Prediction of Non-Remission in a 5-Year Follow-Up of Borderline Personality Disorder in Adolescence

In a 5-year longitudinal follow-up study of adolescents (N = 97) treated for borderline personality disorder (BPD), we examined the characteristics of the persistent BPD group (N = 23), the stability of BPD criteria from baseline to 5 years, and the predictors of remission (N = 74). Significantly more participants in the persistent BPD group, compared to the remitted group, had depression, bipolar disorder, schizophrenia, or another personality disorder, received psychotropic medication, and were less likely to be in a relationship or in education. All nine diagnostic criteria of BPD exhibited extremely low stability over time across groups. Prior sexual abuse, conduct disorder, and high levels of general BPD psychopathology at baseline predicted persistent BPD at the 5-year follow-up. These findings suggest that while the status from late adolescence to young adulthood on each diagnostic criterion for BPD is highly variable over time, clinicians need to be aware that adolescents with high overall levels of BPD symptoms, a record of sexual abuse, and co-occurring externalizing behaviors are at increased risk of a poor prognosis.