10-year study about BPD treatment shows mixed results

[Guest guest]

A study about treatment of BPD was published online in the American Journal

of Psychiatry on April 15, 2010. The " LA Times " and " Medscape Psychiatry "

published articles about the study, which I have summarized below.

First, the facts:

Many Zanarini of McLean Hospital in Massachusetts [an expert researcher in

the field] studied 290 hospitalized patients with BPD over 10 years. Half of

the patients (50%) recovered from the disorder after 10 years of follow-up.

Recovery was defined as at least two years without symptoms and both social

and vocational functioning. Overall, 93% of patients achieved a remission of

symptoms lasting at least two years and 86% for at least four years. The LA

Times says, " A new study offers hope that recovery, although challenging,

can be long-lasting. "

The LA Times article continues, " The research suggests that while it may be

difficult to achieve recovery, once recovery has been attained it appears to

last. While many treatments focus on symptoms, therapy should include work

on improving relationships and functioning in the workplace, areas that

vastly boost the odds of long-term recovery. "

See

http://latimesblogs.latimes.com/booster_shots/2010/04/borderline-personality

-disorder-recovery.html for the whole article.

The Medscape article had a different slant.

" Recovery from borderline personality disorder, which includes symptom

remission and good psychosocial functioning, seems difficult for most

patients to attain, " conclude study investigators in the April 15 online

issue of the American Journal of Psychiatry.

However, " once attained, such a recovery is relatively stable over time, "

first study author C. Zanarini, EdD, of McLean Hospital, Belmont,

Massachusetts, and colleagues report.

These findings stem from a 10-year, prospective, follow-up study of 290

patients who met diagnostic criteria for borderline person0ality disorder.

The patients were overwhelmingly female and white; the mean age was 27.

These were lower-functioning, " conventional " BPs interested in working in

treatment.

At the beginning of treatment, the mean Global Assessment of Functioning

(used to rate the social, occupational, and psychological functioning of

adults, e.g., how well or adaptively one is meeting various

problems-in-living) was 38.9. This means the patients had major impairment

in several areas, such as work or school, family relations, judgment,

thinking, and mood.

Then, researchers interviewed the patients every two years for 10 years. The

assessment included both semistructured interviews and self-report measures.

Attrition was relatively low. Of the original 290 patients, 275 patients

were reinterviewed at two years, 269 at four years, 264 at six years, 255 at

eight years, and 249 at 10 years.

(This attrition rate is low. According to Paris, M.D., because of their

impulsivity, about two thirds of borderline patients drop out of treatment

within a few months. See

http://www.jwoodphd.com/borderline_personality_disorder.htm. My guess would

be that these patients were either more highly motivated at the beginning,

or participating in the study gave them higher motivation.)

The report states that at 10 years, 93% of patients had attained a

symptomatic remission lasting at least two years, and 86% had sustained

remission lasting at least four years. However, only 50% of patients

experienced a recovery from the disorder (which the researchers defined as a

two-year symptomatic remission and the attainment of good social and

vocational functioning during the previous two years, as well as a Global

Assessment of Functioning score of 61 or higher).

The investigators said that, " It is sobering that only half of our study

sample achieved a fully functioning adult adaptation with only mild symptoms

of borderline personality disorder. " Sadly, 34% of patients who recovered

from borderline personality disorder lost their recovery. About 30% of those

who achieved a two-year remission of symptoms experienced a recurrence of

symptoms, as did 15% of those who had achieved a four-year sustained

remission.

In part, the Medscape Psychiatry article

http://www.medscape.com/viewarticle/720303 (but you must register) written

by reads:

" This set of results is consistent with clinical experience, " Dr. Zanarini

and colleagues note in their report. The current study, they point out, is

an extension of the National Institute of Mental Health (NIMH)-funded McLean

Study of Adult Development, which found 'steady, if modest, overall

improvement over six years of prospective follow-up.'

" Another NIHM-funded study - the Collaborative Longitudinal Personality

Disorders Study - found that borderline patients continued to function in

the fair range of global functioning during two years of prospective

follow-up.

" Paris, MD, professor of psychiatry at McGill University, Montreal,

Quebec, Canada, who was not involved in the study, told Medscape Psychiatry

that the latest findings from the McLean study " are not unexpected; they do

confirm what is already out there in the literature. On the other hand, this

is a well-described sample, and it's the first time we've gotten this much

detail.'

" Taken together, Dr. Paris said, the research suggests that patients with

borderline personality disorder 'do get better with time, but they don't get

all better.'The long-term observations in the McLean study, Dr. Zanarini's

team notes, also suggest that remissions are 'far more common than the good

psychosocial functioning needed to achieve a good global outcome.'

" It would thus seem wise for those treating borderline patients to consider

a rehabilitation model of treatment for these psychosocial deficits. Such a

model would focus on helping patients become employed, make friends, take

care of their physical health, and develop interests that would help fill

their leisure time productively.' "