Borderline Patients: 25 to 50 Years Later: With Commentary on Outcome Factors

The current study concerns the long-term follow-up of 40 patients with borderline personality disorder. Sixteen were patients from the PI-500 study, formerly hospitalized at the New York State Psychiatric Institute. Twenty-four had been from the author's private practice 25 to 50 years ago. Twenty-one of the combined group had first been in treatment 50 years ago. This is believed to be the longest follow-up period recorded for borderline patients. The main results are that two-thirds of the patients eventually reached the level of either clinical remission or clinical recovery. Reaching recovery, in the patients now in their 60s and 70s, was associated with having life-long personality traits, as described in the Five-Factor Model, of Agreeableness and Conscientiousness. These traits conduced to better outcome in forming lasting relationships and in workplace success. In some of the patients, genetic vulnerability to mood disorder (recurrent unipolar depression; bipolar disorder) was associated with slower improvement or to poorer outcome. Incest by an older-generation relative appears as another negative prognostic factor. Psychotherapy for most of the patients had originally been psychoanalytically oriented ("expressive"), though circumstances and life crises often led to the use of supportive, psychopharmacological, and behavioral interventions as well.