ABSTRACT
This prospective cohort study of patients with borderline psychopathology reports on the clinical disorders occurring during the course and at 7-year follow-up. Subjects with persistent versus remitted borderline personality disorder (BPD) are compared. The relationship between the initial levels of borderline psychopathology and the occurrence of clinical disorders on follow-up is examined. Consecutive admissions to inpatient units were screened for borderline characteristics. This resulted in a sample of 130 subjects, 88 of whom were positive for BPD based on the Diagnostic Interview for Borderlines. At 7-year follow-up, 81 (62.3%) subjects were reinterviewed in person, 6 (4.6%) suicided, 2 (1.6%) were decreased, 36 (27.7%) refused to participate, and 5 (3.8%) could not be located. Twenty-seven of 57 (47.4%) who initially were positive for BPD were rediagnosed at 7-year follow-up (the persistent group) and 30 (52.6%) were no longer diagnosed as BPD (the remitted group). The persistent individuals were significantly more likely to be diagnosed as having major depression, dysthymia, and other psychiatric disorders than the remitted group. The persistent group had significantly more episodes of substance abuse over the follow-up period compared with the remitted group. Individuals with persistent BPD suffered more episodes of clinical disorders over the follow-up period and the initial level of borderline psychopathology predicted the recurrence of major depression.
Subject(s)
Borderline Personality Disorder/psychology , Adolescent , Aged , Borderline Personality Disorder/diagnosis , Depressive Disorder/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Psychiatric Status Rating Scales , RecurrenceSubject(s)
Borderline Personality Disorder/etiology , Social Environment , Adult , Emotions , Family , Female , Humans , MaleABSTRACT
The objective of this paper was to examine the prognostic significance of borderline personality disorder (BPD) and substance abuse in a cohort of former inpatients screened for BPD and followed up prospectively seven years after the index admission. The impact of comorbidity on borderline psychopathology, impulsivity and psychosocial functioning was examined. The original cohort was assembled between April 1983 and December 1985. Admissions were screened for borderline characteristics which resulted in a sample of 130 subjects, 88 of whom were positive for BPD based on the Diagnostic Interview for Borderlines. At seven years follow-up, 81 out of 130 (62.3%) subjects were re-interviewed. Six (4.6%) had committed suicide, two (1.5%) were deceased and 41 (31.6%) were lost to follow-up. The subjects with BPD and substance abuse were significantly differentiated from subjects with BPD only, substance abuse only and neither disorder on the basis of demonstrating more borderline psychopathology and more self-destructive and suicidal thoughts and behaviours. Probands with initial diagnoses of BPD and substance abuse were twice as likely to be diagnosed BPD on follow-up as probands with initial diagnosis of BPD only (relative risk = 2.19, 95% CI, 1.21 to 3.97). These findings and other research suggest that patients with comorbid BPD and substance abuse should be encouraged to focus on their abuse problems as a priority.
Subject(s)
Borderline Personality Disorder/epidemiology , Substance-Related Disorders/epidemiology , Adolescent , Adult , Alcoholism/diagnosis , Alcoholism/epidemiology , Alcoholism/psychology , Borderline Personality Disorder/diagnosis , Borderline Personality Disorder/psychology , Cohort Studies , Comorbidity , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Admission , Personality Assessment , Prospective Studies , Risk Factors , Social Adjustment , Substance-Related Disorders/diagnosis , Substance-Related Disorders/psychology , Suicide/psychology , Suicide/statistics & numerical dataABSTRACT
The purpose of this study is to identify variables predictive of the psychosocial outcomes of borderline patients 2 years following an acute psychiatric hospitalization. Of the initial 88 inpatients scoring positive for the Diagnostic Interview for Borderlines (DIB), 65 (73.8%) were reinterviewed, 14 (15.9%) refused, five (5.7%) were unable to be located, and four (4.6%) suicided. The dropouts (n = 19) were significantly more likely to be single, separated, or divorced, to be male, and to be diagnosed as having co-existing antisocial personality disorder than the followed-up probands (n = 69). In terms of global functioning, over the 2-year follow-up period, 61 (87.7%) of the 69 probands were judged to be functioning normally less than 50% of the follow-up interval. Using logistic regression, two variables, initial impulse action scores and poor premorbid functioning, predicted poor versus good outcome. This study supports the literature, which indicates that the early course of borderline personality disorder (BPD) is stormy. Impulsivity and poor premorbid functioning may be predictive of poor short-term outcome in borderline patients.
