The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study

Am J Psychiatry. 2007 Jun;164(6):929-35. doi: 10.1176/ajp.2007.164.6.929.

Abstract

Objective: The purpose of this study was to characterize the course of 24 symptoms of borderline personality disorder in terms of time to remission.

Method: The borderline psychopathology of 362 patients with personality disorders, all recruited during inpatient stays, was assessed using two semistructured interviews of proven reliability. Of these, 290 patients met DSM-III-R criteria as well as Revised Diagnostic Interview for Borderlines criteria for borderline personality disorder, and 72 met DSM-III-R criteria for another axis II disorder. Over 85% of the patients were reinterviewed at five distinct 2-year follow-up waves by interviewers blind to all previously collected information.

Results: Among borderline patients, 12 of the 24 symptoms studied showed patterns of sharp decline over time and were reported at 10-year follow-up by less than 15% of the patients who reported them at baseline. The other 12 symptoms showed patterns of substantial but less dramatic decline over the follow-up period. Symptoms reflecting core areas of impulsivity (e.g., self-mutilation and suicide efforts) and active attempts to manage interpersonal difficulties (e.g., problems with demandingness/entitlement and serious treatment regressions) seemed to resolve the most quickly. In contrast, affective symptoms reflecting areas of chronic dysphoria (e.g., anger and loneliness/emptiness) and interpersonal symptoms reflecting abandonment and dependency issues (e.g., intolerance of aloneness and counterdependency problems) seemed to be the most stable.

Conclusions: The results suggest that borderline personality disorder may consist of both symptoms that are manifestations of acute illness and symptoms that represent more enduring aspects of the disorder.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Affective Symptoms / diagnosis
  • Affective Symptoms / psychology
  • Age Factors
  • Borderline Personality Disorder / diagnosis*
  • Borderline Personality Disorder / psychology*
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Follow-Up Studies
  • Hospitalization
  • Humans
  • Impulsive Behavior / diagnosis
  • Impulsive Behavior / psychology
  • Interpersonal Relations
  • Longitudinal Studies
  • Male
  • Outcome Assessment, Health Care
  • Prognosis
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Self Mutilation / diagnosis
  • Self Mutilation / psychology
  • Suicide / psychology
  • Suicide / statistics & numerical data
  • Suicide, Attempted / psychology
  • Suicide, Attempted / statistics & numerical data
  • Syndrome