Prediction of the 10-Year Course of Borderline Personality Disorder

Harvard University, Cambridge, Massachusetts, United States
American Journal of Psychiatry (Impact Factor: 12.3). 06/2006; 163(5):827-32. DOI: 10.1176/appi.ajp.163.5.827
Source: PubMed


The purpose of this study was to determine the most clinically relevant baseline predictors of time to remission for patients with borderline personality disorder.
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.
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.
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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    • "Mejorías modestas en funcionamiento social. Zanarini y colaboradores (2006) Seguimiento de 10 años a pacientes (n= 290) con TPL. 88% lograron remisión total del trastorno. "
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    ABSTRACT: ABSTRACT: Prior to the 1980s there was a general belief that patients with Borderline Personality Disorders (BPD) could not show recovery from their disorder. For various decades there was a therapeutic pessimism regarding their prognosis. Nevertheless, those opinions were not based on longitudinal studies. In the last 30 years a diverse group of researchers have published the results of several longitudinal studies, which show that patients with Personality Disorders in general demonstrate marked favorable changes in their clinical profile. When persons with BPD are included in prolonged follow-ups, the results show that more than 50% demonstrate a marked recovery from their disorder. Nevertheless, it seems that there are some personality traits that are more recalcitrant to show changes and adjustments. In this article we review recent longitudinal data and make some therapeutic recommendations. RESUMEN: Anterior a la década de los 1980s se mantenía una creencia general que postulaba que los pacientes con Trastornos de Personalidad Limítrofe (TPL) difícilmente se podrían recuperar de su diagnóstico clínico. Por varias décadas reinó un pesimismo terapéutico respecto a un mejor pronóstico. Sin embargo, dichas opiniones no se basaban en estudios longitudinales. En los últimos 30 años ya han salido a relucir los resultados de varios estudios longitudinales, los cuales revelan que los Trastornos de Personalidad (TP) en general son mucho más maleables e inestables de lo que se suponía. Cuando se estudia el TPL de manera específica, tenemos que en seguimientos de 10 años, más de la mitad han mantenido una recuperación sostenida. Sin embargo, tal parece que algunos de los rasgos de personalidad son más resistentes al cambio. En este artículo se realiza una revisión detallada de dichos hallazgos y se plantean recomendaciones sobre el manejo clínico de estos pacientes. PALABRAS CLAVE: Trastorno de personalidad limítrofe, estudios longitudinales, psicopatología.
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    • "In conclusion, despite reports of low temporal stability of BPD in adolescents (Zanarini, Frankenburg, Hennen, Reich, et al., 2006) it has been evidenced that dysfunctional areas of borderline personality disorder (like identity disturbance, affective instability, relational difficulties, impulsivity) could represent a clinical core which is relevant for an accurate diagnosis (Miller et al., 2008). In this realm, the IPOP-A seems to be a promising tool in the assessment of those personality dimensions during adolescence. "
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    • "The main characteristic of BPD, is a comprehensive model of instability in the interpersonal relations, self-concept, emotions and impulsiveness which has been commenced from the early adultness and appeared in the different context (DSM IV-TR, 2000). Among all the personality disorder, BPD has lower stability during the time and in many studies of short-term and long-term a high rate of improvement has been reported (Zanarini et al, 2006). It doesn't seem that this improvement rate is affected by major depression disorder, whilst depression improvement rate when has pathologic concomitant to BPD, is reduced extremely (Gunderson et al, 2004). "
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