[Outcome in borderline disorders. A literature review]

This paper reviews the current state of research results on borderline disorders in terms of course and outcome, variables predisposing to good or poor outcome, suicide rates and the influence of psychotherapeutical and pharmacotherapeutical strategies. It turned out that course and outcome of borderline disorders depend on the applied diagnostic criteria and on the length of the follow-up period. The outcome of the follow-up studies of borderline schizophrenia and of the borderline syndrome according to Grinker was on the whole worse compared to those of borderline personality disorder defined by DSM-III/III-R or DIB according to Gunderson or Kernberg's criteria. Further, it could be shown that the GAS or HSRS values of the short-term follow-up studies (up to five years) ranged from 46.4 to 59.2 points whereas those of the long-term studies with an average period of 13.6 till 20 years were measured in the lower and in the mid-60 s that reflects only mild difficulties in psychosocial functioning. However, the high rate of completed suicide in BPD was to be respected: The most extensive follow-up investigation with the highest trace-rate (PI-500) revealed a suicide rate of 9% till now, and the most lethal combination of circumstances was BPD x MAD x alcohol abuse (suicide rate of 38%). Prognostic factors predisposing to poor outcome were substance abuse, admixture with antisocial and schizotypal elements, chronic hostility and affective instability with depressive and anxious features. Prognostic factors predisposing to good outcome were high IQ, extraordinary talent, high attractiveness, likeability and regular appointments with the Alcoholics Anonymous. Finally, the influence of psycho- and pharmacotherapeutical interventions were controversially debated. Several psychodynamic therapy studies resulted in satisfactory outcome scores concerning a subgroup of patients with personality traits like warmth, likeability, reliability, talent. Behavioral treatment strategies such as dialectical behavior therapy by Linehan significantly diminished parasuicidality and impulsiveness. Psychopharmacotherapy should target predominating psychopathological features: Low-dose antipsychotics against micropsychosis and prolonged severe dissociative symptoms, SSRIs and MAOIs against affective instability, and, lithium, carbamazepine or valproate against severe impulsiveness and aggressiveness.