Bridging the Gap Between Remission and Recovery in BPD: Qualitative Versus Quantitative Perspectives

The 10-year outcome for patients with borderline personality disorder (BPD) is diagnostic remission in 85% to 93%; however, less than half achieve good social and vocational functioning, and few attain full psychosocial recovery. To assess the gap between diagnostic remission and psychosocial recovery, quantitative measures of outcome were compared with narrative reports of psychosocial functioning in 150 BPD subjects followed prospectively from 2 to 31 years (mean 9.94 years). Subjects with the best and the worst outcomes were compared on symptom changes over time, and on efforts to improve psychosocial functioning. At intake, poor outcome subjects were more impaired than those with good outcomes, with more borderline psychopathology, hospitalizations, and poverty. At follow-up, 53.8% of good outcome subjects complained of continuing problems with depression, 33.3% with anger and impulse control, and 25.6% with unstable relationships. Despite objective measures of improvement, narrative reports documented residual BPD symptoms, comorbidity, and unemployment interfering with psychosocial recovery.