In a video made by the New York Presbyterian Hospital on BPD, \u201cBack from the Edge,\u201d we find the following:<\/p>\n
It is a good diagnosis prognosis. That is to say, people get better. People recover. They manage their lives in effective ways. They have children. They have careers. (Perry Hoffman, 44 min)<\/p>\n
Sustained remission of psychopathology occurs. (John Gunderson, 44 min)<\/p>\n
Sensitivity will probably always be there, but you can build in ability to regulate. (Marsha Linehan, 44 min)<\/p>\n
Most people with this illness will recover. (Fenton, NIMH, 46 min)<\/p>\n
You can watch the video at https:\/\/www.youtube.com\/watch?v=967Ckat7f98&list=PLuQy-unvha0DEGoZWjmJE0ePeWc6dw9xk&index=2&t=0s<\/a><\/p>\n Mary C. Zanarini\u2019s Landmark Longitudinal Study of BPD Sufferers:<\/strong><\/p>\n Source: Zanarini McLean Webinar\u2013BPD Patient and Family Education Initiative, \u201cThe Long-Term Course of Borderline Personality Disorder,\u201d Originally aired Wednesday, February 3, 2016<\/strong>, accessed at https:\/\/www.mcleanhospital.org\/borderline-personality-disorder-patient-and-family-education-initiative<\/p>\n We should note that a book has been recently published based on the study:<\/strong><\/p>\n Mary C. Zanarini. In the Fullness of Time: Recovery from Borderline Personality Disorder<\/em> (Oxford University Press, 2019).<\/p>\n Zanarini\u2019s quite unequivocal and optimistic conclusion is that \u201cIt [BPD] is quite simply not a chronic condition.\u201d<\/strong> Having said that, let\u2019s look at her criteria for defining \u201cgetting better\u201d and her data.<\/p>\n Zanarini discusses two types of \u201cgetting better\u201d: remission of the acute symptoms (suicidality, self-harm, stormy relationships, and so forth) and even some temperamental ones (chronic dysphoria manifesting in feelings of anger and loneliness\/emptiness, a fragile sense of self, and interpersonal abandonment related-issues) and recovery of psychosocial functioning (having intimate relationships, studying or getting and holding a job).<\/p>\n REMISSION:<\/u><\/strong><\/p>\n Note that Zanarini defines remission as \u201cnot meeting criteria for DSM III-R and DIB-R.\u201d<\/p>\n Most of us are familiar with the list of symptoms\/traits in the DSM III-R. Failure to demonstrate possession of a minimal number of traits means a BPD sufferer is in remission.<\/p>\n The DIB-R (Revised Diagnostic Interview for Borderlines) developed by John Gunderson and revised by Mary Zanarini differentiates BPD from other PDs. Four categories of BPD traits have to be present at the same time to receive a BPD diagnosis: Dysphoric Affective, Disturbed Cognition, Impulsive Behaviors, Troubled Relationships. This diagnostic tool leads to a smaller but very homogeneous group of identified BPD patients (in contrast to the numerous traits in DSM III-R). In short, you had to be unhappy, have troubled thoughts, be impulsive and have relationship troubles to be diagnosed as BPD by the DIB-R.<\/u><\/p>\n FINDINGS<\/u><\/strong><\/p>\n 99% of the subjects were in remission after two years.<\/p>\n 95% were in remission after four years.<\/p>\n 90% were in remission after six years.<\/p>\n 78% were in remission after eight years.<\/p>\n Percent of recurrence after x years of remission: 2 years \u2013 36%, 4 \u2013 25%, 6 \u2013 19%, 8 – 10%. Clearly, the longer the period of remission, the less likely the recurrence.<\/p>\n RECOVERY:<\/u><\/strong><\/p>\n Recovery is defined as a having a concurrent remission from BPD and good social and vocational functioning<\/p>\n FINDINGS<\/u><\/strong><\/p>\n Recovery is more difficult to attain than symptomatic remission, particularly a sustained recovery of 4-8 years:<\/p>\n Loss of Recovery (=the longer you have been in recovery the more likely it is to stick)<\/p>\n After 2 years of recovery – 44%<\/p>\n After 4 years of recovery – 32%<\/p>\n After 6 years of recovery – 26%<\/p>\n After 8 years of recovery – 20%<\/p>\n Why this difficulty achieving and maintaining recovery?<\/strong><\/p>\n Treatment of Subjects in Study <\/u><\/strong><\/p>\n Mostly treated in community, 70% of BPD patients in individual therapy and took standard meds during eight 2-year-periods of study (almost none had evidence-based treatment); rate of psychiatric hospitalization declined from 100% at baseline to 24% 16 years later<\/p>\n Rehabilitation Model<\/u><\/strong><\/p>\n Some may need this supportive model because they have trouble working consistently and competently, managing everyday tasks, often back away from anxiety producing situations, especially in the social realm, and struggle with sleep and pain management.