Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group

Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
Comprehensive Psychiatry (Impact Factor: 2.25). 07/2007; 48(4):329-36. DOI: 10.1016/j.comppsych.2007.02.001
Source: PubMed


This study compared psychosocial functioning and treatment utilization in 130 participants who were diagnosed with a borderline personality disorder (BPD), a non-BPD personality disorder (OPD), a mood and/or anxiety disorder (MAD), or had no current psychiatric diagnosis and served as a healthy comparison group. Diagnostic and Statistical Manual of Mental Disorders (4th Edition) diagnoses, psychosocial functioning, and treatment utilization were determined by using well-established semistructured research interviews conducted by trained doctoral-level clinicians. Analysis of variance revealed the most severe deficits in functioning characterized the BPD group across areas of global functioning with more moderate impairments in functioning occurring in OPD and MAD groups. The BPD group was characterized by significantly greater psychiatric and nonpsychiatric treatment utilization than the other groups. These findings indicate that BPD as well as other personality disorders are a source of considerable psychologic distress and functional impairment equivalent to, and at times exceeding, the distress found in mood and anxiety disorders. The public health impact of BPD diagnosis is highlighted by the high rates of psychiatric and nonpsychiatric treatment utilization.

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    • "This agrees with the finding that Negative Emotionality (or Neuroticism) underlies a great deal of psychopathology (Claridge & Davis, 2001), including personality pathology (Saulsman & Page, 2004; Tromp & Koot, 2009), and is one of the best predictors of clinical and societal costs (Cuijpers et al., 2010; Lahey, 2009; Ozer & Benet-Mart ınez, 2006; Roberts et al., 2007; Steel, Schmidt, & Shultz, 2008). Borderline PD, the only DSM disorder clearly embedded into our Negative Emotionality dimension (Guti errez et al., 2014), has also proved to be the most detrimental of all PDs (Ansell et al., 2007; Zanarini et al., 2005, 2009). "
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    ABSTRACT: Dimensional pathology models are increasingly being accepted for the assessment of disordered personalities, but their ability to predict negative outcomes is yet to be studied. We examine the relative clinical impact of seven basic dimensions of personality pathology through their associations with a wide range of clinical outcomes. A sample of 960 outpatients was assessed through a 7-factor model integrating the Cloninger, the Livesley, and the DSM taxonomies. Thirty-six indicators of clinical outcome covering three areas - dissatisfaction, functional difficulties, and clinical severity - were also assessed. The unique contribution of each personality dimension to clinical outcome was estimated through multiple regressions. Overall, personality dimensions explained 17.6% of the variance of clinical outcome, but varied substantially in terms of their unique contributions. Negative Emotionality had the greatest impact in all areas, contributing 43.9% of the explained variance. The remaining dimensions led to idiosyncratic patterns of clinical outcomes but had a comparatively minor clinical impact. A certain effect was also found for combinations of dimensions such as Negative Emotionality × Impulsive Sensation Seeking, but most interactions were clinically irrelevant. Our findings suggest that the most relevant dimensions of personality pathology are associated with very different clinical consequences and levels of harmfulness. The relative clinical impact of seven basic dimensions of personality pathology is examined. Negative Emotionality (Neuroticism) is 6-14 times as harmful as other pathological dimensions. The remaining dimensions and their interactions have very specific and comparatively minor clinical consequences. We examine only a handful of clinical outcomes. Our results may not be generalizable to other clinical or life outcomes. Our variables are self-reported and hence susceptible to bias. Our design does not allow us to establish causal relationships between personality and clinical outcomes. © 2015 The British Psychological Society.
    British Journal of Clinical Psychology 06/2015; DOI:10.1111/bjc.12091 · 1.90 Impact Factor
    • "The review by Paris and Black (2015), then, is more of an advocacy for BPD than other reviews have been. The aforementioned morbidity and mortality due to bipolar disorder are matched by a similar literature focused on BPD (Ansell et al., 2007; Jeung and Herpertz, 2014; Pompili et al., 2005; Zanarini et al., 2009). However, these are independent literatures, and it is difficult to evaluate the relative morbidity of each disorder in the absence of direct comparisons. "
