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Plausibility and possible determinants of sudden 'remissions' in borderline patients
Psychiatry (2003)
  • John G. Gunderson
  • Donna S. Bender
  • Charles A. Sanislow
  • Shirley Yen
  • Jennifer Bame Rettew
  • Regina Dolan-Sewell
  • Ingrid R. Dyck
  • Leslie C. Morey, Texas A & M University - College Station
  • Thomas H. McGlashan
  • M. Tracie Shea
  • Andrew E. Skodol

THIS STUDY documents dramatic improvements in patients with borderline personality disorder (BPD) and explores their possible determinants. From a sample of the 160 carefully diagnosed borderline patients on whom prospective follow-along data was collected, a subsample of 18 was identified whose DSM-IV criteria count fell to two or fewer during the course of the first 6 months of the study and retained that improvement for the next 6 months. Follow-along data including month-by-month ratings of BPD criteria; week-by-week ratings of Axis I disorders, medication changes, and life events were then used to establish concensus ratings on four hypothesized causes: Axis I remissions, situational change, misdiagnosis, and treatment effects. Follow-up data collected at 2 years was examined to see whether the improvements persisted. The results were that 18 BPD patients underwent dramatic improvements in the first 6 months. Only one had relapsed by 2 years. Though one was judged to have been misdiagnosed at baseline, the most important determinants were judged to be situational changes (n = 10) and remissions of co-occurring Axis I disorders (n = 7). In 10 patients treatment appeared to have facilitated these situational or Axis I resolutions. In conclusion, patients with BPD can make significant improvements that are rapid and of sufficient duration to be considered remissions. Determinants were identified that warrant further prospective evaluation.

  • CLPS,
  • Collaborative Longitudinal Personality Study,
  • Remission,
  • DSM,
  • DSM-IV,
  • Axis I,
  • Axis II,
  • Personality Disorders,
  • Borderline
Publication Date
Summer 2003
Citation Information
Gunderson, J. G., Bender, D., Sanislow, C. A., Yen, S., Rettew, J. B., Dolan-Sewell, R., Dyck, I., Morey, L. C., McGlashan, T. H., Shea, M. T., & Skodol, A. E. (2003). Plausibility and possible determinants of sudden “remissions” in borderline patients. Psychiatry, 66(2), 111-119.