Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

Abstract

Background:This meta-analytic review is the first to synthesise findings from prospective research on the long-term course of borderline personality disorder in adult clinical populations.Methods:Systematic searches were conducted in Medline, PsycINFO, PsycArticles, PubMed and Scopus within the period 1990-2017. Inclusion criteria were: (1) adult BPD sample diagnosed by a validated, semi-structured interview; (2) at least two prospective assessments of outcomes; and (3) follow-up period ≥ 5 years. Quality of evidence was rated with the Systematic Assessment of Quality in Observational Research (SAQOR). Four outcomes were meta-analysed using mixed-effect methods: remission from BPD diagnosis, completed suicide, depressive symptoms, and functioning. Potential moderators regarding the natural course and the initial treatment received were studied.Results:Eleven studies met the inclusion criteria, with 837 participants from nine countries being followed. Between 50% and 70% of the BPD patients achieved remission in the long-term. Significant reductions in depression and functional impairment were also found. Mean suicide rate ranged from 2% to 5%. Younger age was associated with higher likelihood for remission. Being female was correlated with lower functional improvement. Despite some positive trends, there were no significant associations between treatment moderators and the long-term outcome.Conclusions:Findings suggest that the course of BPD is characterised by symptomatic amelioration and a slight functional improvement in the long-term. Age and gender modulate the long-term prognosis and should be considered to adapt treatment resources. Further research is required to draw robust conclusions on the long-term effects of psychotherapeutic interventions.

Predictors of short‐ and long‐term recurrence of suicidal behavior in borderline personality disorder

“…On the other hand, two cohort studies reported rates of suicide near 4% ; however, these studies have larger follow‐up periods (5 years or more) in which a greater number of suicides are expected. Finally, a recently published systematic review reported a suicide rate in BPD between 2% and 5% in cohorts with at least 5 years of follow‐up .…”

Psychoneuroimmunology: The new frontier in suicide research

“…Paradoxically, we know little about the biological factors that contribute to the desire of the vast majority of people to keep living rather than the factors that may contribute to the situation around relatively few suicide events. It is noteworthy here that even in the presence of the most common psychiatric risk factors, about 95% people do not die by suicide ( Álvarez-Tomás et al., 2019 ).…”

“…In the US more than 80% adolescents with suicidal behavior had received some form of mental health treatment ( Gili et al., 2019 ). Even in the most common psychiatric predictors of suicide i.e, severe depression, borderline personality disorder and psychotic or bipolar disorders the suicide deaths occur in a small minority, under 5% ( Álvarez-Tomás et al., 2019 ). Lifetime suicide attempts are reported in less than 50% patients with these disorders ( Dong et al., 2019 ), and half of individuals below 35 years of age who died by suicide had a personality disorder indicating emotional regulation disorder as a more common psychopathology ( Paris, 2019 ).…”

STEPPS (System Training of Emotional Predictability and Problem Solving) in einer vernetzten ambulanten Hilfe für Menschen mit Borderline Persönlichkeitsstörung

“…Sie bilden sich nur langsam und teilweise zurück und führen zu weiteren Folgestörungen, wie sozialer Isolation, einer Häufung schwerwiegender körperlichen Erkrankungen (Frankenburg, F. R., & Zanarini, M. C. 2005) und Abhängigkeit von psychosozialen Hilfen. Besonders problematisch ist die berufliche Integration (Zanarini et al 2010;Kramer et al 2017;Álvarez-Tomás et al 2018). Für die Entwicklung der psychosozialen Funktionseinschränkungen ist offensichtlich nicht nur die Störung selbst, sondern auch die prämorbide Entwicklung beteiligt, etwa durch Ausbildung maladaptiver Schemata, Folgen komplexer Traumatisierung und ungünstiger psychosozialer Entwicklungsbedingungen (Bozzatello et al 2019).…”