You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Since Leo Stone's discussion of the “widening scope of indications for psychoanalysis,” the effects of treating more patients with severe personality disorders and other psychiatric comorbidities with psychoanalysis have been debated. Until research studies specific to psychoanalysis shed light on this issue, one must turn to the broader psychiatric literature for data bearing on this topic. A relevant article was recently published in the Archives of General Psychiatry by a broad consortium of experts in Borderline Personality Disorder (BPD). Of note, the disorder referenced in the following discussion is BPD as defined by DSM-IV, not the different concept of Borderline Personality Organization used by analysts. John Gunderson and colleagues have conducted a multisite longitudinal study of the course of BPD and its associated functional limitations called the Collaborative Longitudinal Personality Disorders Study (CLPS). The 175 patients diagnosed with BPD enrolled in the study initially presented to inpatient and outpatient treatment settings and then consented to be assessed by the investigators at baseline, 6 months, 12 months, and 2, 4, 6, 8, and 10 years later. Presence of the diagnosis of BPD was evaluated by means of structured diagnostic interviews at each time point, and the Longitudinal Interval Follow-up Evaluation (LIFE) was used to assess functioning over time. LIFE includes subscale scores for measuring functional impairment in relationships, recreation, employment, and satisfaction.
Strikingly, Gunderson et al. found that 85 percent of patients diagnosed with BPD experienced remission (meeting two or fewer diagnostic criteria for at least twelve months) over the ten-year follow-up period. This categorical definition of remission may not capture gradations of personality change, but it is of note that very few patients relapsed following remission: