Article

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

Harvard University, Cambridge, Massachusetts, United States
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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    • "Further analysis showed that anxiety disorders were most common, followed by PTSD (Zanarini et al., 1998). Regarding personality disorders, paranoid, avoidant, and dependent personality disorders were most co-morbid both at first diagnosis and at a 6-year follow-up (Zanarini et al., 2004). Ten, twelve, and sixteen year followups showed stagnant results (Zanarini & Frankenburg, 2008;Zanarini, Frankenburg, Reich, & Fitzmaurice, 2010). "

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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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    • "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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