepest level if the operating system.
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« Reply #8 on: May 01, 2010, 12:50:25 AM »

Oh, and I would like to add that I suspect hypnosis (an uncluttered encounter with self as I like to call it) may offer a route to this deepest level if the mind's operating system.
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« Reply #9 on: May 01, 2010, 10:55:29 AM »

These results are very encouraging and a relief.  My impression from past reading was that the prognosis is very dim in most cases.

On the personal side, this gives me a little more optimism that things could turn to the positive for stbxw and her sons.  Also a little relief that maybe my current battles, exposure of her, and discussions with her sons' father won't necessarily have only negative consequences for her.

From my own experience with FOO, I think vast improvement is possible, whether remission or recovery.
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« Reply #10 on: May 01, 2010, 01:30:26 PM »

Thank you for posting the information about the new study, Skip.  I've read lit reviews covering hundreds of studies and this is the first one I recall that dealt with social and vocational functioning, as opposed to merely failure to meet the criteria for the dx.
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« Reply #11 on: May 05, 2010, 06:10:58 AM »

But these are BPD's who are in treatment... from my 20 odd year experience with my BPD mum, it's very difficult to get them to admit anything is wrong and the need for any treatment. What are the odds of someone in denial recovering just miraculously? Is it zero? And how do you get them into treatment?
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« Reply #12 on: May 08, 2010, 09:26:21 AM »

Hi everyone!

I'm new to this particular forum and still have to send my introduction but I have the same question as "Neverending" except it applies to my uBPDH of nearly 22 years.  Forever I've felt like there is no hope... .and almost automatically find myself predicting the answer to this question.  The timing and this article gives me hope Smiling (click to insert in post)   I'm returning to the on-line support group after a couple of years of going totally NC with my H after separating and also disengaging w/my www-page-not-found-net group since 2007.  Clearly "I'm back" which means I'm seeking help again. 
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« Reply #13 on: June 04, 2010, 07:23:56 PM »

Excerpt
I liken it to a flaw in the basic operating system of the mind (faulty logic code installed during initial programming). Humans are extremely adaptable and can find creative workarounds and/or ways to mask it but the flaw will resurface unless it is truly overwritten.

Love this. Overwriting takes time and effort, but is possible. I'm watching it happen with my daughter, as she has gone through DBT and CBT and worked to get her meds on-line. Fascinating, and I wonder if I had been able to watch myself recover (in the 80s) would I have seen similar changes.

Excerpt
In my Hs case, he was always very high functioning, had no other mental illness issues or addictions and Ive felt that was always a big asset to his recovery.

 

I agree. The BPDs I know (including my BPD sister) who I'm pretty sure will never get real help share this- there are significant comorbidities, particularly addiction. I'm on the fence about high vs low functioning... .could be associated, ironically enough, with a more intransigent denial.

vivgood
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« Reply #14 on: February 16, 2011, 07:39:52 AM »

intransigent denial ?

What exactly do you mean by that ?
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« Reply #15 on: February 16, 2011, 12:18:37 PM »

in·tran·si·gent also in·tran·si·geant (n-trns-jnt, -z-)

adj.

Refusing to moderate a position, especially an extreme position; uncompromising.

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« Reply #16 on: February 23, 2011, 06:58:02 PM »

thank you lbjnltx!

By which i mean that someone who is high functioning (working, able to socialize normally, unaddicted) may find it easier to believe that they are not affected by mental illness, whereas someone who is low functioning has "proof" of their dysfunction staring them in the face (homeless, jobless, etc). 


vivgood
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« Reply #17 on: July 09, 2015, 06:37:34 PM »

I believe the hater phase is inevitable, even if you learned all the boundary making and the BPD got all the DBT in the world, it would only delay doomsday
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« Reply #18 on: July 09, 2015, 07:15:27 PM »

I agree 100%.  I find all of the boundary-making and validation approaches to just sound ridiculous and ultimately inconsequential (at best).  I will admit though that I never had the opportunity to employ these approaches because I didn't discover them until I went NC.  And as far as DBT goes, I can say that my ex was doing it and she was eager to get better, but it was absolutely no match for the BPD hard-wiring in her brain.      
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« Reply #19 on: July 09, 2015, 07:19:51 PM »

When we have lost a SO, it is understandable to be angry, hurt, and believe that the breakup was inevitable. However, the research shows that DBT and other forms of therapy can be effective. Can you help me to understand your generalizations here and why you disagree with the research?
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« Reply #20 on: July 09, 2015, 07:25:46 PM »

Thank you for your hard work on these forums.

