Prediction of the 10-Year Course of BPD - Mary C. Zanarini, Ed.D.,

[Skippy]

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.

[Skip]

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.

[Randi Kreger]

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.’”

[Skip]

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

[Steph]

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.

[committed]

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!

[an0ught]

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.

[shefiled]

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.

[shefiled]

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.

[kj1234]

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.

[Desert]

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.

[neverending]

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?

[escapefromoz2]

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    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. 

[Vivgood]

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.

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

[NeilWiste]

intransigent denial ?

What exactly do you mean by that ?

[lbjnltx]

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

adj.

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

[Vivgood]

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

[rotiroti]

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

[Tim300]

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.      

[Mike-X]

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?

[rotiroti]

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

[Mike-X]

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

[Tim300]

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.

[rotiroti]

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

[Mike-X]

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.

[Mike-X]

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.

[Tim300]

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.

[Mike-X]

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.

[rotiroti]

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

[Tim300]

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.        

     

[blissful_camper]

I found it challenging to discuss the r/s on a deeper level with my ex. I couldn't stop the hater phase. I became a trigger. Being a trigger didn't reinforce his sense of wellness or mine.  The healthy option for us both was ending the r/s.

It seems natural to ask the question, "why didn't I leave sooner?"  I feel that I didn't exit earlier because I had neglected to put into motion my own inner work. I appreciate the r/s for pointing me in that direction.

[Tim300]

I became a trigger. Being a trigger didn't reinforce his sense of wellness or mine.  The healthy option for us both was ending the r/s.

I think this is one of the most important aspects of BPD awareness -- recognition that being in a close relationship with a pwBPD is not helping the pwBPD.  It might briefly be helpful for the pwBPD (and the pwBPD will certainly beg for it), but in due course you'll become a crippling trigger . . .

[Skip]

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 think this is one of the most important aspects of BPD awareness -- recognition that being in a close relationship with a pwBPD is not helping the pwBPD.  It might briefly be helpful for the pwBPD (and the pwBPD will certainly beg for it), but in due course you'll become a crippling trigger . . .

I think the bigger question here is why are some of us obsessed with creating such a bleak image of BPD that we start attacking peer reviewed studies from Harvard of a protocol developed at the  University of Washington. Or that we need to openly declare treatment as ineffective. Or that we conclude that isolation (no close relationships) is helpful.

The first question I would ask is why is this rewarding to us? Researchers would say that it is to avoid personal responsibility.

Let's not do that.

Let's also keep matters in perspective - Face the Facts - if you will.

• Most of us did not have a relationship with a clinical borderline. We had relationships with subclinical borderlines or clinical and non-clinical bipolar, OCD, ACHD, addiction, etc.  This stuff largely presents the same way in failed relationships so we can help each other.

• The DSM describes BPD as a disorder of relationship instability - so, for the percent of our members with BPD-ex partners or subclinical BPD-ex partners, relationship instability is statistically likely. Its a given.

• A lot of us have our own bag of issues. Exiting the relationship and leaving the partner did not cure it.  Its important that we not become obsessed with blame shifting - if feels good - it perpetrates future failure. Its call co-rumination.

• Two things can happened when we pulled together a highly specialized group of people like we have on this board -  people who have recovered can reach back and help newer members with perspective and maturity to walk a path of recover (and everyone can be supportive) -  people with issues can band together and convince themselves that they have no issues.  Picking which pack you are in is the single most important decision you make here.

• The recovery statistics on BPD treatment are far higher than alcoholism, breast cancer at 10 years.  We all celebrate recovered alcoholic and breast cancer survivors. We should celebrate those that have battled back from BPD.

• Isolation is the single largest predictor of mental health failure.  Studies have show that those that have recovered from BPD had a trusted relationship - it may have been rocky - but it was important.  The same is true for us.  Having trusted relationships is extremely important part of our recovery.
  
  What is a trusted relationship?  Someone who cares, someone who is strong, someone who is mature enough to lead someone out of the "fog" of woundedness.  Everyone posting here, regardless of the number of posts, knows what this is first hand.

[Pretty Woman]

What I've heard is DBT is effective but it takes years of hard work... .like 8-10 years and getting a non-commital person to commit to that is not a very successful endeavor.

My ex BPD is 43. She knows something is horribly wrong with her. So she goes to "therapy" and convinces her therapist it's all me.

The therapist has no idea she could have BPD and enables her decision making thinking she is a rational person.

