Physical health, primary care utilization and long-term quality of life in borderline personality disorder: A 10-year follow-up study in a Spanish sample.

OBJECTIVE: We aimed to study physical health and primary care utilization in the long-term course of borderline personality disorder (BPD) and their impact on quality of life (QOL) in a Spanish clinical sample. METHODS: This study is part of a longitudinal study following a clinical cohort with BPD. A total of 41 participants were re-evaluated at 10-year follow-up, when current medical conditions, primary care utilization, and quality of life were assessed. Comparative population data were extracted from the Catalan Health Survey ESCA. RESULTS: 68% of BPD patients reported physical health problems, and 32% informed of multiple medical illnesses at follow-up. Higher rates of musculoskeletal disorders and frequent use of general practitioner (GP) consultations were reported by BPD patients compared to the general population. Differences in physical health and use of primary care services between remitted and non-remitted BPD patients were not significant. BPD remission was independently associated with better long-term QOL. Comorbid somatic diseases worsened the long-term QOL of non-remitted BPD patients. CONCLUSION: Chronic somatic conditions are prevalent in people with BPD and interact negatively with persistent BPD pathology, worsening their QOL in the long-term. Health care strategies in the assistance of long-lasting BPD patients are recommended.

Evolución clínica y funcional a largo plazo del trastorno límite de personalidad (AU) / Long-term clinical and functional evolution of borderline personality disorder

Hay una evidencia científica creciente que indica un pronóstico a largo plazo más favorable del esperado para las personas con trastorno límite de la personalidad (TLP). Los resultados de diversos estudios prospectivos a 5 años o más conducidos en muestras clínicas de varios países, incluida España, indican que el TLP tiende a la remisión diagnóstica a largo plazo, aunque se objetivan manifestaciones sintomáticas crónicas del trastorno y una comorbilidad psiquiátrica y médica clínicamente relevante en una parte de las personas con TLP. Así mismo, se informan de tasas de suicidio acumuladas elevadas a largo plazo en esta población. El funcionamiento social y general parece mejorar ligeramente a largo plazo, observándose dificultades persistentes de ajuste social en algunos individuos. Se requieren futuras investigaciones para la identificación de factores predictivos de estas diferencias en el curso del trastorno (AU)

There is growing evidence indicating a better prognosis for borderline personality disorder (BPD) in the long-term than it was expected. Findings of prospective studies at 5-year follow-up and beyond that were conducted in clinical samples from several countries, including Spain, suggest that BPD tends towards diagnostic remission in the long-term, although a portion of the people with BPD may present chronic symptoms of the disorder and other clinically relevant psychiatric and medical comorbidities. High cummulative suicide rates were reported in this population in the long-term. General and social functioning appear to improve slightly over time, with persistent difficulties in social adjustment observed in some individuals. Further research is required to identify predictive factors of these differences in the course of the disorder (AU)

Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies.

BACKGROUND: This meta-analytic review is the first to synthesise findings from prospective research on the long-term course of borderline personality disorder in adult clinical populations. METHODS: Systematic searches were conducted in Medline, PsycINFO, PsycArticles, PubMed and Scopus within the period 1990-2017. Inclusion criteria were: (1) adult BPD sample diagnosed by a validated, semi-structured interview; (2) at least two prospective assessments of outcomes; and (3) follow-up period ≥ 5 years. Quality of evidence was rated with the Systematic Assessment of Quality in Observational Research (SAQOR). Four outcomes were meta-analysed using mixed-effect methods: remission from BPD diagnosis, completed suicide, depressive symptoms, and functioning. Potential moderators regarding the natural course and the initial treatment received were studied. RESULTS: Eleven studies met the inclusion criteria, with 837 participants from nine countries being followed. Between 50% and 70% of the BPD patients achieved remission in the long-term. Significant reductions in depression and functional impairment were also found. Mean suicide rate ranged from 2% to 5%. Younger age was associated with higher likelihood for remission. Being female was correlated with lower functional improvement. Despite some positive trends, there were no significant associations between treatment moderators and the long-term outcome. CONCLUSIONS: Findings suggest that the course of BPD is characterised by symptomatic amelioration and a slight functional improvement in the long-term. Age and gender modulate the long-term prognosis and should be considered to adapt treatment resources. Further research is required to draw robust conclusions on the long-term effects of psychotherapeutic interventions.

Long-Term Course of Borderline Personality Disorder: A Prospective 10-Year Follow-Up Study.

The aim of this prospective study was to expand previously reported evidence on the 10-year clinical and functional course of borderline personality disorder (BPD) in a Spanish sample. Participants diagnosed with BPD were assessed at baseline and at 10-year follow-up to evaluate BPD symptomatology and other relevant clinical measures, suicidal behavior, dimensional personality traits, Axis I and II comorbidity, use of mental health resources, and psychosocial functioning. At the 10-year follow up, significant improvements were observed on BPD domains, suicidal behavior, and other clinical measures. Neuroticism, impulsiveness, and aggression-hostility features trended toward normalization, whereas activity and sociability were impaired over time. Comorbidity with Axis I and personality disorders remained high. Social functioning and occupational functioning were largely unchanged. These findings confirm the tendency toward a symptomatic remission of BPD over the long term with regard to symptom criteria and characteristic dimensional traits. However, psychosocial functioning remains impaired.