You heard that most people get better. That is true, and it is not the whole sentence. In the long studies, symptoms eased for most people. Work, school, and a relationship that holds took longer, and fewer people got there.
Calm water is not solid ground. A river goes quiet years before it builds a bench you can live on. Those are two different clocks, and this article explains what each one measured, in whom, and why you should ask what was counted before you believe any percentage.
Key takeaways
- Long-term studies separate remission, meaning symptoms quiet down, from recovery, meaning symptoms are quiet and you also have work or school and a relationship that holds. The two percentages are not interchangeable.
- In the 24-year McLean follow-up, sustained recovery lasting 2 to 12 years was reached by 37 to 60 percent of people with BPD and 68 to 89 percent of people with other personality disorders. Those are natural-history figures, not treatment results.
- Cohorts cannot give you a personal calendar or prove what caused the change. They can tell you which clock you are watching.
Two words that get swapped
The long-term BPD studies use two different states, and most headlines quietly swap them.123
| Term | What it counts |
|---|---|
| Remission | The person no longer meets enough criteria for the diagnosis. Symptoms have gone quiet. |
| Recovery | Remission plus two more things: full-time work or school, and at least one close, sustaining relationship. Both must hold at the same time. |
In the McLean study, both states are counted only when they last: two, four, eight, or twelve years without a break, depending on the report.123 That is much stricter than “felt better at the last visit.”
A separate large study, the Collaborative Longitudinal Personality Disorders Study, or CLPS, used a twelve-month remission rule and measured global functioning on its own scale. Its percentages are not built the same way and should not be mixed with McLean’s.4
The definitions carry assumptions
Recovery, as the researchers defined it, requires full-time work or school. That embeds assumptions about caregiving, disability, retirement, and chosen part-time work. The same research team showed how much the rule matters: among McLean participants who were impaired at the start, the estimate of reaching good functioning over ten years was 60 percent under a full-time rule and 82 percent when part-time work or school was allowed to count.5
Read that as a warning in both directions. A strict definition can undercount meaningful lives. A loose one can overcount. When someone tells you a recovery rate, ask what was counted.
Who was in the McLean study
The McLean Study of Adult Development enrolled 290 adults with BPD, aged 18 to 35, after a psychiatric hospitalization. Most were women and most were White. They were interviewed every two years for decades, and their treatment was whatever they received in ordinary life, not assigned by the study. The 24-year report also followed 72 people with other personality disorders as a comparison group.123
Every number below comes with that boundary. It describes a formerly hospitalized cohort recruited decades ago and followed naturally. It does not describe the effect of any treatment, and it may not describe today’s more diverse outpatient population.
What 24 years counted, with the diagnosis named
Over the decades, the McLean team reported cumulative figures, meaning the share of people who ever reached a state, not the share who were in it at the last visit.123
| Landmark | Borderline personality disorder |
|---|---|
| By 10 years | 93 percent had reached at least two years of remission; 86 percent had reached four years of remission; 50 percent had reached at least two years of recovery. After a two-year remission, 30 percent had a recurrence; after recovery, 34 percent lost it.1 |
| By 16 years | 78 percent had reached eight continuous years of remission; 40 percent had reached eight continuous years of recovery.2 |
| By 24 years | 77 percent had reached twelve continuous years of remission; 37 percent had reached twelve continuous years of recovery; an estimated 29 percent later lost that recovery.3 |
The 24-year report also lines up BPD against the other-personality-disorder group across sustained states lasting 2 to 12 years.3
| Sustained 2 to 12 years | BPD | Other personality disorders |
|---|---|---|
| Ever reached remission | 77 to 100 percent | 97 to 100 percent |
| Ever reached recovery | 37 to 60 percent | 68 to 89 percent |
| Lost recovery after reaching it | 29 to 59 percent | 15 to 42 percent |
The contrast is the point. Symptoms quieted for the large majority in both groups. Recovery, the fuller state that includes work and a relationship that holds, was reached by fewer people with BPD and was more often lost. Water goes still long before the bench is built, and a flood can still cut the bench away.
A second cohort tells the same two-clock story
CLPS followed 175 people with BPD across several treatment settings, 111 of them with complete ten-year data. By ten years, 85 percent had reached a twelve-month remission and 11 percent had relapsed. Global functioning improved only modestly, from an average of 53 to 57 on a 100-point scale. Just 21 percent reached sustained high functioning. Employment rose from 19 to 36 percent, and marriage or cohabitation from 23 to 41 percent.4
Different cohort, different definitions, same shape: high remission, slow function. Because 37 percent of the sample lacked full ten-year data, the figures carry their own uncertainty.4
Across studies
A 2019 meta-analysis pooled 11 long-term BPD studies with at least five years of follow-up and estimated remission at about 60 percent, with high variation between studies, because they defined remission differently, followed different people, and gave different amounts of treatment.6 A 2018 review summarizes the longitudinal course across these cohorts.7 The broad direction is consistent. The exact number is not, and no single rate applies to everyone.
What the cohorts cannot tell you
- They cannot prove that treatment caused the improvement. Treatment was not assigned, and aging, relationships, economics, and chance were all mixed in.
- They cannot give you a year-by-year timetable. Cumulative percentages over decades are not a calendar for one person.