Getting a BPD into DBT is not an easy task.  BPD actually worsens if untreated. There is a lot of contradictory info out there that a woman can get "better" and outgrow BPD as they come into their late 30's-40's but one needs to realize... .there are many enviromental factors at play. My ex's entire family is f'd up. Even if she got treatment she is surrounded by un-supportive f'up people and many of these people are way over 40yrs of age!

There really is a low success rate overall.

[BorisAcusio]

• Isolation is the single largest predictor of mental health failure.  Studies have show that those that have recovered from BPD had a trusted relationship - it may have been rocky - but it was import.  The same is true for us.  Having trusted relationships is extremely important part of our recovery...
  
  What is a trusted relationship?  Someone who cares, someone who is strong, someone who is mature enough to lead someone out

Could you post a link to those studies?

[Loosestrife]

I agree with pretty woman the success rates for BpD recovery are abmissmal and the other addictions and illnesses you mentioned  have much higher success rates.

[Invictus01]

I agree with pretty woman the success rates for BpD recovery are abmissmal and the other addictions and illnesses you mentioned  have much higher success rates.

One more thing... .We are talking about treatment of personality disordered people who have committed to the treatment. According to psychologists, the vast majority of personality disordered people won't even go into an evaluation, let alone the treatment.

[Skip]

I agree with pretty woman the success rates for BpD recovery are abmissmal and the other addictions and illnesses you mentioned  have much higher success rates.

One more thing... .We are talking about treatment of personality disordered people who have committed to the treatment. According to psychologists, the vast majority of personality disordered people won't even go into an evaluation, let alone the treatment.

In answering this question, I don't want to dilute my point earlier that we should examine why it is so important to have these highly pessimistic beliefs. We don't loved ones with this disorder. We don't have loved ones in treatment.

Committed to the treatment You may want to read the study protocol. The only criteria was that these people were admitted to hospital - they were sick enough to do at least an overnighter.  Some were in structured treatment for some period. Some were in an out. Some took sophisticated treatment.  Some got local family therapist whatever.  Some got virtually nothing.

DBT is 8-10 year process It's not really the case. Most of the studies on DBT are on people with one year or less treatment year of treatment or less. DBT is often given as a course - 2.5 hour sessions, twice a week.

No other board has these beliefs. On the parenting board, virtually all the child (adult children) are diagnosed and there is a far more balanced perception of the recovery there.

The reality of impulse disorders is difficult enough with a balanced perspective - it doesn't help us to exaggerate.

Why it is so important to have these highly pessimistic beliefs?  

[Skip]

I agree with pretty woman the success rates for BpD recovery are abmissmal and the other addictions and illnesses you mentioned  have much higher success rates.

The equivalent study for alcoholism for people that had "any treatment" is

Alcoholism

Years ---------- 1-5 5-10 11-19

Abstain or Light Drinking ----------------------- 7.0% 31.5% 41.7%

2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, or NESARC

[LonelyChild]

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.

Hi Mike. I, as well, have heard of these success stories. But I have never seen them or heard of anyone who have seen them in first-person. I've asked many Ps and Ts. They all say the same - the prognosis is that the chance for change is close to non-existent.

I only see these small studies of novely therapy methods that claim high success, but the fact of the matter is that change seems to be incredibly rare for pwBPD.

To me, it seems that saying that there's big hope for change is giving false hope to people. What about the persons on here who have been married and given EVERYTHING to "fix" their BPD SO? Years of therapy, counseling, what have you, for each of them separately, together, etc, etc. Still no change.

I'm sure some pwBPD get well and I'm sure there are great therapy methods out there, but on the whole, it seems like only a couple in a hundred change for the better. And even then, the change seems to be just barely enough to hold together.

[Skip]

To me, it seems that saying that there's big hope for change is giving false hope to people.

You are hitting the nail on the head here.  Over the years, this has been the single most cited reason for member concern about optimism - our own personal feelings of failure or weakness.  

When we opened the staying board back in 2007, some members accused the staff of "condoning abuse". When we dug into it, the answers we got were about feelings of failure with a partner and fears of being the at fault in the relationship.

Its easier to accept that nothing more can be done.  We had a newbie post these exact words today. "I'm a wreck still, cant understand it. Did I mess up in my frustrated comment? Was I used? I just want to believe its mental illness and use that as closure."

