Weekly Mind Reader: Rethinking BPD

This week, we reconsider the prognosis of borderline personality disorder (BPD) patients, explore opioid prescription precautions, and offer an update on veterans and PTSD.

It’s Not As Bad As We Thought

For years, we all accepted that borderline personality disorder (BPD) persisted as a chronic psychiatric condition with little hope for improvement.

But large-scale follow-up studies in the 1980s challenged this view. Notably, one study by Paris and Zweig-Frank found that 75 percent of BPD patients no longer met diagnostic criteria after 27 years. These results showed that many BPD patients could achieve significant functional recovery, marked by Global Assessment of Functioning (GAF) scores of 61 or higher.

In response, the National Institute of Mental Health (NIMH) funded two prospective studies in the 1990s to examine the long-term course of BPD: the McLean Study of Adult Development (MSAD) and the Collaborative Longitudinal Personality Disorders Study (CLPS). Both used advanced, structured interviews to assess patients with BPD and other personality disorders (OPDs) over a decade of follow-up. Results revealed that 93 percent of BPD patients achieved a two-year remission. But fewer, roughly 50 percent, reached a full recovery, defined by improved psychosocial functioning.

Further research, extending to 24 years, showed that remissions, including 12-year remissions, were common for BPD patients, with recurrence rates remaining low, especially for longer remissions. However, recovery proved more elusive. Only 37 percent of BPD patients achieved a 12-year recovery, compared to 68 percent of those with OPDs.

These findings suggest that while BPD patients can achieve long-term symptomatic remission, functional recovery has proven to be more elusive. The results stress the need for treatment approaches that not only address symptom reduction but also focus on enhancing social relationships and vocational abilities, critical components of a sustained recovery.

IN OTHER PSYCHIATRY AND NEUROLOGY NEWS

• The Journal of Clinical Psychiatry published original research that revealed that a suicide crisis syndrome diagnosis cut readmission risk by more than 70 percent.
• The Primary Care Companion for CNS Disorders features a case study this week that illustrates why healthcare providers should use monitoring programs, conduct urine screenings, and offer treatment and counseling for opioid use disorder when prescribing opioids.
• JCP also reports this week that subthreshold PTSD affects 3.5 percent of veterans and is associated with increased rates of psychiatric disorders, suicidal thoughts and behaviors, and functional difficulties.
• Our news department reports on a study that attempts to answer the question: Why are we convinced we know what we don’t?
• And, finally, catch up on the most recent studies exploring trauma.