Zanarini Mary C, Frankenburg Frances R, Hennen John, Silk Kenneth R
Laboratory for the Study for Adult Development, McLean Hospital, MA, USA.
Am J Psychiatry. 2003 Feb;160(2):274-83. doi: 10.1176/appi.ajp.160.2.274.
The syndromal and subsyndromal phenomenology of borderline personality disorder was tracked over 6 years of prospective follow-up.
The psychopathology of 362 inpatients with personality disorders was assessed with the Revised Diagnostic Interview for Borderlines (DIB-R) and borderline personality disorder module of the Revised Diagnostic Interview for DSM-III-R Personality Disorders. Of these patients, 290 met DIB-R and DSM-III-R criteria for borderline personality disorder and 72 met DSM-III-R criteria for other axis II disorders (and neither criteria set for borderline personality disorder). Most of the borderline patients received multiple treatments before the index admission and during the study. Over 94% of the total surviving subjects were reassessed at 2, 4, and 6 years by interviewers blind to previously collected information.
Of the subjects with borderline personality disorder, 34.5% met the criteria for remission at 2 years, 49.4% at 4 years, 68.6% at 6 years, and 73.5% over the entire follow-up. Only 5.9% of those with remissions experienced recurrences. None of the comparison subjects with other axis II disorders developed borderline personality disorder during follow-up. The patients with borderline personality disorder had declining rates of 24 symptom patterns but remained symptomatically distinct from the comparison subjects. Impulsive symptoms resolved the most quickly, affective symptoms were the most chronic, and cognitive and interpersonal symptoms were intermediate.
These results suggest that symptomatic improvement is both common and stable, even among the most disturbed borderline patients, and that the symptomatic prognosis for most, but not all, severely ill borderline patients is better than previously recognized.
对边缘型人格障碍的综合征及亚综合征现象进行了6年的前瞻性随访研究。
采用修订版边缘型人格障碍诊断访谈量表（DIB-R）及修订版DSM-III-R人格障碍诊断访谈量表中的边缘型人格障碍模块，对362例人格障碍住院患者的精神病理学进行评估。其中，290例符合DIB-R及DSM-III-R边缘型人格障碍标准，72例符合DSM-III-R其他轴II障碍标准（不符合边缘型人格障碍标准）。大多数边缘型患者在本次入院前及研究期间接受了多种治疗。超过94%的存活受试者在2年、4年和6年时由对先前收集信息不知情的访谈者重新评估。
边缘型人格障碍患者中，2年时34.5%达到缓解标准，4年时49.4%，6年时68.6%，整个随访期间为73.5%。缓解者中仅有5.9%复发。随访期间，其他轴II障碍的对照受试者均未发展为边缘型人格障碍。边缘型人格障碍患者的24种症状模式发生率下降，但在症状上仍与对照受试者不同。冲动症状缓解最快，情感症状最为持久，认知和人际症状居中。
这些结果表明，即使在病情最严重的边缘型患者中，症状改善也很常见且稳定，并且大多数（而非全部）重症边缘型患者的症状预后比之前认为的要好。
