Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study.
OBJECTIVE
The purposes of this study were to determine time to attainment of symptom remission and to recovery lasting 2, 4, 6, or 8 years among patients with borderline personality disorder and comparison subjects with other personality disorders and to determine the stability of these outcomes.


METHODS
A total of 290 inpatients with borderline personality disorder and 72 comparison subjects with other axis II disorders were assessed during their index admission using a series of semistructured interviews, which were administered again at eight successive 2-year follow-up sessions. For inclusion in the study, patients with borderline personality disorder had to meet criteria for both the Revised Diagnostic Interview for Borderlines and DSM-III-R.


RESULTS
Borderline patients were significantly slower to achieve remission or recovery (which involved good social and vocational functioning as well as symptomatic remission) than axis II comparison subjects. However, by the time of the 16-year follow-up assessment, both groups had achieved similarly high rates of remission (range for borderline patients: 78%-99%; range for axis II comparison subjects: 97%-99%) but not recovery (40%-60% compared with 75%-85%). In contrast, symptomatic recurrence and loss of recovery occurred more rapidly and at substantially higher rates among borderline patients than axis II comparison subjects (recurrence: 10%-36% compared with 4%-7%; loss of recovery: 20%-44% compared with 9%-28%).


CONCLUSIONS
Our results suggest that sustained symptomatic remission is substantially more common than sustained recovery from borderline personality disorder and that sustained remissions and recoveries are substantially more difficult for individuals with borderline personality disorder to attain and maintain than for individuals with other forms of personality disorder.
McLean Hospital, Belmont, MA, USA. zanarini@mc lean.harvard.edu
Mary C
MC
Zanarini
Frances R
FR
Frankenburg
D Bradford
DB
Reich
Garrett
G
Fitzmaurice
D000293:Adolescent; D000328:Adult; D000987:Antisocial Personality Disorder / Q000523:psychology / Q000628:therapy; D001883:Borderline Personality Disorder / Q000523:psychology / Q000628:therapy*; D016022:Case-Control Studies; D003859:Dependent Personality Disorder / Q000523:psychology / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D053208:Kaplan-Meier Estimate; D010260:Paranoid Personality Disorder / Q000523:psychology / Q000628:therapy; D010324:Passive-Aggressive Personality Disorder / Q000523:psychology / Q000628:therapy; D010554:Personality Disorders / Q000523:psychology / Q000628:therapy*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D012917:Social Adjustment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult