Senior Copyright Harvard Health Publications

I know Borderline Personality Disorder is difficult to treat. Any encouraging news?

Answer by Howard LeWine, M.D.

One of the reasons that Borderline Personality Disorder is challenging to treat is that its symptoms reflect ingrained patterns of thinking and behavior. The disorder has three defining clinical components: impulsiveness, emotional volatility, and a fragile sense of self. Symptoms can include rapidly shifting moods, paranoia, self-injury, and inability to maintain relationships.

Psychotherapy remains a mainstay of treatment, because it is the most effective way to change core personality traits and behaviors. But little is known about the long-term outcomes of Borderline Personality Disorder.

Researchers at four universities, Brown, Columbia, Harvard, and Yale, recruited nearly 600 patients with a variety of diagnoses to participate in the ongoing Collaborative Longitudinal Personality Disorders Study. The researchers compared long-term symptom remission and ability to function socially in patients with Borderline Personality Disorder, obsessive-compulsive disorder, avoidant personality disorder, and major depression.

At the 10-year mark, 85% of people with Borderline Personality Disorder had achieved remission (nearly complete relief of symptoms), similar to the rate for people with major depression. Also encouraging: once people with Borderline Personality Disorder achieved symptom remission, they were unlikely to relapse.

The news about ability to function socially was less encouraging, however. When researchers assessed factors such as life satisfaction, employment, and marital status, they found that people who had Borderline Personality Disorder had improved slightly but remained significantly impaired when compared with people who had major depression. At the 10-year mark, for example, 36% of people with Borderline Personality Disorder were employed full-time, compared with 50% of those with major depression.

The authors concluded that while psychotherapy may help patients with Borderline Personality Disorder learn to reduce stress and paranoia or refrain from hurting themselves, it may not help them to become satisfied with their lives or form lasting relationships. Finding new therapies that combine social learning and rehabilitation might help.