Prognosis
Longitudinal studies have questioned the stable nature of personality disorder symptoms over time. For example, most people with borderline personality disorder (BPD) will experience some decline in symptoms during adulthood.[126]Gunderson JG, Stout RL, McGlashan TH, et al. Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Arch Gen Psychiatry. 2011 Aug;68(8):827-37.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1107231
http://www.ncbi.nlm.nih.gov/pubmed/21464343?tool=bestpractice.com
[127]Stone MH. Borderline patients: 25 to 50 years later: with commentary on outcome factors. Psychodyn Psychiatry. 2017 Summer;45(2):259-96.
http://www.ncbi.nlm.nih.gov/pubmed/28590208?tool=bestpractice.com
In clinical samples, about 85% of people with BPD will no longer meet the threshold for diagnosis within 10 years of longitudinal follow-up.[126]Gunderson JG, Stout RL, McGlashan TH, et al. Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Arch Gen Psychiatry. 2011 Aug;68(8):827-37.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1107231
http://www.ncbi.nlm.nih.gov/pubmed/21464343?tool=bestpractice.com
[128]Zanarini MC, Frankenburg FR, Hennen J, et al. Prediction of the 10-year course of borderline personality disorder. Am J Psychiatry. 2006 May;163(5):827-32.
https://ajp.psychiatryonline.org/doi/10.1176/ajp.2006.163.5.827
http://www.ncbi.nlm.nih.gov/pubmed/16648323?tool=bestpractice.com
However, specific symptoms may persist, and the 10-year course of borderline personality disorder is characterised by severe and persistent impairment in social functioning, and so ongoing treatment may be needed.[14]Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association practice guideline for the treatment of patients with borderline personality disorder Am J Psychiatry. 2024 Nov 1;181(11):1024-8.
http://www.ncbi.nlm.nih.gov/pubmed/39482953?tool=bestpractice.com
[126]Gunderson JG, Stout RL, McGlashan TH, et al. Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Arch Gen Psychiatry. 2011 Aug;68(8):827-37.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1107231
http://www.ncbi.nlm.nih.gov/pubmed/21464343?tool=bestpractice.com
Symptoms are often exacerbated in response to stressors. Personality disorders have been shown to respond to treatment, particularly if relatively intensive treatment is provided over an extended time frame.[129]Bateman A, Fonagy P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry. 1999 Oct;156(10):1563-9.
https://ajp.psychiatryonline.org/doi/10.1176/ajp.156.10.1563
http://www.ncbi.nlm.nih.gov/pubmed/10518167?tool=bestpractice.com
BPD is associated with an increased risk of death due to suicide as well as with increased all-cause mortality, although rates of suicide attempts and episodes of self-harm decline over time.[130]Kjær JNR, Biskin R, Vestergaard C, et al. All-cause mortality of hospital-treated borderline personality disorder: a nationwide cohort study. J Pers Disord. 2020 Dec;34(6):723-35.
http://www.ncbi.nlm.nih.gov/pubmed/30307824?tool=bestpractice.com
[131]Paris J. Suicidality in borderline personality disorder. Medicina (Kaunas). 2019 May 28;55(6):223.
https://www.mdpi.com/1648-9144/55/6/223
http://www.ncbi.nlm.nih.gov/pubmed/31142033?tool=bestpractice.com
[132]Zanarini MC, Frankenburg FR, Reich DB, et al. The 10-year course of physically self-destructive acts reported by borderline patients and axis II comparison subjects. Acta Psychiatr Scand. 2008 Mar;117(3):177-84.
http://www.ncbi.nlm.nih.gov/pubmed/18241308?tool=bestpractice.com
Impact of diagnosis
Care must be exercised in both establishing and documenting personality disorder diagnosis, because of the meaning and social stigma associated with this diagnosis.