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Symptom remission, recurrence common in borderline personality disorder

Remission and recurrence of borderline personality disorder symptoms were common, though acute symptoms, such as self-mutilation and help-seeking suicide attempts, were more likely to remit and less likely to recur than temperamental symptoms.

“Recent reports from two NIMH-funded large-scale, prospective studies of the long-term course of borderline personality disorder — the McLean Study of Adult Development and the Collaborative Longitudinal Personality Disorders Study — have found high rates of remission of borderline personality disorder after 10 years of follow-up,” Mary C. Zanarini, EdD, of Harvard Medical School, Belmont, Massachusetts, and colleagues wrote. “Taken together, the results of these studies have led patients, their families and the mental health clinicians treating them to be more hopeful about the long-term prognosis of borderline personality disorder. However, less attention has been paid to the course of the symptoms of borderline personality disorder.”

To determine cumulative rates of 2-year and 4-year remission and recurrences of 24 borderline personality disorder symptoms, researchers evaluated 290 inpatients with borderline personality disorder and 72 comparison patients with axis II personality disorders. Study participants were interviewed at index admission and eight contiguous 2-year time periods across 16 years.

Symptoms assessed were acute — affective instability, quasi-psychotic thought, serious identity disturbance, substance abuse/dependence, sexual deviance, self-mutilation, manipulative suicide efforts, stormy relationships, devaluation/manipulation/sadism, demandingness/entitlement, serious treatment regressions and countertransference problems/“special” treatment relationships — and temperamental — chronic/major depression, chronic feelings of helplessness/hopelessness, chronic anger/frequent angry acts, chronic anxiety, chronic loneliness/emptiness, odd thinking/unusual perceptual experiences, nondelusional paranoia, general impulsivity, intolerance of aloneness, abandonment/engulfment/annihilation concerns, counterdependency/serious conflict over help/care and dependency/masochism.

Compared with temperamental symptoms, acute symptoms were more likely to remit for a 2-year period and 4-year period and were less likely to recur after remission lasting 2 or 4 years.

“The results of this study suggest that the symptoms of borderline personality disorder are quite fluid, with remissions and recurrences being common. However, the more clinically urgent acute symptoms of borderline personality disorder seem to have a better prognosis than the less turbulent temperamental symptoms of the disorder,” the researchers concluded. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.