This is OK stuff for a newbie - get through the crisis - thats why we don't have hard and fast rules.  But at some point, we can get carried away.  

Does your experience seem inconsistent with:?

40% of patients with borderline personality disorder remit after 2 years, with 88% no longer meeting the criteria after 10 years   And if you read the studies, the self harm, suicide, reckless behaviors tend to resolve earlier in the cycles and the interpersonal traumas later.  

I remember reading someone criticizing this (interpersonal traumas later.) - but that is a little self centered when we do - if we were the ones with BPD, we would be most concerns about the suicide, and self harm. Researchers too.  The suicide rates is what really go the ball rolling here.

The studies are not about the social issue of hope.  It proof of principal of a method.  Science stuff. The studies with depression followed the same model - CBT.  Those numbers are very encouraging. But neither are social statements,

But what about the social issues?  Should we be optimistic or pessimistic?

The anti-stigma people will argue that the more hope there is (less hysteria), the more likely people will get treated.  We have seen that with mental issues like bipolar, we saw it with physical issues like HIV/AIDS.  When the stigmas lifted, many more people got tested/treated.

Here (bpdfamily), we aren't encouraging any social agenda - our charter says we are not to advocate (positive or negative).  

We want to provide perspective.  A lot of it is sobering.

[Randi Kreger]

I agree with your point about personal responsibility and many parts of your post. However, when people quote studies about treatment like those below  

"I think the bigger question here is why are some of us obsessed with creating such a bleak image of BPD that we start attacking peer reviewed studies from Harvard of a protocol developed at the  University of Washington. Or that we need to openly declare treatment as ineffective. Or that we conclude that isolation (no close relationships) is helpful.

To conduct a study with subjects who have BPD, BPD must be narrowly defined to ensure consistently. Before subjects are considered for the study, they are evaluated specifically for self-harm and suicidal thoughts.

The studies in Washington are about DBT, of course. DBT has two goals: reduction of  self-harm and suicidal thoughts. The results show reduction in those two areas. This is critical because insurance companies will pay to prevent more costly ER visits. And of course, you can't help a patient who isn't alive.

So it's not quite so simple to say that treatment works, when some treatments work for some people who are qualified for the treatment because they fit the narrow definition of BPD.

It's also wrong and a simplification to say people with BPD are untreatable and will never be cured.

Whatever the mental disorder is, a person can be helped if they have access to the proper treatment, are willing to go and work hard, and are willing to stick with it for years.

In addition, you can call treatment "successful" when it meets the goals you have set up; in DBT this involves those two principal traits/ Kiera Van Gelder, one recovered woman who wrote a memoir, has discussed "when has treatment really worked" and some clinical seminars.

Do we count treatment successful when a person is no longer self-harming? When they feel better? When they don't need meds? When family members don't feel burdened. Right now all we can quantify are things like emergency room visits and inpatient stays for those two main traits.

I believe that most people who enter DBT do feel better, but statistics do not bear this out. Someone can no longer be classified as having BPD now if they only have four out of 9 traits. And the drop out rate is incredible, the treatment is expensive, and clients are urged more than once.

So I think people split about this and think in black and white. For families, I think that "better" mostly means that they can live with the person in a reasonably happy way without abuse and hopefully with some closeness.

In terms of why people on the board are pessimistic, I believe that:

1. It's so much easier to complain than learn tools and techniques.

2. The initial change must come from the family member

3. Learned helplessness

4. Comorbidity with substance abuse and narcissism. About 30% of all people with BPD have NPD or NPD traits.

I think that happiness can't depend on treatment when the person refuses to go.

[Tyrwhitt1]

My experience of 22 years with my exBPDh who's now almost 60 years old, spent years in therapy and on meds is that whatever the research, BPD doesn't change with age, and as for therapy, my exBPDh accepted he wanted to change and sought prof help.  I thought he was doing it for himself and us but it was to keep me there, hoping our marriage would stabilize.

He told the therapist exactly what he wanted her to hear, promised all sorts of behavioural changes then walked away and carried on.  You see, it's not only you a person with BPD mirrors, it's everyone. 

And yes, the hater phase was inevitable, and in that stage, you can't do anything except part. The rage increases and it can get dangerous.

[LonelyChild]

My experience of 22 years with my exBPDh who's now almost 60 years old, spent years in therapy and on meds is that whatever the research, BPD doesn't change with age, and as for therapy, my exBPDh accepted he wanted to change and sought prof help.  I thought he was doing it for himself and us but it was to keep me there, hoping our marriage would stabilize.

