Prediction of the 10-Year Course of Borderline Personality Disorder

Harvard University, Cambridge, Massachusetts, United States
American Journal of Psychiatry (Impact Factor: 12.3). 06/2006; 163(5):827-32. DOI: 10.1176/appi.ajp.163.5.827
Source: PubMed


The purpose of this study was to determine the most clinically relevant baseline predictors of time to remission for patients with borderline personality disorder.
A total of 290 inpatients meeting criteria for both the Revised Diagnostic Interview for Borderlines and DSM-III-R for borderline personality disorder were assessed during their index admission with a series of semistructured interviews and self-report measures. Diagnostic status was reassessed at five contiguous 2-year time periods. Discrete survival analytic methods, which controlled for baseline severity of borderline psychopathology and time, were used to estimate hazard ratios.
Eighty-eight percent of the patients with borderline personality disorder studied achieved remission. In terms of time to remission, 39.3% of the 242 patients who experienced a remission of their disorder first remitted by their 2-year follow-up, an additional 22.3% first remitted by their 4-year follow-up, an additional 21.9% by their 6-year follow-up, an additional 12.8% by their 8-year follow-up, and another 3.7% by their 10-year follow-up. Sixteen variables were found to be significant bivariate predictors of earlier time to remission. Seven of these remained significant in multivariate analyses: younger age, absence of childhood sexual abuse, no family history of substance use disorder, good vocational record, absence of an anxious cluster personality disorder, low neuroticism, and high agreeableness.
The results of this study suggest that prediction of time to remission from borderline personality disorder is multifactorial in nature, involving factors that are routinely assessed in clinical practice and factors, particularly aspects of temperament, that are not.

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    • "Mejorías modestas en funcionamiento social. Zanarini y colaboradores (2006) Seguimiento de 10 años a pacientes (n= 290) con TPL. 88% lograron remisión total del trastorno. "
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    ABSTRACT: ABSTRACT: Prior to the 1980s there was a general belief that patients with Borderline Personality Disorders (BPD) could not show recovery from their disorder. For various decades there was a therapeutic pessimism regarding their prognosis. Nevertheless, those opinions were not based on longitudinal studies. In the last 30 years a diverse group of researchers have published the results of several longitudinal studies, which show that patients with Personality Disorders in general demonstrate marked favorable changes in their clinical profile. When persons with BPD are included in prolonged follow-ups, the results show that more than 50% demonstrate a marked recovery from their disorder. Nevertheless, it seems that there are some personality traits that are more recalcitrant to show changes and adjustments. In this article we review recent longitudinal data and make some therapeutic recommendations. RESUMEN: Anterior a la década de los 1980s se mantenía una creencia general que postulaba que los pacientes con Trastornos de Personalidad Limítrofe (TPL) difícilmente se podrían recuperar de su diagnóstico clínico. Por varias décadas reinó un pesimismo terapéutico respecto a un mejor pronóstico. Sin embargo, dichas opiniones no se basaban en estudios longitudinales. En los últimos 30 años ya han salido a relucir los resultados de varios estudios longitudinales, los cuales revelan que los Trastornos de Personalidad (TP) en general son mucho más maleables e inestables de lo que se suponía. Cuando se estudia el TPL de manera específica, tenemos que en seguimientos de 10 años, más de la mitad han mantenido una recuperación sostenida. Sin embargo, tal parece que algunos de los rasgos de personalidad son más resistentes al cambio. En este artículo se realiza una revisión detallada de dichos hallazgos y se plantean recomendaciones sobre el manejo clínico de estos pacientes. PALABRAS CLAVE: Trastorno de personalidad limítrofe, estudios longitudinales, psicopatología.
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    • "In conclusion, despite reports of low temporal stability of BPD in adolescents (Zanarini, Frankenburg, Hennen, Reich, et al., 2006) it has been evidenced that dysfunctional areas of borderline personality disorder (like identity disturbance, affective instability, relational difficulties, impulsivity) could represent a clinical core which is relevant for an accurate diagnosis (Miller et al., 2008). In this realm, the IPOP-A seems to be a promising tool in the assessment of those personality dimensions during adolescence. "
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    ABSTRACT: Borderline personality disorder can be assessed in adolescence mainly through a dimensional approach that takes into account strengths and weaknesses of emerging personality patterns. Clinical interviews could help clinicians to gather information about adolescent’s functioning, fostering therapeutic alliance and promoting a mentalizing stance during the assessment of borderline adolescents. In this article, the Interview of Personality Organization Processes in Adolescence (IPOP-A) is presented through clinical case material to show its usefulness in clinical and research settings. The IPOP-A assesses an adolescent’s emerging personality along three dimensions: identity, quality of object relations and affect regulation. These dimensions are the core of borderline personality in adolescence.
    Journal of Infant Child and Adolescent Psychotherapy 03/2015; 14(1):82-97. DOI:10.1080/15289168.2015.1003722
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    • "Fifty-eight percent of inpatients and 25% of outpatients with BPD also meet diagnostic criteria for PTSD (Golier et al., 2010; Zanarini et al., 2011)—twice as many as patients with other types of personality disorder. Patients with comorbid BPD–PTSD are hospitalized more frequently than patients with BPD alone (Zlotnick et al., 2003) and are less likely to achieve remission from BPD (Zanarini et al., 2006). They also have a poorer quality of life, greater emotional dysregulation, more comorbidity with other Axis I conditions such as major depression, higher rates of non-suicidal self-harm and higher lifetime odds of making a suicide attempt (Harned et al., 2010a; Pagura et al., 2010). "
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    ABSTRACT: Individuals with borderline personality disorder (BPD) and comorbid post-traumatic stress disorder (PTSD) have a worse prognosis than individuals with BPD alone. A common view is that the emotional instability and impulsivity of BPD should be treated before attempting to address trauma. However, PTSD symptoms may interfere with patients' ability to benefit from such 'stabilizing' treatments. The effect of BPD-PTSD comorbidity on self-harm and BPD symptom outcomes was evaluated in 89 patients receiving dialectical behaviour therapy, using multilevel modelling. Patients with comorbid BPD-PTSD showed a trend towards elevated BPD symptoms throughout the treatment year (β = 2.12, 95% CI = -0.21-4.44, p = 0.07). There was a three-way interaction between PTSD comorbidity, treatment completion and time, whereby PTSD comorbidity was associated with less reduction in self-harm frequency over time, but only in those completing the full 12 months of treatment (incident risk ratio = 1.16, 95% CI = 1.04-1.30, p < 0.01). Patients with comorbid PTSD had a poorer outcome from dialectical behaviour therapy than those with BPD alone, possibly because of the negative impact of unaddressed trauma. The results provide further grounds for recently developed treatments targeting BPD traits and PTSD symptoms simultaneously. Copyright © 2013 John Wiley & Sons, Ltd.
    Personality and Mental Health 08/2013; 7(3):181-90. DOI:10.1002/pmh.1227 · 1.10 Impact Factor
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