Borderline Personality Disorder Prognosis and Treatment

Many people who have been diagnosed with borderline personality disorder (BPD) are told that their chronic disorder is not treatable. However, BPD can have a good prognosis if properly treated.

“It’s time to reject the notion that people with personality disorders are beyond help,” says Peter Aldhous.

Personality disorders cause difficulties with social interactions that can be debilitating for those with the disorder as well as their loved ones. Time magazine summed up the reputation of BPD as “the disorder that doctors fear most.”

BPD is characterized by emotional instability, distress and neurosis. Individuals with this disorder tend to experience difficulty in forming stable relationships. A paranoid fear of being abandoned haunts these patients, and this fear frequently becomes a self-fulfilling prophecy. Angry outbursts are common. People with BPD tend to view people in black and white, idealizing someone one day and devaluing them the next.

In the past few years, major research has been conducted on the prognosis of BPD, namely two long-term studies called the Collaborative Longitudinal Personality Disorders Study (CLPS) and the McLean Study of Adult Development (MSAD). These studies examined the course of BPD in populations of individuals seeking treatment for the disorder.

One major finding was that the remission rate went from 30 to 50 percent by the second year follow-up, up to 80 percent by the tenth year. What this means is that remission of symptoms might be more frequent than what researchers and clinicians previously believed.

Another important finding was that many variables influence the symptomatic outcome of this disorder. Variables such as adverse childhood experiences, family history of psychiatric disorders, older age and extent of earlier psychiatric treatment all affect the patient outcome. Sometimes individuals with BPD require hospitalization due to suicide attempts or self-injurious behavior. In addition the presence of comorbid issues such as post-traumatic stress disorder and substance use disorders also influence the course of the disorder. Anxious personality disorder traits and certain temperament variables also affect symptom outcome.

Individuals with BPD often experience difficulty trusting healthcare workers and clinicians. Because of this they may misinterpret interactions with others. Often healthcare workers do not understand that this aspect is innate to the pathology and will take these actions personally. Adding to this is the fact that psychiatrists have believed for years that this disorder is a lifelong affliction.

Specialized psychotherapy can significantly improve the lives of individuals with this debilitating disorder. Remission from BPD includes psychopathology, personality and socio-demographic variables.

It is important to note that the majority of studies on BPD prognosis have been conducted in North America. Consequently, little is known about the course of BPD in different countries and cultures. Because social factors shape how personality disorders are expressed, further research needs to be conducted cross-culturally. One study found that over-involvement in family relationships predicts a poor outcome of borderline personality disorder in both Japanese and Canadian patients.