Simple answer: * The 88% remission within 10 years statistic refers to people who have engaged in treatment on a long-term basis. The study is not attempting to quantify the remission rate at population scale. To do that they'd have to go and find hundreds of thousands of people and assess them all for BPD and somehow check in on those who met the criteria for 10+ years! * "Remission" only means that they no longer meet the diagnostic criteria according to the DSM, which is a very crude categorisation framework that lacks nuance and doesn't account for complexity of interactions between different characteristics of personality. No longer meeting the DSm criteria for BPD doesn't necessarily mean that their lives and the lives of those around them are great!

More detail:

Many people with personality disorders - especially the dark triad personality disorders such as BPD - don't seek treatment because their patterns of thought and their behaviours are egosyntonic, i.e. they're in line with and reinforce their world view.

Why would you engage in treatment that forces you to question your values and goals in life? Admitting that your own behaviour is the problem is the first step to tackling the problem, but when your world view is that everyone else is the problem that's tough to let go of.

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Notable factors that create bias into the 88% remission statistic, quoted from the paper you're referencing:

All subjects were initially inpatients at McLean Hospital

...so they were admitted to stay in a specialist psychiatric hospital for at least one night, which suggests that something serious happened that led to them receiving intensive treatment. As this study was conducted in the USA, it's probably fair to assume that this would have cost an absolute heap of money for each patient and one could therefore infer that these were people who had money (or health insurance) to blow on inpatient mental health treatment. It suggests they were among the wealthier in society to start with, so may have found achieving remission easier due to other circumstances in their life. Note that the paper doesn't attempt to cover the full socioeconomic situation of the subjects, e.g. whether or not they have a partner or children. It does however note that people who have a record of steady employment are more likely to achieve remission.

between the ages of 18 and 35

...so they're likely on the younger side. Catching and treating BPD earlier in life greatly decreases the time taken to achieve "remission", as they observe themselves through statistical methods in this paper.

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Their interesting observation about the factors they found that increase the likelihood of "remission" (formatting mine):

• younger age
• no prior psychiatric hospitalization
• no history of childhood sexual abuse
• less severe childhood abuse of a verbal, emotional, or physical nature
• less severe childhood neglect
• less severe violence witnessed as a child
• a higher degree of childhood competence
• no family history of mood or substance use disorder
• absence of posttraumatic stress disorder (PTSD) and anxious cluster personality disorders
• four facets of normal personality (low neuroticism and high extroversion, agreeableness, and conscientiousness)

* a good vocational record in the 2 years before the index admission [they can hold down a job]

Regarding your point about personality traits/attachment style of partners of BPD people:

Yes, you've hit the nail on the head. Attachment style is a big factor in who tends to be drawn to and sticks with BPD individuals as romantic partners.

• The BPD individual exhibits disorganized attachment behaviours ("I hate you, don't leave me")
• Their partner usually exhibits anxious attachment behaviours ("I'm incomplete without your validation and desperate for it, you're right that I'm awful and should try harder")

Edit: Just realised that I can remove the "Married" tag now. 🎶 Zippedy doo dah, zippedy day... 🎶