He told the therapist exactly what he wanted her to hear, promised all sorts of behavioural changes then walked away and carried on.  You see, it's not only you a person with BPD mirrors, it's everyone. 

And yes, the hater phase was inevitable, and in that stage, you can't do anything except part. The rage increases and it can get dangerous.

Having a uBPD father and uBPDxgf, I can only agree. It IS inevitable. They might stop the self-harm and suicide attempts, but they still do not function well in any kind of r/s, and reciprocity is literally impossible.

[Loosestrife]

I am appreciative of the honest and different opinions. I've met several Ps who say it the negative behaviours only ever get better for a short period of time and don't ever really settle down until the BpD person gets into their 50's... .

[LonelyChild]

I am appreciative of the honest and different opinions. I've met several Ps who say it the negative behaviours only ever get better for a short period of time and don't ever really settle down until the BpD person gets into their 50's... .

My dad calmed down somewhat in his 60's. The rages have actually stopped. He's still a wreck though. He's like an empty shell. He has no friends, his family don't really want contact with him, no interests, he can't sleep at night due to anxiety, he has no routine whatsoever, he doesn't know how to care for himself at all. He had 3 dogs and 2 cats (all are thankfully dead now). They all became mentally ill. Yes, I'm not kidding. Even his animals became crazy around him. The dogs lost extreme amounts of weight because of stress and we had to get rid of two (this was over 10 years ago). The last one, that he kept, was insane. He could come and cuddle with you, and when you cuddled back, he became super agressive. Dog form of push/pull. Even the cats couldn't relax and one died of some kind of heart attack. As I'm typing this, it sounds ridiculous, but I'm dead serious.

[BorisAcusio]

I am appreciative of the honest and different opinions. I've met several Ps who say it the negative behaviours only ever get better for a short period of time and don't ever really settle down until the BpD person gets into their 50's... .

My dad calmed down somewhat in his 60's. The rages have actually stopped. He's still a wreck though. He's like an empty shell. He has no friends, his family don't really want contact with him, no interests, he can't sleep at night due to anxiety, he has no routine whatsoever, he doesn't know how to care for himself at all. He had 3 dogs and 2 cats (all are thankfully dead now). They all became mentally ill. Yes, I'm not kidding. Even his animals became crazy around him. The dogs lost extreme amounts of weight because of stress and we had to get rid of two (this was over 10 years ago). The last one, that he kept, was insane. He could come and cuddle with you, and when you cuddled back, he became super agressive. Dog form of push/pull. Even the cats couldn't relax and one died of some kind of heart attack. As I'm typing this, it sounds ridiculous, but I'm dead serious.

I can relate to that as my father also mellowed out in his late 50s.  The extreme vicious rages paired verbal abuse halted and transformed into a child-like narcissistic regression, passive-aggression and dissociative detachment. My mother keeps him afloat but apart from that, almost completely isolated.

It took me a while to recognize why my ex's behaviour was so familiar.

[fromheeltoheal]

So what's the upside?  There's benefit in considering borderline behavior inevitable and treatment just a delay, or folks wouldn't do it.  The benefit is it makes it easier to let go of hope that the relationship could have worked or that it might work.  Going from a sliver of hope to no hope at all is a huge leap, and a painful one, but absolutely necessary for detachment, and in some sense the beginning of the real work.

And of course there's the piece that if it was them and it was inevitable then it wasn't me, so I don't need to feel guilty.  But that's secondary to letting go of that sliver of hope.

So whatever it takes.  If painting the borderline evil and doomed for a while helps us let go of that hope, then great, then on with the real work, addressing the challenges that show up once there's some time and distance, and once we do that, most likely our perceptions of our borderline exes will change too, some compassion might even show up.  It takes what it takes.

[LonelyChild]

So what's the upside?  There's benefit in considering borderline behavior inevitable and treatment just a delay, or folks wouldn't do it.  The benefit is it makes it easier to let go of hope that the relationship could have worked or that it might work.  Going from a sliver of hope to no hope at all is a huge leap, and a painful one, but absolutely necessary for detachment, and in some sense the beginning of the real work.

And of course there's the piece that if it was them and it was inevitable then it wasn't me, so I don't need to feel guilty.  But that's secondary to letting go of that sliver of hope.

