New results from the 24-year-long McLean Study of Adult Development (MSAD) reveal a long-term course of symptomatic disorders in patients with borderline personality disorder (BPD). This extensive study, published in the Journal of Clinical Psychiatry, provides the first comprehensive look into how BPD patients fare over time, comparing their experiences with those of individuals with other personality disorders and exploring predictors of recovery.
The researchers from McLean Hospital, a member of the Mass General Brigham health care system, found that individuals with BPD experienced higher rates of all five symptomatic disorder categories studied compared to those with other personality disorders. Despite ongoing treatment efforts, mood disorders (60%) and anxiety disorders (47%) remained notably high even after 24 years, while PTSD (21%), substance use disorders (15%), and eating disorders (14%), although still present, were significantly less prevalent.
In terms of categories of disorders, it was found that recovered borderline patients had significantly lower rates of three of these types of disorders than non-recovered borderline patients at baseline: mood, PTSD, and anxiety disorders.
The persistence of mood and anxiety disorders suggests current treatments are not as effective as once believed and spotlights the need for improved therapeutic strategies tailored specifically for BPD patients.
“Our findings provide crucial insights into the long-term course of BPD and highlight the need for ongoing, targeted interventions to address both mood and anxiety disorders and integrate substance use treatment into BPD recovery plans,” said lead study author Mary C. Zanarini, EdD, director of the Laboratory for the Study of Adult Development at McLean Hospital and principal investigator of the MSAD.
The MSAD study followed 362 inpatients over 24 years, collecting data between 1992 and 2018. During the study follow-up, researchers conducted assessments every two years using the Structured Clinical Interview for DSM-III-R Axis I Disorders—conditions that include mental health and substance use disorders.
The study showed that the absence of substance use disorders was identified as the most significant predictor of recovery from BPD, which according to the authors, underscores the critical importance of addressing substance use issues as part of comprehensive treatment plans for BPD.
The researchers also found that while the prevalence of all five types of symptomatic disorders decreased over time for both BPD patients and comparison subjects, emotional disorders (mood and anxiety disorders) showed a slower decline compared to impulsive disorders like substance use and eating disorders.
Limitations of the study were that the patient population consisted predominantly of seriously ill inpatients who were often receiving intermittent treatment as usual in the community during the study period. Thus, the findings may not fully represent the experiences of individuals with BPD who are less severely ill or not engaged in treatment.
“The results gleaned from our long-running study emphasize the need for a multifaceted approach to treatment that addresses both BPD and its associated disorders, particularly substance use,” said Zanarini, who is also a professor of psychiatry at Harvard Medical School.
Media Requests
Journalist or member of the media? We are available 24/7 for media requests.
