Plausibility and possible determinants of sudden "remissions" in borderline patients.
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THIS STUDY documents dramatic improvements in patients with borderline personality disorder (BPD) and explores their possible determinants. From a sample of the 160 carefully diagnosed borderline patients on whom prospective follow-along data was collected, a subsample of 18 was identified whose DSM-IV criteria count fell to two or fewer during the course of the first 6 months of the study and retained that improvement for the next 6 months. Follow-along data including month-by-month ratings of BPD criteria; week-by-week ratings of Axis I disorders, medication changes, and life events were then used to establish concensus ratings on four hypothesized causes: Axis I remissions, situational change, misdiagnosis, and treatment effects. Follow-up data collected at 2 years was examined to see whether the improvements persisted. The results were that 18 BPD patients underwent dramatic improvements in the first 6 months. Only one had relapsed by 2 years. Though one was judged to have been misdiagnosed at baseline, the most important determinants were judged to be situational changes (n = 10) and remissions of co-occurring Axis I disorders (n = 7). In 10 patients treatment appeared to have facilitated these situational or Axis I resolutions. In conclusion, patients with BPD can make significant improvements that are rapid and of sufficient duration to be considered remissions. Determinants were identified that warrant further prospective evaluation.
Gunderson, J. G., Bender, D., Sanislow, C., Yen, S., Rettew, J. B., Dolan-Sewell, R., ... Skodol, A. E.
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Gunderson, John G||Bender, Donna||Sanislow, Charles||Yen, Shirley||Rettew, Jennifer Bame||Dolan-Sewell, Regina||Dyck, Ingrid||Morey, Leslie C||McGlashan, Thomas H||Shea, M Tracie||Skodol, Andrew E
