These results suggest that symptomatic improvement is both common and stable, even among the most disturbed borderline patients, and that the symptomatic prognosis for most, but not all, severely ill borderline patients is better than previously recognized.

The results of this study suggest that axis I disorders are less common over time in patients with initially severe borderline personality disorder, particularly for patients whose borderline personality disorder remits over time. The findings also suggest that substance use disorders are most closely associated with the failure to achieve remission from borderline personality disorder.

The McLean Study of Adult Development (MSAD) began 12 years ago. It is the first NIMH-funded prospective study of the course and outcome of borderline personality disorder (BPD). After careful analysis of the first six years of follow-up, 5 main findings concerning the symptomatic and psychosocial course of BPD have emerged from this study. The first finding is that remissions are far more common than previously recognized (about 74%). The second is that these remissions are quite stable and thus, recurrences are quite rare (about 6%). The third finding is that completed suicides are far more rare than anticipated (about 4% vs. 10%). The fourth finding is that a "complex" model of borderline psychopathology best describes BPD. In this model, some symptoms resolve relatively quickly, are the best markers for the disorder, and are often the immediate reason for needing costly forms of treatment, such as psychiatric hospitalizations. We termed these symptoms (e.g., self-mutilation, help-seeking suicide threats or attempts) acute symptoms. Other symptoms resolve more slowly, are not specific to BPD, and are closely associated with ongoing psychosocial impairment. We termed such symptoms (e.g., chronic feelings of intense anger, profound abandonment concerns) temperamental symptoms. Fifth, it was also found that borderline patients were improving psychosocially over time, particularly remitted borderline patients; psychosocial functioning of remitted patients continued to improve as time progressed, suggesting that they were somewhat belatedly achieving the milestones of young adulthood and not simply returning to a prodromal level of functioning. Taken together, these results suggest that the prognosis for BPD is better than previously recognized.

No abstract

This study compared reliably diagnosed borderline personality disorder patients (n = 35) with major depressives (n = 25) and normals (n = 30) on 4 dimensions of object relations and social cognition coded from Thematic Apperception Test (TAT) responses: Complexity of Representations of People, Affect-Tone of Relationship Paradigms (malevolent to benevolent), Capacity for Emotional Investment in Relationships, and Understanding of Social Causality. As predicted, borderlines scored significantly lower on all 4 scales than did normals and lower on Affect-Tone and Capacity for Emotional Investment than did nonborderline major depressives. Borderlines also produced more pathological responses than did both groups on every scale, indicating more poorly differentiated representations, grossly illogical attributions, malevolent expectations, and need-gratifying relationship paradigms. The results suggest the importance of distinguishing several interdependent but distinct cognitive-affective dimensions of object relations and the potential utility of assessing object relations and social cognition from TAT responses.