So whatever it takes.  If painting the borderline evil and doomed for a while helps us let go of that hope, then great, then on with the real work, addressing the challenges that show up once there's some time and distance, and once we do that, most likely our perceptions of our borderline exes will change too, some compassion might even show up.  It takes what it takes.

What is a more reasonable position to take? That a reciprocal r/s with a pwBPD is possible if you're not codependet or such?

I mean, in the end, isn't this binary? Either the problem is on both ends of the r/s, which means that your BPD SO just happened to not work well with you in particular. OR, they are damaged goods and do not work well with anyone, in which case the position of "the pwBPD is the problem" is correct. This, of course, does not mean that us nons do not have any issues.

[Skip]

So what's the upside?  There's benefit in considering borderline behavior inevitable and treatment just a delay, or folks wouldn't do it.  The benefit is it makes it easier to let go of hope that the relationship could have worked or that it might work.  Going from a sliver of hope to no hope at all is a huge leap, and a painful one, but absolutely necessary for detachment, and in some sense the beginning of the real work.

You know, heal', this is precisely why a person with BPD paints their partner black. Rather than feel disappointed or vulnerable, its "cleaner" to just pile in on someone else.

Is this dysfunctional when a person with BPD paint us black but "absolutely necessary" when we do it...

[rotiroti]

So what's the upside?  There's benefit in considering borderline behavior inevitable and treatment just a delay, or folks wouldn't do it.  The benefit is it makes it easier to let go of hope that the relationship could have worked or that it might work.  Going from a sliver of hope to no hope at all is a huge leap, and a painful one, but absolutely necessary for detachment, and in some sense the beginning of the real work.

You know, heal', this is precisely why a person with BPD paints their partner black. Rather than feel disappointed or vulnerable, its "cleaner" to just pile in on someone else.

Is this dysfunctional when a person with BPD paint us black but "absolutely necessary" when we do it...

I think nons can make an informed decision to walk away while someone with BPD might not be able to.

[fromheeltoheal]

So what's the upside?  There's benefit in considering borderline behavior inevitable and treatment just a delay, or folks wouldn't do it.  The benefit is it makes it easier to let go of hope that the relationship could have worked or that it might work.  Going from a sliver of hope to no hope at all is a huge leap, and a painful one, but absolutely necessary for detachment, and in some sense the beginning of the real work.

You know, heal', this is precisely why a person with BPD paints their partner black. Rather than feel disappointed or vulnerable, its "cleaner" to just pile in on someone else.

Is this dysfunctional when a person with BPD paint us black but "absolutely necessary" when we do it...

Yep, "it's them not me" works both ways.  It's not 'absolutely necessary' though, it's an option, I used it and it worked for me, and then as we hopefully transition from dysfunctional to functional, perceptions change.  Whatever it takes, on the way to a healthier future.

[Skip]

Yep, "it's them not me" works both ways.  It's not 'absolutely necessary' though, it's an option, I used it and it worked for me, and then as we hopefully transition from dysfunctional to functional, perceptions change.  Whatever it takes, on the way to a healthier future.

This gets into the whole "emotional equals" discussion.  

Spiting is self deception.  A person with BPD does it because they can't handle reality.  So, it would say we can handle the reality any better. We can't cope can't better.

And a person with BPD doesn't typically concern themselves with changing this.  Many of us don't either.

Some will talk endlessly about their partners pitiful weakness - but we get defensive when it come to them doing the same thing.

Just a reality check.  

Something to reflect on.

which means that your BPD SO just happened to not work well with you in particular. OR, they are damaged goods and do not work well with anyone, in which case the position of "the pwBPD is the problem" is correct. This, of course, does not mean that us nons do not have any issues.

I think it is healthier to look at all breakups the first way and at the same time add in some of second. Get the balance that fits your ex accurately.

[myself]

Facing the facts = Some of it was them, some of it was us.

It's usually not 50/50 though. Disordered or not. Good, bad, whatever.

It's inevitable that balance helps with acceptance, which helps with balance... .

[LonelyChild]

Yep, "it's them not me" works both ways.  It's not 'absolutely necessary' though, it's an option, I used it and it worked for me, and then as we hopefully transition from dysfunctional to functional, perceptions change.  Whatever it takes, on the way to a healthier future.

This gets into the whole "emotional equals" discussion.  

Spiting is self deception.  A person with BPD does it because they can't handle reality.  So, it would say we can handle the reality any better. We can't cope can't better.

And a person with BPD doesn't typically concern themselves with changing this.  Many of us don't either.

