Recent advances in understanding physical health problems in personality disorders.

Personality disorders are associated with a range of adverse health outcomes, contributing to the high healthcare utilization seen in patients with these disorders. A growing literature supports a robust association of personality disorders and health problems. The primary aim of this article is to summarize the most recent research documenting the associations between personality disorders and health conditions. Extending past reviews, we discuss the association of personality disorders with chronic physical illnesses, sleep disturbances, pain conditions, and obesity. We provide recommendations for future research in this area.

Randomized Controlled Trial of Web-Based Psychoeducation for Women With Borderline Personality Disorder.

OBJECTIVE: To determine if internet-based psychoeducation for borderline personality disorder is effective in reducing symptom severity and improving psychosocial functioning. METHODS: Eighty women who met DSM-IV criteria for borderline personality disorder were randomly assigned either to the internet-based psychoeducation treatment group (n = 40) or to the internet-based control group with no psychoeducation (n = 40). Recruitment was conducted from July 2013 to March 2015. Subjects participated in 15 assessment periods that were divided into an acute phase (weeks 1-12) and a maintenance phase (months 6, 9, and 12). Main outcomes were assessed using the Zanarini Rating Scale for Borderline Personality Disorder. RESULTS: In the acute phase, women in the treatment group were found to have a significant decline in their scores on all 10 outcomes studied, while women in the control group had a significant decline on 7 of these outcomes. Two between-group differences were found to be significant-those in the treatment group reported a significantly greater decline in their impulsivity (z = -1.98, P = .048) and a significantly greater increase in their psychosocial functioning (z = -1.97, P = .049) than those in the control group. In the maintenance phase, those in the treatment group were found to have a significant decline in their scores on 9 of the 10 outcomes studied, while those in the control group had a significant decline in 3 of these outcomes. In terms of between-group differences, those in the treatment group reported a significantly greater decline in all 5 studied areas of borderline psychopathology: affective symptoms (z = -2.31, P = .021), cognitive symptoms (z = -3.20, P = .001), impulsivity (z = -2.44, P = .015), interpersonal difficulties (z = -2.15, P = .032), and overall borderline personality disorder symptoms (z = -2.11, P = .035). CONCLUSIONS: Taken together, these results suggest that internet-based psychoeducation is an effective form of early treatment for reducing the symptom severity of borderline personality disorder for periods up to 1 year. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01719731.

The 10-year course of adult aggression toward others in patients with borderline personality disorder and axis II comparison subjects.

This study had two aims. The first was to assess and compare various types of aggressive behavior toward others reported by borderline patients and axis II comparison subjects over time. The second was to determine the best baseline and time-varying predictors of aggressive behavior in these borderline patients. At baseline, a series of interviews and self-report measures were administered to 290 borderline patients and 72 axis II comparison subjects. Measures assessing aggression toward others, axis I and II disorders as well as adult adversity were re-administered every two years over the course of ten years. It was found that borderline patients reported significantly higher rates of verbal, emotional, and physical aggression toward others than comparison subjects but the rates of these forms of aggression toward others declined significantly for those in both study groups. Multivariate analyses indicated that the strongest predictors of adult aggression towards others were severity of adult adversity and a substance use disorder. Taken together, these results suggest that borderline patients commonly report aggression toward others but that this aggression declines significantly over time. These results also suggest that this aggression toward others is most strongly associated with adult experiences of adversity and concurrent substance abuse.

Treatment rates for patients with borderline personality disorder and other personality disorders: a 16-year study.

OBJECTIVE: The goal of this study was to document the use of 16 treatment modalities reported by 290 patients with borderline personality disorder and 72 patients with other axis II disorders over 16 years of prospective follow-up. METHODS: This study built upon previous findings of the McLean Study of Adult Development. Treatment use was assessed at baseline and at eight two-year follow-up periods with a semistructured interview of proven reliability and validity. RESULTS: Patients with borderline personality disorder reported significantly higher rates of use of 12 of the 16 treatment modalities studied. Only four of the 16 treatment modalities were used by roughly the same percentage of patients with borderline personality disorder and those with other axis II disorders: individual therapy, intensive individual therapy, couples or family therapy, and electroconvulsive therapy. In addition, rates of participation in 13 treatment modalities declined significantly over the first eight years of follow-up for those in both study groups. However, the rates of participation in 15 of 16 treatment modalities did not decline significantly over the second eight years of follow-up for those in either study group. CONCLUSIONS: The results of this study suggest that rates of treatment use by patients with borderline personality disorder decline significantly over the short and medium term. They also suggest that these rates remain stable or fail to decline further over the longer term.

The course of marriage/sustained cohabitation and parenthood among borderline patients followed prospectively for 16 years.

The purpose of this study was to determine the rate of marriage/sustained cohabitation and parenthood reported by recovered and nonrecovered borderline patients, the age first undertaken, and the stability of these relationships. Borderline patients were interviewed about these topics during their index admission and eight times over 16 years of prospective follow-up. Recovered borderline patients were significantly more likely than nonrecovered borderline patients to have married/lived with an intimate partner and to have become a parent. In addition, they first married/cohabited and became a parent at a significantly older age. They were also significantly less likely to have been divorced or ended a cohabiting relationship. In addition, they were significantly less likely to have given up or lost custody of a child. Taken together, the results of this study suggest that stable functioning as a spouse/partner and as a parent are strongly associated with recovery status for borderline patients.