title: Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years.
abstract: The purpose of this study was to determine the course of the psychosocial functioning of patients with borderline personality disorder (BPD) over 6 years of prospective follow-up. The psychosocial functioning of 290 patients meeting both DIB-R and DSM-III-R criteria for BPD and 72 patients meeting DSM-III-R criteria for another Axis II disorder (and neither criteria set for BPD) was assessed at baseline using a semistructured interview of demonstrated reliability. Over 94% of surviving patients were reinterviewed about their psychosocial functioning blind to all previously collected information at three distinct follow-up waves: 2-, 4-, and 6-year follow-up. The psychosocial functioning of borderline patients improved substantially over time, with the percentage meeting criteria for good overall psychosocial functioning increasing from 26% at baseline to 56% during the third wave of follow-up. Despite this improvement, borderline patients functioned significantly more poorly than Axis II comparison subjects, particularly in the area of vocational achievement. However, a more detailed examination revealed that borderline patients who had experienced a symptomatic remission during the course of the study functioned significantly better both socially and vocationally than never-remitted borderline patients. More specifically, they were significantly more likely to have a good relationship with a spouse/partner and at least one parent, good work/school performance, a sustained work/school history, a GAF score of 61 or higher (43% vs. 0% 6 years after their index admission), and to have good overall psychosocial functioning (66% vs. 27% at 6 year follow-up). Taken together, the results of this study suggest that psychosocial improvement is both common among borderline patients and strongly related to their symptomatic status.
authors.affiliation: Laboratory for the Study for Adult Development, McLean Hospital, Belmont, MA 02478, USA. zanarini@mclean.harvard.edu
authors.forename: Mary C
authors.initials: MC
authors.lastname: Zanarini
authors.forename: Frances R
authors.initials: FR
authors.lastname: Frankenburg
authors.forename: John
authors.initials: J
authors.lastname: Hennen
authors.forename: D Bradford
authors.initials: DB
authors.lastname: Reich
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Silk
mesh_terms: D000293:Adolescent; D000328:Adult; D001883:Borderline Personality Disorder / Q000175:diagnosis* / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation; D002423:Cause of Death; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008404:Massachusetts; D010552:Personality Assessment; D010554:Personality Disorders / Q000175:diagnosis* / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation; D011379:Prognosis; D011446:Prospective Studies; D012050:Rehabilitation, Vocational; D012917:Social Adjustment; D012919:Social Behavior; D012951:Socialization; D013405:Suicide / Q000706:statistics & numerical data