The neuroscience behind borderline personality disorder, meanwhile, appears more promising, Dr. Coccaro noted. Studies of brain function have shown that negative emotions in patients with borderline personality disorder lead to increased amygdala reactivity. With regard to the neuroendocrinology of borderline personality disorder, trauma in those patients appears similar to what can be seen in patients with posttraumatic stress disorder (PTSD) with “increased central and decreased peripheral stress hormone response.” In fact, he said, 75% of people with borderline personality disorder experienced childhood physical, sexual, or emotional abuse (Curr Psychiatry Rep. 2005 Mar;7[1]:39).
Dr. Coccaro noted that, although the prevalence of borderline personality disorder is likely between 2% and 3%, the illness is encountered at a rate of 20% for patients in clinic and 40% for those in hospitals and emergency departments. Borderline personality disorder is more prevalent and more severe in women, but no gender differences are apparent in affective disturbance, impulsivity, or suicidality. Borderline personality disorder also is likely to be comorbid with at least two conditions: Men with borderline personality disorder tend to have narcissistic and antisocial personality disorders; women with borderline personality disorder have higher rates of major depression, anorexia and bulimia, and PTSD.
Borderline personality was traditionally associated with a “dismal prognosis,” but the lifetime course of the disorder appears to be more promising. In the Collaborative Longitudinal Personality Disorder Study (CLPS), 25% of 668 patients had achieved remission after 2 years, which was defined as having fewer than two symptoms for more than 2 months. After a decade, 85% of those patients had reached remission for at least 12 months (JAMA Psychiatry. 2011;68[8]:827-37). Another trial, the McLean Study of Adult Development, analyzed 290 patients who had a remission rate at 16 years of 78% that lasted for at least 8 years (J Pers Disord. 2005 Oct;19[5]:505-23).
However, Dr. Coccaro noted, patients with borderline personality disorder likely do not achieve true remission. Instead, he said, patients simply fail to meet all the criteria to be diagnosed with borderline personality disorder. “They still have some of the features, but they are less intense,” Dr. Coccaro said.
Dr. Coccaro reported serving as a consultant to Azevan, Avanir Pharma, and Brackett. He also reported receiving grants from the National Institute on Mental Illness and the National Institute on Alcoholic Abuse and Alcoholism, and receiving royalties from UpToDate.
The meeting was presented by Global Academy for Medical Education. Global Academy and this news organization are owned by the same parent company.