Stop Walking on Eggshells

When someone in your life has borderline or narcissistic personality disorder

The Good News and Bad News About BPD Treatment

A 10-year study of borderline patients offers mixed results

A study about treatment of BPD was published online in the American Journal of Psychiatry on April 15, 2010. The LA Times and Medscape Psychiatry published articles about the study, which I have summarized below.

First, the facts:

Mary C. Zanarini, EdD, of McLean Hospital, Belmont, Massachusetts, and colleagues 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 (probably suicidal ideation and self-mutilation; I was not able to read the study itself) 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" (well, at least for two to four years).

The LA Times article, titled, "Study shows long-term success in recovery from borderline personality disorder," 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."

The Medscape article had a different slant. It said (with my edits):

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"Recovery from borderline personality disorder, which includes symptom remission and good psychosocial functioning, seems difficult for most patients to attain. However, once attained, such a recovery is relatively stable over time."

The patients were overwhelmingly female and white; the mean age was 27. Obviously, these were the very low-functioning, "conventional" BPs interested in working in treatment (perhaps even more so that other of the "conventional" type).

At the beginning of treatment, the researchers obtained a baseline measurement. They did this using 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).

The mean score 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.

Very few people left treatment. 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 lower than average. According to Joel Paris, M.D., because of their impulsivity, about two thirds of borderline patients drop out of treatment within a few months. My own guess would be that these patients were either more highly motivated at the beginning of treatment, or perhaps simply participating in the study was reinforcing or motivating.

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. Remember, the baseline was about 39).

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.

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." 

This study, as well as the NIHM-funded study, "The Collaborative Longitudinal Personality Disorders Study," suggests that patients with borderline personality disorder do get better with time, but they don't get all better, and not every patient gets better. Still, these studies offer hope and refute the myth that borderline disorder is incurable.

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."

The researchers say, "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."

 

Randi Kreger
Author, "The Essential Family Guide to Borderline Personality Disorder: New Tools and Techniques to Stop Walking on Eggshells"
Available at www.BPDCentral.com

 

Randi Kreger is the co-author of Stop Walking on Eggshells.

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