Ten-Year Course of Borderline Personality Disorder: Psychopathology and Function From the Collaborative Longitudinal Personality Disorders Study
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CONTEXT: Borderline personality disorder (BPD) is traditionally considered chronic and intractable. OBJECTIVE: To compare the course of BPD's psychopathology and social function with that of other personality disorders and with major depressive disorder (MDD) over 10 years. DESIGN: A collaborative study of treatment-seeking, 18- to 45-year-old patients followed up with standardized, reliable, and repeated measures of diagnostic remission and relapse and of both global social functioning and subtypes of social functioning. SETTING: Nineteen clinical settings (hospital and outpatient) in 4 northeastern US cities. PARTICIPANTS: Three study groups, including 175 patients with BPD, 312 with cluster C personality disorders, and 95 with MDD but no personality disorder. MAIN OUTCOME MEASURES: The Diagnostic Interview for DSM-IV Personality Disorders and its follow-along version (the Diagnostic Interview for DSM-IV Personality Disorders-Follow-Along Version) were used to diagnose personality disorders and assess changes in them. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Longitudinal Interval Follow-up Evaluation were used to diagnose MDD and assess changes in MDD and in social function. RESULTS: Eighty-five percent of patients with BPD remitted. Remission of BPD was slower than for MDD (P < .001) and minimally slower than for other personality disorders (P < .03). Twelve percent of patients with BPD relapsed, a rate less frequent and slower than for patients with MDD (P < .001) and other personality disorders (P = .008). All BPD criteria declined at similar rates. Social function scores showed severe impairment with only modest albeit statistically significant improvement; patients with BPD remained persistently more dysfunctional than the other 2 groups (P < .001). Reductions in criteria predicted subsequent improvements in DSM-IV Axis V Global Assessment of Functioning scores (P < .001). CONCLUSIONS: The 10-year course of BPD is characterized by high rates of remission, low rates of relapse, and severe and persistent impairment in social functioning. These results inform expectations of patients, families, and clinicians and document the severe public health burden of this disorder.
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Research into the longer-term outcome of patients with Borderline Personality Disorder shows that whilst education predicts better psychosocial functioning, gender appears to have little effect.
“This finding is consistent with research into the longer-term outcome of patients with Borderline Personality Disorder (BPD), showing that whilst education predicts better psychosocial functioning, gender appears to have little effect 4 .”
From The influence of personality disorder on the future mental health and social adjustment of young adults: a population-based, longitudinal cohort study (2016) · cites this paper as [4]
Collectively these studies show that whilst symptomatic remission is common, impairment in social functioning is an enduring feature of some personality disorder subtypes.
“Collectively these studies show that whilst symptomatic remission is common, impairment in social functioning is an enduring feature of some personality disorder subtypes 4,28 .”
From The influence of personality disorder on the future mental health and social adjustment of young adults: a population-based, longitudinal cohort study (2016) · cites this paper as [4]
In CLPS, patients with another personality disorder had higher recurrence rates than BPD patients (25% vs. 11%).
“However, the opposite pattern was found in the Collaborative Longitudinal Personality Disorders Study where those with another personality disorder (who had as their primary axis II diagnosis either avoidant or obsessive-compulsive personality disorder) had higher rates of recurrence than those with borderline personality disorder (25% vs. 11%).”
In CLPS, roughly 20% of borderline patients had a GAF score of 71 or above for at least two months.
“In terms of overall functioning, about 20% of borderline patients attained a GAF score of 71 or higher for two months or more.”
In CLPS, 85% of borderline patients achieved a remission of 12 months or longer.
“In the Collaborative Longitudinal Personality Disorders Study, it was found that 85% of borderline patients achieved a remission lasting 12 months or more.”
In borderline PD, 85% of the original sample had remitted after 10 years.
“With regard to borderline PD (BPD), 85% of the original sample had remitted after 10 years (17).”
From Prevalence and 10-year stability of personality disorders from adolescence to young adulthood in a high-risk sample (2022) · cites this paper as [17]
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- Authors
- Gunderson, J. G.
- Affiliations
- Harvard University (US)
- Corresponding author
- Gunderson, John G.
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2011-08-01
- Volume
- 68
- Issue
- 8
- Pages
- 827
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC3158489
- OpenAlex
- W2107582521
- Cited by
- 770
- References
- 72
- Citations by year
- 2026: 33 · 2025: 37 · 2024: 48 · 2023: 36 · 2022: 52 · 2021: 51 · 2020: 82 · 2019: 45 · 2018: 66 · 2017: 56 · 2016: 49 · 2015: 56 · 2014: 63 · 2013: 53 · 2012: 36
- FWCI
- 54.76
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01 MH 73708, R01MH50850, R01 MH 50837, K23MH073708, R01 MH 01654, R01 MH 080221, R01MH050838, K23MH080221, R01MH050837, R01 MH 50839, R01MH050840, R01MH050839, R01MH050850, R01 MH 50838, R01 MH 50840, K23MH069904, R01 MH 69904, K05MH001654)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- borderline personality disorder, long-term course, remission, relapse, social functioning, personality disorders, cluster C personality disorders, major depressive disorder, Global Assessment of Functioning, treatment-seeking patients
- MeSH terms
- Adolescent, Adult, Borderline Personality Disorder, Major Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Middle Aged, Personality Disorders, Psychiatric Status Rating Scales, Recurrence, Remission, Spontaneous, Social Behavior, Disease Progression, Kaplan-Meier Estimate
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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