BPD Research at McLean: Improving Knowledge and Treatment

According to Mary C. Zanarini, EdD, director of the Laboratory for the Study of Adult Development at McLean Hospital, “Research has proven that borderline personality disorder is a valid psychiatric disorder and not a catch-all category for challenging patients with different clinical presentations.” With this in mind, research into the disorder is ongoing at McLean Hospital, with new findings pointing the way to a deeper understanding—and improved treatments—for borderline personality disorder (BPD).

Here is a look at three current BPD-related research efforts at McLean.

McLean Study of Adult Development (MSAD)

Now in its 25th year, MSAD is the core study of the Laboratory for the Study of Adult Development. Funded by the National Institute of Mental Health, this investigation of the longitudinal course of BPD has produced several significant findings, including:

• 99% of those with BPD achieve at least a two-year symptomatic remission, and 78% achieve at least an eight-year symptomatic remission
• Recurrences of BPD are relatively rare
• Suicides are less common than expected among those with BPD
• BPD is composed of two types of symptoms—acute symptoms, such as self-mutilation, which resolve relatively rapidly and temperamental symptoms, such as intense anger, which resolve relatively slowly
• Recovery, which is defined as concurrent remission and good social and good full-time vocational functioning, is more difficult for patients with BPD to achieve than remission alone
• 60% of borderline patients do achieve recovery, but 40% do not, primarily because of their inability to work or go to school on a full-time basis
• These sub-types of BPD—recovered and non-recovered—are stable sub-types
• Non-recovered borderline patients have substantially poorer physical health than recovered borderline patients and make more poor health-related choices, such as smoking a pack of cigarettes per day
• Non-recovered borderline patients are more likely to die prematurely due to causes other than suicide (88% of early deaths) than recovered borderline patients

Zanarini stated that “these results suggest that BPD is a good prognosis diagnosis, particularly symptomatically, and in fact, has the best prognosis of all of the major psychiatric disorders.”

BPDPSYCHOED

An internet-based, randomized controlled trial, BPDPSYCHOED used psychoeducation as an early form of treatment for those with BPD. According to Zanarini, the study was “developed because patients are rarely told they have BPD, and even if they are told, they are typically not given the latest and most comprehensive information about the disorder.”

For the trial, half of these 80 young women were given information about their condition and half were not. All 80 completed symptomatic and psychosocial functioning assessments online for a period of one year. It was found that women who took part in the BPDPSYCHOED trial showed significant reductions in the severity of their BPD symptoms.

In addition, those in the treatment group had far better symptomatic outcomes in the acute phase of the study (weeks 1-12) and in the maintenance phase of the trial (months 6, 9, and 12) than control subjects.

“Learning about BPD seems to lessen symptom severity even over a period as long as one year for young women not in any other form of treatment at study entrance,” said Zanarini. “We believe that taking frequent assessments online helped these young women to think about their condition and formed part of the treatment by encouraging self-reflection.”

McLean/Mount Sinai Study of Child and Adolescent Development (MSCAD)

For this study, researchers compared 104 adolescents with BPD who were inpatients to 60 psychiatrically healthy boys and girls who also were ages 13-17. Adolescents with BPD were also compared to adults with BPD (ages 18-35) on a wide number of parameters.

The study found that adolescents as young as 13-17 manifest full-blown BPD that is similar in many ways to the BPD manifested by adults. “We also found that BPD was not a difficult phase of normal development and that psychiatrically healthy adolescents were not only less symptomatic than those with BPD, but also functioned substantially better,” said Zanarini.

This study and similar studies, Zanarini said, “suggest that BPD can start earlier than previously known, and it paves the way for prevention and early intervention studies.”