Borderline Personality Disorder Follow-up

  • Author: Roy H Lubit, MD, PhD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Sep 2, 2011
 

Further Inpatient Care

Inpatient care is generally not indicated, unless the goals of treatment are well defined (see Treatment).

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Further Outpatient Care

Patients usually require long-term treatment with an appropriate therapist in individual and/or group psychotherapy.

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Deterrence/Prevention

To the authors' knowledge, no specific information is available on deterrence and prevention of borderline personality disorder.

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Complications

  • Ongoing and serious psychosocial dysfunction occurs if borderline personality disorder (BPD) is left untreated.
  • Suicide
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Prognosis

  • Short-term follow-up studies indicate that borderline personality disorder is a chronic condition, although many improve over time.
    • In a 1998 prospective follow-up study, Links et al reported that almost 50% of their former inpatients with borderline personality disorder continued to meet diagnostic criteria at 7 years.[31]
    • Furthermore, these patients have significantly more comorbid personality psychopathology; this finding supported the assertion that the level of pathology at the initial assessment primarily predicts the level of borderline psychopathology.
  • The long-term outcome is variable. The initial diagnosis of borderline personality disorder is rarely made in patients older than 40 years. Children with borderline pathology tend to develop a wide range of personality disorders, not necessarily borderline personality disorder. Andrulonis believes that borderline personality disorder traits in girls are more likely to evolve toward affective disorders, whereas borderline personality disorder traits in boys evolve toward episodic dyscontrol syndromes and substance abuse.[18]
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Patient Education

  • Patients should be helped to understand that their feelings are very intense, but will change if they can wait and pause. They will feel great despair and want to hurt themselves, they will feel great anger and want to hurt others, they will feel terrible emptiness and want to jump into a risky activity to deal with it. Helping them to learn that the feelings will not last and that there are things they can do to soothe themselves is very helpful.
  • Similarly, patients need to learn about their tendency to overidealize and then devalue people. Helping them to establish an understanding of their feelings can help them learn to not act out on feelings in self-destructive ways. They should also be taught that their mood fluctuations and excessive reactions will ease as they get older. They need to learn social skills and how people normally function in relationships and not let their feelings carry them away.
  • Educating family to understand what is happening with the patient with borderline personality disorder is crucial. Family members can easily become burned out. If patients loses this support they are likely to become far more unstable. Family members should be helped to understand that the person is not consciously manipulating them, but experiences overpowering emotions in response to events that overwhelm the person's judgment. Family members should understand the chronic abandonment fears of individuals with borderline personality disorder and act to avoid inadvertently stirring up those fears.
  • For excellent patient education resources, visit eMedicine's Mental Health and Behavior Center. Also, see eMedicine's patient education article Schizophrenia.
  • National Institute of Mental Health, Borderline Personality Disorder
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Contributor Information and Disclosures
Author

Roy H Lubit, MD, PhD  Assistant Clinical Professor, Mount Sinai School of Medicine; Clinical Faculty, Department of Child Psychiatry, New York University School of Medicine; Private Practice

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Elizabeth A Finley-Belgrad, MD and Joseph A Davies, MD to the development and writing of this article.

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