Complete recovery from personality disorder tough

NEW YORK (Reuters Health) - For those suffering from borderline personality disorder, friends and a job may be harder to secure than symptom relief, according to a new study.

“There’s been this idea that if people had fewer symptoms of the disorder, then they would naturally evolve socially and vocationally,” lead researcher Mary Zanarini of McLean Hospital in Belmont, Massachusetts told Reuters Health. “That does not seem to be true.”

Borderline personality disorder is a mental illness afflicting about 2 percent of adults, mostly young women. It is characterized by pervasive instability in moods, relationships, self-image, and behavior. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations.

Yet many unanswered questions remain. “We really had no good information as to what happened to patients suffering from this disorder over time,” said Zanarini.

So Zanarini and her colleagues followed 290 people with borderline personality disorder, originally inpatients at McLean Hospital, to see how their condition changed over the course of a decade.

Nearly all patients were on regular treatment -- typically some form of “talk therapy” and drugs. There currently is no standard treatment for personality disorder, and no evidence that drugs can trigger the remission of borderline personality disorder, Dr. Joel Paris of McGill University in Montreal, who was not involved in the study, told Reuters Health by email.

Zanarini’s team found that 93 percent of the patients had at least one 2-year break from the symptoms of the disorder during the 10 years, and 86 percent had at least one 4-year symptom-free period. Once achieved, symptoms rarely returned.

However, only about 50 percent of patients achieved full recovery, which was defined as a reprieve from symptoms lasting at least 2 years, plus good social and vocational functioning. Of those that did reach this mark, about a third later redeveloped symptoms, or once again struggled socially or with their job.

The authors note in the American Journal of Psychiatry that outcomes may differ for people who have never been hospitalized for the disorder. “Obviously, these patients would not have been as sick to begin with, and may have done much better,” said Zanarini.

But there is still the apparent gap between eliminating symptoms and regaining a healthy life. Treatments for borderline personality disorder tend to focus solely on the symptoms rather than on things like making friends or getting a job and keeping it, Zanarini explained.

She suggests a need for therapists to pay more attention to these practical problems, perhaps with the help of vocational counselors. “It could be something as simple as the person doesn’t know how to write a resume,” she said. “Probably very few of these people absolutely can’t work. It’s more that they’ve gotten out of the habit.”

Paris agreed. “While borderline personality disorder improves with time, mainly due to the reduction of active symptoms, many patients retain functional deficits for years to come,” he said. “Efforts should be focused on getting patients to work and to find social networks.”

SOURCE: here 09.09081130v1

The American Journal of Psychiatry, April 15, 2010.