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10-Year Course of Borderline Personality Disorder

Mary C. Zanarini, Ed.D.
Professor of Psychology, Harvard Medical School
Director, Laboratory for the Study of Adult Development,
McLean Hospital

Studies have shown that 1.8% of American adults meet the criteria for Borderline Personality Disorder (BPD). Mary C. Zanarini, Ed. D. addresses BPD and its many changes over the course of ten years. The continuum of BPD is one in which some patients recover without help, some use non-intensive outpatient treatments and are never hospitalized and others become severely ill, using tremendous amounts of mental health services. Dr. Zanarini highlights her study of 290 patients and briefly discusses the limitations of earlier studies, such as not having a comparison group or the reliance on a small sample size with high attrition rates. Retention rates for Dr. Zanarini’s longitudinal study are high: 92% of surviving patents with BPD are still participating in the study, and 88% have had a symptomatic remission. Dr. Zanarini proposes the differences between acute and temperamental symptoms. Acute symptoms are resolved relatively quickly. Additionally, she found that 79% of patients with BPD attain or maintain good psychosocial functioning over the course of ten years of prospective follow up. Patients with BPD have been shown to have steady improvements in terms of the social realm but remain more impaired in the vocational sphere. Younger age, vocational record, no history of childhood sexual abuse, no family history of substance abuse, absence of an anxious cluster personality disorder, high agreeableness and low neuroticism are the seven factors that Dr. Zanarini proposes to predict an earlier time of remission. Her main findings focus on remission and recurrence of BPD. She concludes that 90% of patients with BPD experience a remission of their disorder and recurrences are in fact very rare. Lastly, Dr. Zanarini notes that the prognosis for most patients with BPD is better than what was previously recognized.


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