In the Fullness of Time: Recovery from Borderline Personality Disorder
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.
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1 History of the Borderline Diagnosis
2 Models of the Core Features of Borderline Personality Disorder
3 Earlier Studies of the Longitudinal Course of BPD
4 The McLean Study of Adult Development MSAD
5 The Symptoms of Borderline Personality Disorder Assessed in MSAD
6 The LongTerm Course of the Symptoms of Borderline Personality Disorder
7 Symptomatic Remissions and Recurrences of the Borderline Diagnosis
8 Prevalence and Predictors of Physically SelfDestructive Acts over Time
13 Cooccurring Disorders over Time
14 Mental Health Treatment over Time
15 Physical Health and Medical Treatment
16 Adult Victimization over Time
17 Sexual Issues over Time
18 Defense Mechanisms over Time
19 Going Forward
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10-year follow-up achieved addition adult affective American Psychiatric Association and/or anxiety disorders assessed Axis II comparison Axis II disorders baseline behavior bipolar disorder bord borderline diagnosis borderline patients borderline patients reported borderline personality disorder borderline psychopathology childhood history childhood sexual abuse chronic clinical clinicians co-occurring cognitive comparison subjects course of BPD criteria for BPD defenses DIB-R dissociation disturbed borderline patients DSM-III DSM-III-R DSM-III-R criteria eating disorders emotional erline patients ever-remitted factors feelings Fitzmaurice follow-up period Frankenburg GAF score Gunderson II comparison subjects impulsivity index admission inpatients interpersonal line patients major depression mood disorder MSAD multivariate non-recovered one’s outcome pain patients and Axis patients with BPD percentage of borderline prevalence prospective follow-up psychiatric hospitalizations psychosocial functioning psychotherapy PTSD recurrence Reich remitted self-harm self-mutilation severely disturbed borderline sexual relationship difficulties six-year follow-up social substance use disorder symptomatic remission symptoms of BPD therapist therapy time-to-recovery time-to-remission treaters YR FU