title: Plausibility and possible determinants of sudden "remissions" in borderline patients.
abstract: THIS STUDY documents dramatic improvements in patients with borderline personality disorder (BPD) and explores their possible determinants. From a sample of the 160 carefully diagnosed borderline patients on whom prospective follow-along data was collected, a subsample of 18 was identified whose DSM-IV criteria count fell to two or fewer during the course of the first 6 months of the study and retained that improvement for the next 6 months. Follow-along data including month-by-month ratings of BPD criteria; week-by-week ratings of Axis I disorders, medication changes, and life events were then used to establish concensus ratings on four hypothesized causes: Axis I remissions, situational change, misdiagnosis, and treatment effects. Follow-up data collected at 2 years was examined to see whether the improvements persisted. The results were that 18 BPD patients underwent dramatic improvements in the first 6 months. Only one had relapsed by 2 years. Though one was judged to have been misdiagnosed at baseline, the most important determinants were judged to be situational changes (n = 10) and remissions of co-occurring Axis I disorders (n = 7). In 10 patients treatment appeared to have facilitated these situational or Axis I resolutions. In conclusion, patients with BPD can make significant improvements that are rapid and of sufficient duration to be considered remissions. Determinants were identified that warrant further prospective evaluation.
authors.affiliation: McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Gunderson
authors.forename: Donna
authors.initials: D
authors.lastname: Bender
authors.forename: Charles
authors.initials: C
authors.lastname: Sanislow
authors.forename: Shirley
authors.initials: S
authors.lastname: Yen
authors.forename: Jennifer Bame
authors.initials: JB
authors.lastname: Rettew
authors.forename: Regina
authors.initials: R
authors.lastname: Dolan-Sewell
authors.forename: Ingrid
authors.initials: I
authors.lastname: Dyck
authors.forename: Leslie C
authors.initials: LC
authors.lastname: Morey
authors.forename: Thomas H
authors.initials: TH
authors.lastname: McGlashan
authors.forename: M Tracie
authors.initials: MT
authors.lastname: Shea
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Skodol
mesh_terms: D000293:Adolescent; D000328:Adult; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012075:Remission, Spontaneous; D013997:Time Factors; D016896:Treatment Outcome