As for your question, it's exactly that. Personal hurt and a recent one at that. As I am learning more and more about BPD, that hurt is slowly turning into compassion and sympathy. As for the research, I was really surprised myself to see the remission rate was something like 80% (right? I think I read it in I hate you -- don't leave me). I really do wish the best mental and physical health for every living creature on this planet. It's just that from my one run-in with a pwBPD, it's left lots of pain
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« Reply #21 on: July 09, 2015, 07:43:53 PM »

Thanks. I appreciate your reply, and I am sorry for your pain. What factors might contribute to high remission rates?
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« Reply #22 on: July 09, 2015, 07:46:45 PM »

I haven't seen any research that would dissuade me from agreeing entirely with rotiroti's conclusion (that DBT "would only delay doomsday", but I would be appreciative to be pointed to any such persuasive research.
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« Reply #23 on: July 09, 2015, 07:51:56 PM »

The study referred in the book said age was a factor. For whatever reason they saw a huge remission with age. Some suspect hormonal changes (ie menopause) or some unknown process where the BPD 'grows' out of it. I thought it was interesting

and thanks Mike-X! Being on here definitely helps process the hurt. I'm having a particular good day today. I was able to look through some holiday pictures with the ex and not have an anxiety attack

woowoo
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« Reply #24 on: July 09, 2015, 08:05:16 PM »

Thanks. I appreciate your reply, and I am sorry for your pain. What factors might contribute to high remission rates?

The study referred in the book said age was a factor. For whatever reason they saw a huge remission with age. Some suspect hormonal changes (ie menopause) or some unknown process where the BPD 'grows' out of it. I thought it was interesting

and thanks Mike-X! Being on here definitely helps process the hurt. I'm having a particular good day today. I was able to look through some holiday pictures with the ex and not have an anxiety attack

woowoo

It is good to hear that you are having a good day and benefiting from the site!

Although I have not read the particular study, there are often an host of factors that potentially affect therapeutic success and remission rates. Compliance is typically an issue and an issue with keeping people with BPD in therapy. Remember, accepting that there is an issue and help is need often is a know problem for pwBPD (anosognosia). I can imagine that continued compliance with practicing the techniques would be an issue affecting remission rates. Another thing might be severity of the symptoms, the measurement of initial treatment success, and the measurement of remission. These are just a few things that come to mind off hand.  

Here is an article on treatment for BPD with references for supporting studies, if you haven't read it:

https://bpdfamily.com/content/treatment-borderline-personality-disorder

As for your question, it's exactly that. Personal hurt and a recent one at that. As I am learning more and more about BPD, that hurt is slowly turning into compassion and sympathy. As for the research, I was really surprised myself to see the remission rate was something like 80% (right? I think I read it in I hate you -- don't leave me). I really do wish the best mental and physical health for every living creature on this planet. It's just that from my one run-in with a pwBPD, it's left lots of pain

Maybe I have misread/misunderstood what you posted here, and I am sorry if I did. By remission, is the book saying that they remitted back to meeting criteria for BPD or that their BPD symptoms remitted and to where they no longer met criteria?  As stated in the links that I posted, the McLean Study found that 40% of patients with borderline personality disorder remit (no longer met criteria for BPD) after 2 years, with 88% no longer meeting the criteria after 10 years.

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« Reply #25 on: July 09, 2015, 08:39:01 PM »

Here is an abstract from part of the McLean study showing evidence of successful treatment and also additional factors related to treatment success. Note that this was an inpatient group, too.

American Journal of Psychiatry. 2006 May;163(5):827-32.

Prediction of the 10-year course of borderline personality disorder.

Zanarini MC1, Frankenburg FR, Hennen J, Reich DB, Silk KR.

OBJECTIVE:

The purpose of this study was to determine the most clinically relevant baseline predictors of time to remission for patients with borderline personality disorder.

METHOD:

A total of 290 inpatients meeting criteria for both the Revised Diagnostic Interview for Borderlines and DSM-III-R for borderline personality disorder were assessed during their index admission with a series of semistructured interviews and self-report measures. Diagnostic status was reassessed at five contiguous 2-year time periods. Discrete survival analytic methods, which controlled for baseline severity of borderline psychopathology and time, were used to estimate hazard ratios.

