Borderline personality disorder usually goes away over time, but patients can be left with lingering "scars" that continue to hold them back in life, according to a major study on the disorder published Monday.
Borderline personality disorder is a severe condition marked by chronic difficulties with mood and emotional control, relationships and self-image. Therapists often dislike treating such patients because they seem to defy treatment at times. "[A] firmly entrenched pessimism about the prognosis of patients with BPD has persisted," noted the authors of a new study, published in the Archives of General Psychiatry.
However, the study, a 10-year project conducted by some of the leading experts in borderline personality disorder in the United States, yielded some surprising findings. Researchers studied 111 patients with borderline personality disorder, 114 with obsessive-compulsive personality disorder and 62 with major depression for more than 10 years. All the patients had sought treatment for their problems. The study found 85% of the people with BPD experienced remission and only 12% of those patients relapsed. The relapse rate was lower than for either major depression or other personality disorders.
"What is evident appears clinically counterintuitive: Patients with BPD improve symptomatically more often, more quickly and more dramatically than expected and, once better, maintain improvements more enduring than for many other major psychiatric disorders," wrote the authors, led by Dr. John Gunderson of McLean Hospital and Harvard University.
However, many of the patients with BPD still had more dysfunction compared with people who had obsessive-compulsive personality disorder or major depression -- perhaps the result of having an illness that impeded development at some point in their lives. People with BPD, for example, were less likely to have full-time employment.
Treatments for BPD have improved as has the training of therapists in working with these patients. But future therapies should be devoted to helping people with BPD address functional impairment as they recover from their symptoms, the authors wrote.
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