Long-Term Outcomes Are Mixed for Patients with Borderline Personality Disorder

Many clinicians consider a diagnosis of borderline personality disorder (BPD) to inevitably confer a bleak lifelong outlook. Realistic prognostications based on prospective research should help patients, families, and clinicians in long-term planning. This long-term study enrolled 290 patients with BPD and 72 comparison subjects with other axis II disorders, all initially encountered during an index hospitalization (see JW Psychiatry May 10 2010 and Mar 20 2003).

Assessments occurred every 2 years in eight follow-up waves. Remission was defined as not meeting diagnostic criteria for BPD or another personality disorder for at least 2 years. Recovery was defined as a Global Assessment of Functioning Scale score of 61 or higher (typically, remission, an emotionally sustaining relationship, and the ability to work or go to school full-time, consistently, and competently).

At 16-year follow-up, 99% of BPD patients had experienced a remission lasting 2 years; 78% had a remission lasting 8 years. Recurrence was noted in 36% of BPD patients achieving a 2-year remission and in 10% of those with an 8-year remission. Sixty percent had recoveries lasting 2 years, and 40% had recoveries lasting 8 years. BPD patients were significantly slower to achieve remission and recovery, and their rates were lower than those of comparison subjects.