- They cannot speak for every diagnosis. The strong long-term data are about BPD. The other-personality-disorder group in the 24-year report is the best comparison available, and it is smaller.
A two-track map instead of a calendar
Since a calendar would be false precision, use two questions, asked separately, at each check-in with your clinician.
Track one, the symptom clock. Which criteria are quieter than a year ago, and which still fire? Remission is counted here.
Track two, the function clock. What is holding at work or school, and which relationship is holding? Recovery is counted here, and it is the slower clock.
If track one is moving and track two is not, that is not failure. It is the pattern the cohorts saw in most people. It is also the moment to ask for help aimed at track two.
Work support as its own lane
Evidence for vocational rehabilitation specific to BPD is limited. One registry-based study of Individual Placement and Support, a supported-employment model, described competitive employment among people with personality disorders alongside other groups with serious mental illness. It had no untreated comparison and did not isolate BPD, so it supports opportunity, not a guaranteed effect.8 The practical point is that the function clock sometimes needs its own service, such as supported employment, and not only psychotherapy.
When to get help sooner
Get urgent help for suicidal intent, a plan with access, or an inability to stay safe. Get urgent help for an attempt or overdose, or for self-harm that is escalating or medically serious. Call or text 988 in the United States for suicide or emotional crisis. Call 911 or go to the nearest emergency department for immediate danger.
What to do next
At your next appointment, ask two questions instead of one: which symptoms are quieter, and what is holding at work and in one relationship. Write both answers down with the date. That is your own two-clock record, and it is more honest than any cohort percentage.
Frequently asked questions
Do most people with BPD get better?
Most reach symptom remission. In the 24-year McLean follow-up, 77 to 100 percent reached sustained remission lasting 2 to 12 years. Fewer reached full recovery, which also requires work or school and a relationship that holds.
What is the difference between remission and recovery?
Remission means the symptoms have quieted enough that the diagnosis no longer applies. Recovery adds full-time work or school plus a close, sustaining relationship, all holding at the same time.
How long does recovery take?
The studies count states that lasted 2 to 12 years without a break. They cannot give an individual timetable. Function usually moves more slowly than symptoms.
Do these numbers apply to other personality disorders?
The strongest long-term data are for BPD. In the same 24-year study, people with other personality disorders reached sustained recovery more often, 68 to 89 percent, and lost it less often.
Do these percentages show that treatment works?
No. They are natural-history figures from people followed in ordinary life. Treatment was not assigned, so the cohorts cannot say what caused the change.
This article is for education, not personal medical advice. Do not start, stop, restart, or change a medication without the clinician who manages it. Every numeric and citation claim was verified against primary journal sources on September 7, 2026. Evidence changes; confirm current status before acting on anything here.
Related reading on NP FADY
- Borderline Personality Disorder: Beyond the Stigma
- What DBT Actually Is and How to Find It
- Rebuilding a Self After the Diagnosis
- Supporting Someone With a Personality Disorder
- Can NPD Be Treated? What the Evidence Shows
References
1. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. “Time to attainment of recovery from borderline personality disorder and stability of recovery: a 10-year prospective follow-up study.” American Journal of Psychiatry. 2010;167(6):663–667. DOI: 10.1176/appi.ajp.2009.09081130. Open full text.
2. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. “Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and Axis II comparison subjects: a 16-year prospective follow-up study.” American Journal of Psychiatry. 2012;169(5):476–483. DOI: 10.1176/appi.ajp.2011.11101550. Open full text.
3. Zanarini MC, Frankenburg FR, Hein KE, Glass IV, Fitzmaurice GM. “Sustained Symptomatic Remission and Recovery and Their Loss Among Patients With Borderline Personality Disorder and Patients With Other Types of Personality Disorders: A 24-Year Prospective Follow-Up Study.” Journal of Clinical Psychiatry. 2024;85(4):24m15457. DOI: 10.4088/JCP.24m15457. PMID: 39480146. 290 with BPD; 72 with other personality disorders. PubMed.
4. Gunderson JG, Stout RL, McGlashan TH, et al. “Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders Study.” Archives of General Psychiatry. 2011;68(8):827–837. DOI: 10.1001/archgenpsychiatry.2011.37. 175 at baseline; 111 with full ten-year data. Open full text.
5. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. “The 10-year course of psychosocial functioning among patients with borderline personality disorder and Axis II comparison subjects.” Acta Psychiatrica Scandinavica. 2010;122(2):103–109. DOI: 10.1111/j.1600-0447.2010.01543.x. Open full text.
6. Álvarez-Tomás I, Ruiz J, Guilera G, Bados A. “Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies.” European Psychiatry. 2019;56:75–83. DOI: 10.1016/j.eurpsy.2018.10.010. PMID: 30599336. 11 studies. PubMed.
7. Temes CM, Zanarini MC. “The Longitudinal Course of Borderline Personality Disorder.” Psychiatric Clinics of North America. 2018;41(4):685–694. DOI: 10.1016/j.psc.2018.07.002. PMID: 30447732. PubMed.
8. Juurlink TT, Lamers F, van Marle HJF, et al. “Individual placement and support and employment in personality disorders: a registry based cohort study.” BMC Psychiatry. 2022;22(1):188. DOI: 10.1186/s12888-022-03823-4. Open full text.
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