Bridging the Gap Between Remission and Recovery in BPD: Qualitative Versus Quantitative Perspectives

2019 ◽  
pp. 1-20
Author(s):  
Paul H. Soloff
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Impulse Control ◽  
Borderline Personality ◽  
Objective Measures ◽  
Changes Over Time ◽  
Symptom Changes ◽  
Over Time

The 10-year outcome for patients with borderline personality disorder (BPD) is diagnostic remission in 85% to 93% however, less than half achieve good social and vocational functioning, and few attain full psychosocial recovery. To assess the gap between diagnostic remission and psychosocial recovery, quantitative measures of outcome were compared with narrative reports of psychosocial functioning in 150 BPD subjects followed prospectively from 2 to 31 years (mean 9.94 years). Subjects with the best and the worst outcomes were compared on symptom changes over time, and on efforts to improve psychosocial functioning. At intake, poor outcome subjects were more impaired than those with good outcomes, with more borderline psychopathology, hospitalizations, and poverty. At follow-up, 53.8% of good outcome subjects complained of continuing problems with depression, 33.3% with anger and impulse control, and 25.6% with unstable relationships. Despite objective measures of improvement, narrative reports documented residual BPD symptoms, comorbidity, and unemployment interfering with psychosocial recovery.

scholarly journals Levels of Acceptance and Forgiveness Reported by Patients With BPD and Personality-Disordered Comparison Subjects Over 20 Years of Prospective Follow-Up

2020 ◽  
Vol 34 (2) ◽  
pp. 262-272 ◽  
Author(s):  
Mary C. Zanarini ◽  
Christina M. Temes ◽  
Frances R. Frankenburg ◽  
D. Bradford Reich ◽  
Garrett M. Fitzmaurice
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Recovery Status ◽  
Personality Disordered ◽  
Over Time

This study had two objectives: to determine the levels of acceptance and forgiveness reported by patients with borderline personality disorder (BPD) and personality-disordered comparison subjects and by recovered versus non-recovered patients with BPD over 20 years of prospective follow-up. Levels of acceptance and forgiveness were reassessed every 2 years. Patients with BPD reported levels of these states that were approximately 70% lower than comparison subjects at baseline. These states increased significantly over time for patients with BPD but not for comparison subjects. Recovered patients with BPD reported approximately three times the levels of these states than non-recovered patients with BPD. These levels increased for both groups over time; one state (accepting of myself) increased at a significantly steeper rate for recovered patients with BPD. These results suggest that patients with BPD report becoming more accepting and forgiving over time. Additionally, recovery status is significantly associated with increasing time in these states.

10-Year Outcome of Suicidal Behavior in Borderline Personality Disorder

2019 ◽  
Vol 33 (1) ◽  
pp. 82-100 ◽  
Author(s):  
Paul H. Soloff ◽  
Laurel Chiappetta
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Lower Socioeconomic ◽  
Increased Risk ◽  
Core Symptoms ◽  
Predominately Female

Prospective predictors of suicide attempts were assessed in 118 subjects with borderline personality disorder (BPD) after 10 or more years of follow-up. Mean (SD) time to follow-up was 14.4 (4.7) years. Subjects were predominately female (78.8%), Caucasian (81.4%), and of lower socioeconomic status. Initial recruitment was evenly balanced between inpatient, outpatient, and non-patient (community) sources. In the 10-year interval, 55 subjects (46.6%) attempted suicide. Compared to baseline, suicidal ideation, number of attempts, and non-suicidal self-injury diminished markedly. Core symptoms of BPD, substance abuse, and alcohol use disorders decreased significantly; however, major depressive disorder (MDD) remained constant at 50%. Forty-four percent of subjects had poor psychosocial, vocational, and economic outcomes. Psychosocial outcome was independent of suicide history and any treatment. Increased risk was associated with interval hospitalization prior to any attempt (illness severity), as well as poor social, vocational, and psychosocial functioning at baseline.

Abandonment Psychotherapy and Psychosocial Functioning Among Suicidal Patients With Borderline Personality Disorder: A 3-Year Naturalistic Follow-Up

2019 ◽  
pp. 1-11
Author(s):  
Antonio Andreoli ◽  
Yvonne Burnand ◽  
Laura Frambati ◽  
Donna Manning ◽  
Allen Frances
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Randomized Study ◽  
Borderline Personality ◽  
Psychotic Symptoms ◽  
Global Functioning ◽  
Treatment As Usual ◽  
Treatment Conditions

The authors present the results from a 3-year follow-up among 170 patients who had participated in the original randomized study, which consisted of three treatment conditions: (a) 3-month abandonment psychotherapy (AP) delivered by certified psychotherapists, (b) AP delivered by nurses, and (c) treatment as usual in a psychiatric crisis center. All subjects were recruited at the emergency room after a suicide attempt and met diagnostic criteria for borderline personality disorder and major depression. Psychotic symptoms, bipolar disorder, and mental retardation were exclusion criteria. At 3-year follow-up, 134 (78.8%) subjects had blind, reliable assessment by clinical psychologists. The intent-to-treat analysis indicated that those patients who had received AP during acute treatment had better global functioning, improved work adjustment, and less unemployment/disability at 3-year follow-up. No differences were found as a function of type of therapist delivering AP. The data confirm that short-term AP gains in psychosocial functioning are sustained over the longer term.

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