Some will talk endlessly about their partners pitiful weakness - but we get defensive when it come to them doing the same thing.

Just a reality check.  

Something to reflect on.

which means that your BPD SO just happened to not work well with you in particular. OR, they are damaged goods and do not work well with anyone, in which case the position of "the pwBPD is the problem" is correct. This, of course, does not mean that us nons do not have any issues.

I think it is healthier to look at all breakups the first way and at the same time add in some of second. Get the balance that fits your ex accurately.

Either they work with some people - which means that you two just happened to not work out. Or they don't work out with anyone (in the long term) which automatically puts the blame on her. Because that means that even if you HAD done everything right, it still wouldn't have worked out. That's my take on it.

[antelope]

what exactly does remission mean?  does this mean that the most severe, impulsive behavior is quelled? 

they studied inpatients... .people who had reached a severe breaking point and had to be hospitalized... .what about the supposed 'quiet' borderlines, so steeped in denial and façade... .what does their 'remission' entail?

how is remission calculated?  by interview, like with recovering alcoholics?  I have worked in a few rehabs, and know first hand the lies a recovering addict will tell to make themselves 'look good'... .the same can be said for a BPD

as far as why their symptoms lessen with age? bridge burning and feelings of shame eventually drown their outward behavior, and they may become involved in other dysfunctional endeavors (hoarding, emotional or financial dependence on children, etc)

I'm not saying that BPD is a death sentence.  In fact, I def. believe that recovery, no matter how big or small, is possible... .

but studies, esp. psychological ones regarding aspects of temperament, personality, and character are extremely difficult to assess when the main instrument used is interview and questionnaire

[boatman]

Going from a sliver of hope to no hope at all is a huge leap, and a painful one, but absolutely necessary for detachment, and in some sense the beginning of the real work.

I absolutely agree. People do not change, they gain awareness of who they are. An alcoholic does not become a non-alcoholic, rather he/she becomes aware of what he/she is and chooses to change his/her behavior accordingly. Someone with BPD or BPD traits is not going to change and is quite likely NOT going to gain much awareness either.

In any situation one has three choices:

1) Surrender to the situation as it is.

2) Leave the situation.

3) Take action to change the situation.

It took two years for my last therapist to drill into my head that my parents with BPD traits are not attached to me and are not going to change and that my exBPDgf is not going to change. Letting go of the false, completely unrealistic hope that the people in my life will change, as heeltoheal said, was a huge painful leap. It IS however absolutely necessary and NOTHING like the abusive projecting/splitting that someone with BPD does.

One side note, I chose option #2. Maybe one day I will have the spiritual fortitude to employ option #1 but I am not there yet.

[Sunfl0wer]

I hope my comment is not in poor taste... .

There is one situation where the hater/painted black phase does not happen... .

If the non dies during the idealization phase, they will forever remain white.

The pwBPD can remain the perpetual victim through the loss of the r/s by death.

However, I cannot think of a more favorable circumstance for the non to not enter a black phase.

[myself]

^^ Could be painted black for dying on them... .Talk about abandonment.

[Sunfl0wer]

^^ Could be painted black for dying on them... .Talk about abandonment.

Holy Cow!

I'm having my first good belly laugh in a LONG time!

Hysterical!

I soo Needed that!

[FannyB]

but studies, esp. psychological ones regarding aspects of temperament, personality, and character are extremely difficult to assess when the main instrument used is interview and questionnaire

Antelope

I agree wholeheartedly with this assessment. I would love to see some corroborating evidence from the nons in their lives that the pwBPD in question is no longer a colossal p.i.t.a. to live with.  That would tip the argument for me!

Fanny

[arn131arn]

If I think about my ex getting help or wonder if this mental illness can be cured; I think about what my therapist told me the first day he saw me. He said, "we don't treat people with BPD; we treat their family members."

Coming from a guy who is very renowned in his field; I was taken back. It was almost like he hammered the nail in the coffin on this issue.

But being a football fan; I also look at Brandon Marshall, the best wide receiver in the NFL.  He openly admitted his diagnosis after some behavioral problems early in his career; and he has from what I've read, become a better person in dealing with it; and he is a role model for kids now and a model citizen.

But this is a guy who makes millions of dollars.  DBT isn't cheap; and I'm sure he has the absolute best tx options available to him.

It's hard for me to go back down this rabbit hole... .but great if this study is factual.