RESULTS:

Eighty-eight percent of the patients with borderline personality disorder studied achieved remission. In terms of time to remission, 39.3% of the 242 patients who experienced a remission of their disorder first remitted by their 2-year follow-up, an additional 22.3% first remitted by their 4-year follow-up, an additional 21.9% by their 6-year follow-up, an additional 12.8% by their 8-year follow-up, and another 3.7% by their 10-year follow-up. Sixteen variables were found to be significant bivariate predictors of earlier time to remission. Seven of these remained significant in multivariate analyses: younger age, absence of childhood sexual abuse, no family history of substance use disorder, good vocational record, absence of an anxious cluster personality disorder, low neuroticism, and high agreeableness.

CONCLUSIONS:

The results of this study suggest that prediction of time to remission from borderline personality disorder is multifactorial in nature, involving factors that are routinely assessed in clinical practice and factors, particularly aspects of temperament, that are not.
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« Reply #26 on: July 09, 2015, 08:46:38 PM »

Here is an article on treatment for BPD with references for supporting studies, if you haven't read it:

https://bpdfamily.com/content/treatment-borderline-personality-disorder

Thanks.  I have probably read this before.  I just read it now anyhow.  I would like to read the articles cited in footnotes 1 and 2 but they are not available for free (as far as I can tell, thanks for posting the abstract for footnote 1 though).  To put it mildly, I am very skeptical of the ability to capture an effective methodology to accurately determine the strength of one's BPD.  As an additional concern, I do wonder how an appropriate sample of people is selected.  I'm not intentionally trying to be difficult here; I'm just trying to think about this objectively in an effort to reach an understanding that seems realistic to me based on my knowledge of the disorder.
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« Reply #27 on: July 09, 2015, 09:02:45 PM »

Here is an article on treatment for BPD with references for supporting studies, if you haven't read it:

https://bpdfamily.com/content/treatment-borderline-personality-disorder

Thanks.  I have probably read this before.  I just read it now anyhow.  I would like to read the articles cited in footnotes 1 and 2 but they are not available for free (as far as I can tell, thanks for posting the abstract for footnote 1 though).  To put it mildly, I am very skeptical of the ability to capture an effective methodology to accurately determine the strength of one's BPD.  As an additional concern, I do wonder how an appropriate sample of people is selected.  I'm not intentionally trying to be difficult here; I'm just trying to think about this objectively in an effort to reach an understanding that seems realistic to me based on my knowledge of the disorder.

You're welcome. I feel like I am constantly learning new things when I re-read the articles available on here.

Sometimes the authors (or others make them available), or if they are funded by government agencies like NIH, various forms might be available through pubmed.

Zanarini study: www.sjsu.edu/people/phyllis.connolly/courses/c16/s1/Zanarini2006DBT827.pdf

another treatment study: www.wesscholar.wesleyan.edu/cgi/viewcontent.cgi?article=1148&context=div3facpubs

A quick search didn't reveal free copies of the Amarine or Grillo studies, but they might be out there.
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rotiroti
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Gender: Male
What is your sexual orientation: Straight
Who in your life has "personality" issues: Ex-romantic partner
Posts: 758



« Reply #28 on: July 09, 2015, 10:36:58 PM »

As for your question, it's exactly that. Personal hurt and a recent one at that. As I am learning more and more about BPD, that hurt is slowly turning into compassion and sympathy. As for the research, I was really surprised myself to see the remission rate was something like 80% (right? I think I read it in I hate you -- don't leave me). I really do wish the best mental and physical health for every living creature on this planet. It's just that from my one run-in with a pwBPD, it's left lots of pain

Maybe I have misread/misunderstood what you posted here, and I am sorry if I did. By remission, is the book saying that they remitted back to meeting criteria for BPD or that their BPD symptoms remitted and to where they no longer met criteria?  As stated in the links that I posted, the McLean Study found that 40% of patients with borderline personality disorder remit (no longer met criteria for BPD) after 2 years, with 88% no longer meeting the criteria after 10 years.

Hey Mike, it was remission as in they no longer met the criteria. It was 80% something, it must be the 88% you are referring to!