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    ABSTRACT: Compared with bipolar disorder, borderline personality disorder (BPD) is as frequent (if not more frequent), as impairing (if not more impairing), and as lethal (if not more lethal). Yet, BPD has received less than one-tenth the funding from the National Institutes of Health than has bipolar disorder. More than other reviewers of the literature on the interface between bipolar disorder and BPD, Paris and Black (Paris J and Black DW (2015) Borderline Personality Disorder and Bipolar Disorder: What is the Difference and Why Does it Matter? J Nerv Ment Dis 203:3-7) emphasize the clinical importance of correctly diagnosing BPD and not overdiagnosing bipolar disorder, with a focus on the clinical feature of affective instability and how the failure to recognize the distinction between sustained and transient mood perturbations can result in misdiagnosing patients with BPD as having bipolar disorder. The review by Paris and Black, then, is more of an advocacy for BPD than other reviews in this area have been. In the present article, the author will illustrate how the bipolar disorder research community has done a superior job of advocating for and "marketing" their disorder compared with researchers of BPD. Specifically, researchers of bipolar disorder have conducted multiple studies highlighting the problem with underdiagnosis, written commentaries about the problem with underdiagnosis, developed and promoted several screening scales to improve diagnostic recognition, published numerous studies of the operating characteristics of these screening measures, attempted to broaden the definition of bipolar disorder by advancing the concept of the bipolar spectrum, and repeatedly demonstrated the economic costs and public health significance of bipolar disorder. In contrast, researchers of BPD have almost completely ignored each of these issues and thus have been less successful in highlighting the public health significance of the disorder.
    The Journal of nervous and mental disease 01/2015; 203(1):8-12. DOI:10.1097/NMD.0000000000000226 · 1.69 Impact Factor
    • "Both bipolar disorder and borderline personality disorder are serious mental health disorders resulting in significant psychosocial morbidity, reduced health related quality of life, and excess mortality. In largely separate literatures both disorders have been associated with impaired occupational functioning (Skodol et al., 2002; Morgan et al., 2005; Kessler et al., 2006; Ansell et al., 2007; Zanarini et al., 2009; Zimmerman et al., 2010), impaired social functioning (Jovev and Jackson, 2006; Grant et al., 2008; Judd et al., 2008; Gunderson et al., 2011; Miklowitz, 2011; Jeung and Herpertz, 2014; Lazarus et al., 2014), substance use problems (Trull et al., 2000; Goldberg, 2001; Grant et al., 2008; Oquendo et al., 2010; Farren et al., 2012; Di Florio et al., 2014), high rates of suicide (Isometsa et al., 1994; Angst et al., 2002; Pompili et al., 2005; Baldessarini et al., 2006; McIntyre et al., 2008; Oquendo et al., 2010;) and suicide attempts, (Baldessarini et al., 2006; McIntyre et al., 2008; Oquendo et al., 2010; Zimmerman et al., 2014), and high health care utilization and costs (Bender et al., 2001; Morgan et al., 2005; Kessler et al., 2006; van Asselt et al., 2007; Soeteman et al., 2008; Dilsaver, 2011; Williams et al., 2011; Kleine-Budde et al., 2013). While both disorders are associated with high levels of morbidity and mortality, they are perceived differently. "
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    ABSTRACT: The relationship between bipolar disorder and borderline personality disorder has generated intense interest. Similar to patients with bipolar disorder, patients with borderline personality disorder are frequently hospitalized, are chronically unemployed, abuse substances, attempt and commit suicide. However, one significant difference between the two disorders is that patients with borderline personality disorder are often viewed negatively by mental health professionals. In the present paper we examined whether this negative bias against borderline personality disorder might be reflected in the level of research funding on the disorder. We searched the National Institute of Health (NIH) Research Portfolio Online Portfolio Reporting Tool (RePORT) for the past 25 years and compared the number of grants funded and the total amount of funding for borderline personality disorder and bipolar disorder. The yearly mean number of grants receiving funding was significantly higher for bipolar disorder than for borderline personality disorder. Results were the same when focusing on newly funded grants. For every year since 1990 more grants were funded for bipolar disorder than borderline personality disorder. Summed across all 25 years, the level of funding for bipolar disorder was more than 10 times greater than the level of funding for borderline personality disorder ($622 million vs. $55 million). These findings suggest that the level of NIH research funding for borderline personality disorder is not commensurate with the level of psychosocial morbidity, mortality, and health expenditures associated with the disorder.
    Psychiatry Research 10/2014; 220(3). DOI:10.1016/j.psychres.2014.09.021 · 2.47 Impact Factor
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