Is the Prognosis for BPD Hopeless?

Rabu, 13 Januari 2010

Because of its associations with impairment in functioning, the need for hospitalization and intensive outpatient treatment, self-destructive behavior, and the potential for suicide, a diagnosis of BPD often provokes shock and despair in patients and families. However, follow-up studies of individuals who receive a diagnosis of BPD suggest that the prognosis is not as grave as is often presumed. A review of 13 studies of the stability of a BPD diagnosis made according to specified criteria and with the assistance of a standardized interview (Skodol et al. 2002b) revealed that only about half of the subjects retained the diagnosis. The lowest stability was found among patients who were diagnosed in adolescence, a time when
personality is often considered to be in flux. In general, the longer the follow-up period, the greater the chance for improvement (McDavid and Pilkonis 1996; Perry 1993). In the prospective follow-along CLPS study, 10% of those diagnosed with BPD showed dramatic improvement within the first 6 months of follow-up, and resolution of a co-occurring mental disorder or a psychosocial or interpersonal crisis played a major role in the improvement (Gunderson et al. 2003). Only 41% of BPD patients met full criteria every month for the first year (Shea et al. 2002). Poor prognostic factors include a history of childhood sexual abuse and incest; early age at first psychiatric contact; impulsivity, aggression, and substance abuse; and greater severity and chronicity of symptoms (Skodol et al. 2002b). Nonetheless, the prognosis of BPD is clearly not as poor as has generally been believed.