<\/p>\n Q & A: (39-45 minutes)<\/p>\n Q: Did Zanarini observe better outcomes with certain treatments?<\/p>\n A: I cannot access the effect of treatment since it is a naturalistic study. My personal opinion is that the patients who did best had therapists dedicated to keeping them functioning as best as they can and improving that function, not particularly focused on their miserable pasts, on their history and adversity. Instead, they threw all their psychotherapeutic weight behind keeping their patients employed, trying to get them to start the day. Those therapists, just by my observation, tend to do better.<\/p>\n Q: Which treatments correlate with improved psychosocial functioning. That is to say, which therapy encourages and supports the sufferer and focuses on functioning, instead of on their miserable past. How can a family member identify this kind of therapist?<\/p>\n A: If a therapist wants to engage in intensive therapy, work through all the past in great detail and understand every little thing this is a red flag. Is therapy a lifestyle or an adjunct to life? The therapist meets patient once a week, so they need to help them be adaptive. Best to help patient move forward, have great confidence in their ability to succeed and display this, have a fighting spirit, to help them get the life they originally planned to have for themselves.<\/u> (Not focus on victimhood or allow the sufferer to exude a pervading sense that she can\u2019t be possibly expected to do anything\u2014get up in the morning\/clean her room\/study\/go to work\u2014with the therapist seeming to believe in that and colluding with her sense of hardship and the impossibility of succeeding) Editor: That is not to say, that the therapist should invalidate the sufferer\u2019s pain and hardship, but the therapist must also be vehemently optimistic about the sufferer\u2019s capabilities and throw her weight behind the sufferer getting the life she originally planned.<\/p>\n Limitations of the Study:<\/strong><\/span><\/p>\n Zarini notes that \u201cthis study has a number of limitations. The first is that all subjects were initially inpatients. It may well be that borderline patients who have never been hospitalized are less severely ill symptomatically and less impaired psychosocially and thus, more likely to remit more rapidly and attain a good global outcome over time. The second is that the majority of those in both study groups were in non-intensive outpatient treatment over time and thus, the results may not generalize to untreated subjects.\u201d<\/p>\n We should also note certain exclusionary criteria that informed the study: \u201call subjects were initially inpatients at McLean Hospital in Belmont, Massachusetts. Each patient was first screened to determine that he or she: 1) was between the ages of 18\u201335; 2) had a known or estimated IQ of 71 or higher; 3) had no history or current symptoms of schizophrenia, schizoaffective disorder, bipolar I disorder, or an organic condition that could cause psychiatric symptoms; and 4) was fluent in English.\u201d Most importantly, those with \u201ca history or current symptoms of schizophrenia, schizoaffective disorder, or bipolar I disorder\u201d were excluded, though a comorbidity with other Axis I or II disorders does not seem to have functioned as an exclusionary criteria. (See Mary C. Zanarani et al, \u201cMethodological considerations for treatment trials for persons with borderline personality disorder\u201d Ann Clin Psychiatry. 2010 May; 22(2): 75\u201383, where a panel of the foremost BPD researchers discuss exclusionary criteria, such as severity, comorbidity, and psychotropic medication, in depth.)<\/p>\n Mary C. Zanarini<\/a>, Ed.D., Frances R. Frankenburg<\/a>, M.D., D. Bradford Reich<\/a>, M.D., and Garrett Fitzmaurice<\/a>, Sc.D. \u201cAttainment and Stability of Sustained Symptomatic Remission and Recovery among Borderline Patients and Axis II Comparison Subjects: A 16-year Prospective Follow-up Study.\u201d Am J Psychiatry. 2012 May; 169(5): 476\u2013483.<\/a> doi: 10.1176\/appi.ajp.2011.11101550<\/a><\/p>\n ________________________________________________________________________<\/p>\n Hebrew Reference:<\/p>\n\n
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