Authors' reply

We thank Ashman & Haigh for their comments but are not clear why they find it ‘disturbing’ rather than heartening that current follow-up studies in the USA suggest that improvement rates associated with borderline personality disorder are far better than previously thought and that substantial numbers of those seeking treatment no longer meet diagnostic criteria on follow-up. The study by Zanarini and colleagues has, in fact, now had its 10-year follow-up (the most recent published report is Zanarini et al, 2005). The Collaborative Longitudinal Study of Personality Disorders is at present only 4 years and shows a more rapid recovery from major depressive disorder than is manifested in borderline personality disorder. We do not believe that the rapid recovery from major depressive disorder has led health experts to suggest that depression should not be treated. There is a third study, by Cohen et al (2005), that shows similar findings in personality disorder. Why such high remission rates are observed in this population is a matter of controversy and is discussed in some detail by Livesley (2005). Issues of sampling, diagnostic criteria and interview methodology may all need to be carefully thought about before implications for clinical management and health policy are determined and this was neither the explicit nor implicit aim of our editorial. However, we feel strongly that no matter what the limitations of empirical data, systematically collected information is to be preferred to emotionally charged claims based on personal experience that for far too long have overly influenced policy in our field, to the great disadvantage of the client group.

We are sure that Ashman & Haigh will join us in hoping for a debate on the issue of remission that is well-informed by controlled trials and systematically collected follow-up data. Health policy is determined by the best currently available evidence but we make it clear that the current data are incomplete. We are not in the habit of oversimplifying complex issues and do not wish to minimise the seriousness of this disorder or the resources required for its appropriate treatment, which may indeed bring forward remission. We feel, however, that the recent follow-up data, whatever the limitations, should give hope to both families of individuals with borderline personality disorder and service providers faced with the challenge of helping these individuals, an objective that is at the core of Borderline UK's mission.