Evidence-based optimism coming from prospective follow-up studies and randomised controlled trials of psychotherapies for patients with borderline personality disorder

The article summaries encouraging new results from well-designed studies carried out in the last decade on the better than previously-expected future prospects for patients with borderline personality disorder. The article outlines recent evidence suggesting that the natural course of borderline personality disorder is more benign than formerly believed. Two rigorously designed prospective follow-up studies show symptom recovery in half of the number of patients within two years. There is strong evidence from the McLean Study of adult development that 88% of patients with borderline personality disorder no longer meet the diagnostic criteria of borderline personality disorder of 10 years ago. Recurrences are rare, perhaps no more than 10% over six years. More trait-like diagnostic criteria are more enduring, whereas behavioural symptoms seemed to resolve first.

There is a growing body of evidence suggesting that many forms of psychotherapy for borderline patients produce substantial positive and enduring change in multiple domains in a 12-month treatment period. Roughly equivalent improvement gained support from different types of psychotherapies, such as dialectical behavioural therapy, mentalisation-based therapy, transference-focused psychotherapy, schema-focused therapy and cognitive-analytic psychotherapy. We describe the most important studies including the main outcome results of these, briefly characterizing the treatments as well.

Keywords: borderline personality disorder – prospective follow-up studies – randomised controlled trials of psychotherapies for borderline patients

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