Psychosocial Functioning of Borderline Patients and Axis II Comparison Subjects Followed Prospectively for Six Years

• Published in: Journal of personality disorders Vol. 19; no. 1; pp. 19 - 29
• Main Authors: Zanarini, Mary C., Frankenburg, Frances R., Hennen, John, Reich, D. Bradford, Silk, Kenneth R.
• Format: Journal Article
• Language: English
• Published: New York, NY Guilford 01.02.2005; Guilford Press
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Adult Development; Biological and medical sciences; Borderline Personality Disorder - diagnosis; Borderline Personality Disorder - mortality; Borderline Personality Disorder - psychology; Borderline Personality Disorder - rehabilitation; Cause of Death; Comorbidity; Comparative analysis; Diagnostic and Statistical Manual of Mental Disorders; Female; Follow-Up Studies; Humans; Informed Consent; Interrater Reliability; Male; Massachusetts; Medical sciences; Meetings; Patients; Personality; Personality Assessment; Personality disorders; Personality Disorders - diagnosis; Personality Disorders - mortality; Personality Disorders - psychology; Personality Disorders - rehabilitation; Personality Problems; Prognosis; Prospective Studies; Psychiatry; Psychology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Rehabilitation, Vocational; Schizophrenia; Social Adjustment; Social Behavior; Socialization; Suicide - statistics & numerical data; Validity; Massachusetts; Human; Symptomatology; Borderline; Social behavior; Follow up study; Evolution; Personality disorder
• ISSN: 0885-579X; 1943-2763
• DOI: 10.1521/pedi.19.1.19.62178

The purpose of this study was to determine the course of the psychosocial functioning of patients with borderline personality disorder (BPD) over 6 years of prospective follow-up. The psychosocial functioning of 290 patients meeting both DIB-R and DSM-III-R criteria for BPD and 72 patients meeting DSM-III-R criteria for another Axis II disorder (and neither criteria set for BPD) was assessed at baseline using a semistructured interview of demonstrated reliability. Over 94% of surviving patients were reinterviewed about their psychosocial functioning blind to all previously collected information at three distinct follow-up waves: 2-, 4-, and 6-year follow-up. The psychosocial functioning of borderline patients improved substantially over time, with the percentage meeting criteria for good overall psychosocial functioning increasing from 26% at baseline to 56% during the third wave of follow-up. Despite this improvement, borderline patients functioned significantly more poorly than Axis II comparison subjects, particularly in the area of vocational achievement. However, a more detailed examination revealed that borderline patients who had experienced a symptomatic remission during the course of the study functioned significantly better both socially and vocationally than never-remitted borderline patients. More specifically, they were significantly more likely to have a good relationship with a spouse/partner and at least one parent, good work/school performance, a sustained work/school history, a GAF score of 61 or higher (43% vs. 0% 6 years after their index admission), and to have good overall psychosocial functioning (66% vs. 27% at 6 year follow-up). Taken together, the results of this study suggest that psychosocial improvement is both common among borderline patients and strongly related to their symptomatic status.