Prognosis of the borderline disorders

Area of Science:

• Psychiatry
• Clinical Psychology
• Longitudinal Studies

Background:

• Borderline schizophrenia, borderline syndrome, and borderline personality disorder require rigorous methodological evaluation.
• Existing follow-up studies often lack the standards necessary for definitive conclusions.

Purpose of the Study:

• To critically evaluate existing follow-up studies of borderline schizophrenia, borderline syndrome, and borderline personality disorder.
• To assess the natural history and identify predictive factors for these conditions.

Main Methods:

• Systematic review and critical appraisal of longitudinal studies.
• Analysis of outcome data for borderline schizophrenia, borderline syndrome, and borderline personality disorder.

Main Results:

• Borderline schizophrenia outcomes are variable, approaching those of schizophrenia, with approximately 20% progressing to schizophrenia.
• Grinker's borderline syndrome demonstrates variable outcomes, often with a poor prognosis.
• Borderline personality disorder has a variable prognosis, generally better than schizophrenia, and is frequently comorbid with major affective disorders that impact outcome.

Conclusions:

• The diverse outcomes challenge the notion of a single 'natural history' for these disorders.
• Few reliable predictive factors have been identified, necessitating further high-quality research.
• Improved study designs are crucial for identifying factors that predict the course of these borderline conditions.