In the Fullness of Time: Recovery from Borderline Personality Disorder

Mary C. Zanarini

Oxford University Press, 2018 - Medical - 232 pages

Borderline personality disorder (BPD) has been widely viewed as a chronic disorder, which has led many clinicians to avoid treating patients with this diagnosis. BPD is also one of the most stigmatized of psychiatric disorders, due to the awkward manner in which these individuals attempt to get their needs met. As such those with BPD are increasingly marginalized by society and prevented from accessing quality care.

In the Fullness of Time debunks the common myth that BPD is incurable, drawing on the findings of the NIMH-funded study, the McLean Study of Adult Development, which has found that BPD has the best symptomatic outcome of all major psychiatric illnesses. Citing and analyzing the results of this landmark, decades-long study, Mary Zanarini explains why there is reason for optimism when it comes to BPD: remissions lasting two to eight years are common and stable; furthermore, remission of all 24 symptoms of the disorder are also quite typical. Equally promisingly, the acute and most life-threatening symptoms of BPD, such as self-harm and suicide attempts, remit rapidly, and recur less frequently than do temperamental symptoms. Zanarini also reports on more sobering findings concerning high levels of poor outcomes relating to vocational impairment and physical health, reported by the 40% of patients who have not recovered, which have significant impact on wellbeing and use of medical and other services. Considered together, the findings generated by this important research provide much-needed hope for those diagnosed with BPD, particularly in guiding future research on and treatment for borderline personality disorder.

Contents

• 1 History of the Borderline Diagnosis: 1
• 2 Models of the Core Features of Borderline Personality Disorder: 7
• 3 Earlier Studies of the Longitudinal Course of BPD: 21
• 4 The McLean Study of Adult Development MSAD: 35
• 5 The Symptoms of Borderline Personality Disorder Assessed in MSAD: 45
• 6 The LongTerm Course of the Symptoms of Borderline Personality Disorder: 67
• 7 Symptomatic Remissions and Recurrences of the Borderline Diagnosis: 81
• 8 Prevalence and Predictors of Physically SelfDestructive Acts over Time: 87
• 9 Additional Symptom Areas over Time: 99
• 10 Psychosocial Functioning over Time: 107
• 11 Recovery from Borderline Personality Disorder: 117
• 12 Predictors of TimetoRemission and Recovery: 129
• 13 Cooccurring Disorders over Time: 141
• 14 Mental Health Treatment over Time: 149
• 15 Physical Health and Medical Treatment: 161
• 16 Adult Victimization over Time: 171
• 17 Sexual Issues over Time: 175
• 18 Defense Mechanisms over Time: 181
• 19 Going Forward: 189
• References: 193
• About the Author: 209
• Index: 211

About the author

Mary C. Zanarini, EdD, is Professor of Psychology at Harvard Medical School and Director of McLean Hospital's Laboratory for the Study of Adult Development. She has spent her career studying the phenomenology and long-term course of borderline personality disorder (BPD), childhood experiences of adversity, and co-occurring disorders. She has also conducted a series of medication trials and trials of psychosocial treatments for BPD, and she developed the most widely used diagnostic and severity measures for BPD. Dr. Zanarini is the founding President of the North American Society for the Study of Personality Disorders and a past Vice President of the International Society for the Study of Personality Disorders.

Bibliographic information

• Title: In the Fullness of Time: Recovery from Borderline Personality Disorder
• Author: Mary C. Zanarini
• Publisher: Oxford University Press, 2018
• ISBN: 0195370600, 9780195370607
• Length: 232 pages
• Subjects: Medical / Psychiatry / General; Psychology / Clinical Psychology