Do People with BPD Get Better?

(From Stop Walking on Eggshells, 1998, New Harbinger, Randi Kreger and Paul T. Mason, MS.)

A fair amount of research has been conducted to answer the question, "Do people with BPD get better?" Here is a short summary: 

•  The McGlashan Chestnut Lodge study (1986) showed that 53 percent of patients with BPD were considered "recovered" and that patients seemed to do better once they reached their forties.
      
• A New York State Psychiatric Institute study (Stone 1990) showed that two-thirds of patients in their thirties and forties were rated as either "good" or "recovered" on the global assessment scale. (This scale is a standard tool used by clinicians to measure functioning.)
    
• In two studies (Stone 1990; McGlashan 1986), factors associated with  positive outcomes were likableness, candor, perseverance, talent, superior intelligence, the lessening or elimination of obsessive traits, attractiveness (whether as a child or adult), and lessened or eliminated depression. Poor outcomes were associated with substance abuse (especially continued alcohol abuse.)
  
  In our three years of interviewing BPs who greatly improved, we noticed several common threads. First and foremost, they accepted responsibility for their behavior and for their recovery. They also:
      
  • Were willing to work through their inner pain instead of deflecting it onto other people or dealing with it through other means (e.g., drugs, self-mutilation, etc.). Frequently, they lapsed back into old patterns, but they got back on track.
      
  • Had faith in themselves and believed that other people (or a supreme being) had faith in their inner worthiness-the "real them" behind the borderline symptoms. However, it was difficult for non-BPs to be supportive when the BP continued blaming all their problems on others.
      
  • Had access to continued therapy with a competent clinician who did not take their actions personally, believed that recovery was possible, genuinely cared about them, were willing to stick with them in the long term, and who observed appropriate limits.
       
  • Received the appropriate medication.