Axis II comorbidity of borderline personality disorder: Description of 6-year course and prediction to time-to-remission

Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA, USA.
Acta Psychiatrica Scandinavica (Impact Factor: 5.61). 01/2005; 110(6):416-20. DOI: 10.1111/j.1600-0447.2004.00362.x
Source: PubMed

ABSTRACT The purpose of this study was to compare the axis II comorbidity of 202 patients whose borderline personality disorder (BPD) remitted over 6 years of prospective follow-up to that of 88 whose BPD never remitted.
The axis II comorbidity of 290 patients meeting both DIB-R and DSM-III-R criteria for BPD was assessed at baseline using a semistructured interview of demonstrated reliability. Over 96% of surviving patients were reinterviewed about their co-occurring axis II disorders blind to all previously collected information at three distinct follow-up waves: 2-, 4-, and 6-year follow-up.
Both remitted and non-remitted borderline patients experienced declining rates of most types of axis II disorders over time. However, the rates of avoidant, dependent, and self-defeating personality disorders remained high among non-remitted borderline patients. Additionally, the absence of these three disorders was found to be significantly correlated with a borderline patient's likelihood-of-remission and time-to-remission; self-defeating personality disorder by a factor of 4, dependent personality disorder by a factor of 3 1/2, and avoidant personality disorder by a factor of almost 2.
The results of this study suggest that axis II disorders co-occur less commonly with BPD over time, particularly for remitted borderline patients. They also suggest that anxious cluster disorders are the axis II disorders which most impede symptomatic remission from BPD.

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    • "In addition, comorbid Axis I (e.g., Grant et al., 2008; Zanarini et al. 2004a) and Axis II (e.g., Grant et al., 2008; Zanarini et al., 2004b) disorders are very common among BPD patients. "
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    ABSTRACT: In this chapter we discuss in detail the findings on overgeneral memory / reduced memory specificity in patients with borderline personality disorder. Additionally, we investigate to what extent these findings are consistent with the prevailing theoretical models on autobiographical memory organization. Finally, directions for further research are outlined.
    Clinical Perspectives on Autobiographical Memory, Edited by Lynn Watson, dorthe berntsen, 04/2015: chapter Overgeneral memory in borderline personality disorder: pages 221-241; Cambridge University Press., ISBN: 9781107039872
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    • "Our results demonstrate a significant decrease in identity diffusion and instability of the image of self and others during the relatively short, specific inpatient treatment, compared with inpatient TAU. Although the DST group showed a significant higher Axis II Cluster C comorbidity, which presumably impedes a successful outcome (Zanarini et al., 2004), these patients benefited from inpatient psychotherapy. It seems that the absence of the TFP-based emphasis on identity diffusion in the TAU group explains its lack of positive change. "
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    ABSTRACT: Patients with borderline personality disorder (BPD) show various psychopathological symptoms and suffer especially from disturbance in their identity. The purpose of the study was to investigate changes—particularly in affective BPD symptoms and identity diffusion—during a structured, disorder-specific inpatient treatment (DST) that combined a psychodynamic transference-focused psychotherapy approach with modules of dialectical behavioural skills training. In a prospective, two-group comparison trial, 44 patients with BPD were assessed with questionnaires addressing identity diffusion and state, as well as trait affective psychopathology, before and after 12 weeks of inpatient treatment. Thirty-two patients received DST, whereas 12 patients were given inpatient treatment-as-usual (TAU). The patients were allocated in a non-random procedure for two groups, in order of admission and availability of treatment options in the DST unit. In the pre-post-comparison, the DST group showed a significant decrease in identity diffusion (p < 0.001) and improvements in instability of the image of self and others (p < 0.008), as well as in pathological (trait and state) symptoms. However, there was no significant improvement in the TAU group. After a 12-week inpatient treatment, the findings indicate significant improvements in the DST group in typical affective borderline symptomatology and in the personality structure feature of identity diffusion. This highlights the significance of a short-term specific inpatient therapy for BPD. Copyright
    Clinical Psychology & Psychotherapy 08/2014; DOI:10.1002/cpp.1915 · 2.59 Impact Factor
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    • "There are 126 different possibilities (clusters) to fulfil the diagnostic criteria for BPD (at least 5 of 9 different criteria) [9]. These dissimilarities can lead to alternate courses of the disorder [10] as well as different treatment responses. "
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    ABSTRACT: The core features of borderline personality disorder (BPD) are affective instability, unstable relationships and identity disturbance. Axis I comorbidities are frequent, in particular affective disorders. The concept of atypical depression is complex and often underestimated. The purpose of the study was to investigate the comorbidity of atypical depression in borderline patients regarding anxiety-related psychopathology and interpersonal problems. Sixty patients with BPD were assessed with the Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID I, SCID II) as well as the Atypical Depression Diagnostic Scale (ADDS). Additionally, patients completed a questionnaire (SCL-90-R, BDI, STAI, STAXI, IIP-C). Forty-five BPD patients (81.8%) had a comorbid affective disorder of which 15 (27.3%) were diagnosed with an atypical depression. In comparison to patients with major depressive disorder or no comorbid depression, patients with atypical depression showed significant higher scores in psychopathological symptoms regarding anxiety and global severity as well as interpersonal problems. The presence of atypical depression in borderline patients is correlated with psychopathology, anxiety, and interpersonal problems and seems to be of clinical importance for personalized treatment decisions.
    Comprehensive psychiatry 12/2013; 55(3). DOI:10.1016/j.comppsych.2013.11.021 · 2.25 Impact Factor
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