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How symptom-free is "remission"?
- AhmedS Huda (1 February 2006)
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AhmedS Huda, Locum Consultant Psychiatrist None
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sameiaman{at}yahoo.co.uk AhmedS Huda
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In the editorial about borderline personality disorder (Fonagy & Bateman 2006), they state that "after 6 years, 75% of patients diagnosed with borderline personality disorder ... achieve remission by standardised diagnostic criteria" based on 2 studies. I managed to acquire one of the references they quoted, Zanarini et al's study (Zanarini et al 2003). I understand by the word "remission" a state of welll-being that is largely symptom-free (even if this state is temporary) rather than a level of psychopathology that fails to meet diagnostic criteria (but may still include distressing symptoms). In the long-term study of outcome with borderline personality disorder mentioned above(Zanarini et al 2003)73.5% of the surviving borderline personality disorder subjects ( 11 out of the 290 borderline personality disorder subjects killed themselves) no longer met the criteria for that diagnosis by the end of 6 years. the authors of that study indeed called this "remission. However the study also showed significant levels of psychopathology remained in the group after 6 years. For example, 41.3% experienced chronic or major depression, 42.9% suffered chronic anger or frequent angry acts, 34.9% had chronic anxiety, 55.6% had miscellaneous impulsive patterns of behaviour (excluding self harm or substance abuse). Now is this remission in the sense that we apply to, for example, major depressive disorder where research subjects often have to be largely symptom-free? Would not a better description be that "the level of severity reduces to a large extent but a significant amount of distress and psychopathology remains"? I understand the authors are probably trying to injext some optimism in the way psychiatrists view patients with borderline personality disorder but this is best done by not overstating the case with overly optimistic terminology. REFERENCES Fonagy, P. & A. Bateman (2006)Progress In The Treatment of Personality Disorder. The British Journal of Psychiatry 188: 1-3. Zanarini, M. C., Frankenburg, F. R., Hennen, J., et al (2003) The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. American Journal of Psychiatry, 160, 274 -283 |
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