I'm not sure which book it was, it was either Stop Walking on Eggshells (the newest edition) or from I hate you -- Don't Leave me 2011 edition
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Tim300
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Who in your life has "personality" issues: Ex-romantic partner
Posts: 557


« Reply #29 on: July 09, 2015, 10:41:09 PM »

Here is an article on treatment for BPD with references for supporting studies, if you haven't read it:

https://bpdfamily.com/content/treatment-borderline-personality-disorder

Thanks.  I have probably read this before.  I just read it now anyhow.  I would like to read the articles cited in footnotes 1 and 2 but they are not available for free (as far as I can tell, thanks for posting the abstract for footnote 1 though).  To put it mildly, I am very skeptical of the ability to capture an effective methodology to accurately determine the strength of one's BPD.  As an additional concern, I do wonder how an appropriate sample of people is selected.  I'm not intentionally trying to be difficult here; I'm just trying to think about this objectively in an effort to reach an understanding that seems realistic to me based on my knowledge of the disorder.

You're welcome. I feel like I am constantly learning new things when I re-read the articles available on here.

Sometimes the authors (or others make them available), or if they are funded by government agencies like NIH, various forms might be available through pubmed.

Zanarini study: www.sjsu.edu/people/phyllis.connolly/courses/c16/s1/Zanarini2006DBT827.pdf

another treatment study: www.wesscholar.wesleyan.edu/cgi/viewcontent.cgi?article=1148&context=div3facpubs

A quick search didn't reveal free copies of the Amarine or Grillo studies, but they might be out there.

Thanks.  I just read both of the studies you posted.  I do not find them persuasive in refuting rotiroti's conclusion (that DBT "would only delay doomsday".

I will start with the Wesleyan study, because it's more thorough.  The study does not seem to specify what type of treatment the BPD patients were receiving, noting only that the patients were observed in urban clinical settings.  The study concludes that after 10 years, 85% of patients showed signs of remission using their "12-month definition" (it wasn't entirely clear what this 12-month definition meant).  "Remission" was defined as meeting 2 fewer DSM criteria for BPD.  Only 111 patients were observed through the end, because 37% of the patients dropped out.  Off the bat, this doesn't look great.  It appears that 176 patients started the program, and after 10 years of access to clinical treatment, only 94 patients (that is, 53% of patients, a number the cheerleading researchers didn't mention) ultimately made it through and showed a remission of just 2 traits of BPD.  Presumably, at least a handful of these 94 patients still met enough of the criteria to be diagnosed with BPD, which means that this study's boastful 85% rate is really equal to a rate of <50% for remission of BPD.  Ten years of clinical access and fewer than 50 percent might have significantly improved -- wow, that's not promising.  But the numbers are likely even worse -- as the study has several shortcomings.  Among other shortcomings, the study seems to have relied on 8 interviews of each patient over the 10-year stretch.  As we all know, BPD is a mood disorder and pwBPD cycle through times of stability and instability.  Certainly, a snapshot interview of someone with BPD seems like a difficult way to gather much info.  No outside informants were included as part of the study.  Also worth noting, the study found that only a third of the patients had full-time jobs at the 10-year mark (this % might have been significantly lower had the study's dropouts been included).  Finally, the study conceded that part of the explanation for the remission might simply have been that the patients were in life circumstances with "less stress" -- without noting whether any patients had managed to maintain a successful intimate, romantic relationship.  So what to make of this study?  I don't know.  The study seems useless to me at best --- and downright dismal at worst.  Note that this is a relatively recent study (2011) yet it claims to be 1 of only 2 ten-year studies on possible BPD remission (so apparently there's not a great supply of more-persuasive sources on this subject).  The other 10-year article cited was published in 2010.

     

Next, the American Journal of Psychiatry study.  First, the stated objective of this study was to identify factors that predict remission of BPD; so, these researchers had apparently already reached their conclusion at the outset that BPD remits -- this is interesting given that when the article was published in 2006, no 10-year studies had yet ever been published to try to establish this (in fact, the title of the article is "Prediction of the 10-year Course of Borderline Personality Disorder".  At least these researchers seemed to define "remission" as no longer meeting the DSM criteria for having BPD (as opposed to defining remission as simply having 2 fewer observable BPD traits).  There is not as much detail provided with this study (as in the Wesleyan study), but the fact that it relied exclusively on "a series of semistructured interviews and self-report measures" to determine remissions, leaves much to be desired.  The researchers didn't romantically date the patients, they didn't hang out with the patients on any regular basis, they didn't spend holidays with the patients, they didn't conduct interviews of the patients' friends, family members, or lovers.  Accordingly, I'm not persuaded.  As so many stories on here make clear, sometimes you literally have to full-on date a pwBPD for 6 months or more to see the traits manifest themselves.  To rely on a combination of interviews of the patients and self-reporting for a 2-year stretch?  When people with BPD are widely known to have difficulty presenting the truth.  Give me a break.        

     
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