A long-term follow-up study of 290 hospitalized patients with borderline personality disorder-characterized by unstable interpersonal relationships, chronic unhappiness, frequent changes in mood, cognitive distortions, and marked impulsivity-revealed that 10 years after hospitalization, 86 percent of the patients had sustained symptom remissions.

Mary Zanarini, Ed.D, and colleagues at McLean Hospital in Massachusetts, evaluated patients every two years with a series of semistructured interviews and self-report measures. Although most patients no longer met diagnostic criteria for the disorder, only 50 percent of these patients had achieved recovery, meaning they experienced a two-year symptom remission and maintained or achieved both social and vocational functioning.

The long period of follow up in the study and use of outcome measures of greatest interest to patients and their families represents a major advance in defining recovery from borderline personality disorder.

The authors found that while concurrent symptomatic remission and good psychosocial functioning seem difficult for many borderline personality disorder patients to attain, once such a recovery is attained it is relatively stable. Two-thirds of the patients who became functionally recovered remained so, and the proportion was even higher when improvement was defined as a symptom remission lasting at least four years.

The authors raise the possibility of incorporating a rehabilitative approach into treatment for borderline personality disorder, to address social and vocational functioning. Dr. Zanarini notes, "Improving interpersonal relationships and job performance is a large part of the goal for many patients and their families. A rehabilitation approach might also have the practical effect of reducing the percentage of patients who receive Social Security disability benefits, and, equally important, it could help alleviate some of their feelings of low self-worth."

The study will appear on April 15 at AJP in Advance, the online advance edition of The American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association.

Funding for this study was received from the National Institute on Mental Health.