Predictors of 2-Year Outcome for Patients With Borderline Personality Disorder

Columbia University, New York, New York, United States
American Journal of Psychiatry (Impact Factor: 12.3). 06/2006; 163(5):822-6. DOI: 10.1176/appi.ajp.163.5.822
Source: PubMed


The primary purpose of this report was to investigate whether characteristics of subjects with borderline personality disorder observed at baseline can predict variations in outcome at the 2-year follow-up.
Hypothesized predictor variables were selected from prior studies. The patients (N=160) were recruited from the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. Patients were assessed at baseline and at 6, 12, and 24 months with the Structured Clinical Interview for DSM-IV Axis I Disorders; the Diagnostic Interview for DSM-IV Personality Disorders, a modified version of that instrument; the Longitudinal Interval Follow-Up Evaluation; and the Childhood Experiences Questionnaire-Revised. Univariate Pearson's correlation coefficients were calculated on the primary predictor variables, and with two forward stepwise regression models, outcome was assessed with global functioning and number of borderline personality disorder criteria.
The authors' most significant results confirm prior findings that more severe baseline psychopathology (i.e., higher levels of borderline personality disorder criteria and functional disability) and a history of childhood trauma predict a poor outcome. A new finding suggests that the quality of current relationships of patients with borderline personality disorder have prognostic significance.
Clinicians can estimate 2-year prognosis for patients with borderline personality disorder by evaluating level of severity of psychopathology, childhood trauma, and current relationships.

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    • "This could result in low variance of traumatic experiences and consequently a publication bias due to non-significant results. However, childhood abuse has been correlated with poor functional outcome (Gunderson et al. 2006) and childhood sexual abuse has been reported as a significant independent predictor of poor psychosocial functioning, after controlling for age, gender and race amongst patients with borderline personality disorder (Zanarini et al. 2002). "
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    ABSTRACT: Objectives We aimed to examine the association between childhood trauma and functional impairment in psychotic disorders, bipolar disorder and borderline personality disorder, to speculate on possible mechanisms that underlie this association and discuss the implications for clinical work. Methods Narrative review of the peer-reviewed English language literature in the area. Results High rates of childhood trauma in psychotic disorders, bipolar disorder and borderline personality disorder were identified. This was associated with impaired social and occupational functioning in both the premorbid and established phases of each of these psychiatric disorders over and above the deficits typically observed in these populations. Possible mechanisms mediating this relationship include neurocognitive deficits, insecure attachment, higher rates of comorbidities and problems with adherence and response to treatment. Conclusions Routine clinical inquiry about childhood maltreatment should be adopted within mental health settings. This has potentially important treatment implications for identifying those individuals at elevated risk of functional disability. While there is no clear guidance currently available on how to target childhood trauma in the treatment of psychotic disorders, bipolar disorder or borderline personality disorder, there are several promising lines of enquiry and further research is warranted.
    Irish journal of psychological medicine 03/2015; 32(1):21-30. DOI:10.1017/ipm.2014.74
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    • "As a result, ethnic minorities have been underrepresented in BPD research, which has tended to focus on community samples (Bornovalova, Hicks, Iacono, & McGue, 2009; Grant et al., 2008; Korfine & Hooley, 2009; Samuels et al., 2002; Torgersen , Kringlen, & Cramer, 2001) or clinical populations (Gunderson et al., 2006; Korzekwa , Dell, Links, Thabane, & Webb, 2008; Pascual et al., 2008; Widiger & Weissman, 1991). Prevalence rates of BPD range from 1–2% in the general population (Samuels et al., 2002; Torgersen et al., 2001), 8–27% in psychiatric outpatient settings, and 15–51% among psychiatric inpatients (Gunderson et al., 2006; Korzekwa et al., 2008; Pascual et al., 2008; Widiger & Weissman, 1991). The few studies that have examined BPD among primary care patients (Gross et al., 2002; Hueston, Werth, & Mainous, 1999; Sansone & Sansone, 2003; Sansone, Whitecar, Meier, & Murry, 2001) have reported prevalence rates (6.4–26%) that are substantially higher than those observed in the general popula- tion. "
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    ABSTRACT: Objective: Few data are available on interpersonal trauma as a risk factor for borderline personality disorder (BPD) and its psychiatric comorbidity in ethnic minority primary care populations. This study aimed to examine the relation between trauma exposure and BPD in low-income, predominantly Hispanic primary care patients. Method: Logistic regression was used to analyze data from structured clinical interviews and self-report measures (n = 474). BPD was assessed with the McLean screening scale. Trauma exposure was assessed with the Life Events Checklist (LEC); posttraumatic stress disorder (PTSD) was assessed with the Lifetime Composite International Diagnostic Interview, other psychiatric disorders with the SCID-I, and functional impairment with items from the Sheehan Disability Scale and Social Adjustment Scale Self-Report (SAS-SR). Results: Of the 57 (14%) patients screening positive for BPD, 83% reported a history of interpersonally traumatic events such as sexual and physical assault or abuse. While interpersonal trauma experienced during adulthood was as strongly associated with BPD as interpersonal trauma experienced during childhood, noninterpersonal trauma was associated with BPD only if it had occurred during childhood. The majority (91%) of patients screening positive for BPD met criteria for at least one current DSM-IV Axis I diagnosis and exhibited significant levels of functional impairment. Conclusion: Increased awareness of BPD in minority patients attending primary care clinics, high rates of exposure to interpersonal trauma, and elevated risk for psychiatric comorbidity in this population may enhance physicians' understanding, treatment, and referral of BPD patients.
    Psychiatry Interpersonal & Biological Processes 12/2013; 76(4):365-80. DOI:10.1521/psyc.2013.76.4.365 · 3.05 Impact Factor
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    • "Otros encuentran una relación entre TLP y abuso emocional (Kingdon et al, 2010) y distintos tipos de abuso (Grover, 2007; Tyrka et al, 2009). Una historia de trauma en la infancia predice un mal pronóstico en pacientes borderline (Gunderson, 2006). Los síntomas de TEPT predicen junto con la sintomatología disociativa las conductas autodestructivas (Spitzer et al, 2000; Sansone et al, 1995). "
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    ABSTRACT: Borderline personality disorder and dissociation are strongly related. DSM-IV-R criteria of BPD, for instance, include isola- ted dissociative symptoms (APA, 1994). Two thirds of BPD may be diagnosed of a dissociative disorder. Both diagnoses have been related with high rates of childhood trauma. The close relationship between trauma, dissociation and borderli- ne features can be understood from the perspective of the theory of structural dissociation of the personality (Van der Hart, Nijenhuis & Steele, 2006/2008) which transcends the traditional approach of describing “comorbidity”. In this arti- cle we will review the empirical data which supports the rela- tion between early traumatizing and attachment disruption situations, and both borderline and dissociative symptoms. Borderline personality disorder will be explained in terms of structural dissociation of the personality.
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