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Hastrup LH, Jennum P, Ibsen R, Kjellberg J, Simonsen E. Borderline personality disorder and the diagnostic co-occurrence of mental health disorders and somatic diseases: A controlled prospective national register-based study. Acta Psychiatr Scand 2024; 149:124-132. [PMID: 38072006 DOI: 10.1111/acps.13642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/27/2023] [Accepted: 11/20/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Information on borderline personality disorder (BPD) and its comorbidities is often limited to concentrate on a few diagnoses. The aim of the study was to use national register data to investigate all diagnostic co-occurring mental health disorders and somatic diseases 3 years before and after initial BPD diagnosis compared with a matched control group. METHOD The study was a register-based cohort of 2756 patients with incident BPD (ICD F60.3) and 11,024 matched controls, during 2002-2016. Comorbidity data were classified into main disease groups, in accordance with the World Health Organization ICD-10 criteria. RESULTS Almost half the patients had been diagnosed with mental and behavioral disorders before the BPD diagnosis as compared to 3% in the control group. Further, the co-occurrence of diseases due to external causes of morbidity, including injury, self-harm, and poisoning were more represented in the BPD group before diagnosis as compared to the control group. In addition, co-occurring morbidity related to diseases in the circulatory, the respiratory, the digestive, the musculoskeletal, and the genitourinary system was more represented in the BPD group. After diagnosis, the proportion of patients with co-occurring morbidity increased further in all main disease groups in the BPD group. As many as 87% of patients had mental and behavioral co-occurring morbidity and 15% nervous diseases as compared with 3% and 4%, respectively, in the control group. Also, comorbidities related to external causes of morbidity, including for example, injury and self-harm were more represented in the BPD group. The BPD group had more somatic co-occurring morbidity, especially digestive, respiratory, circulatory, and endocrine diseases. Finally, the mortality over 12 years was statistically significantly higher in people with BPD than in the control group. CONCLUSION Patients with BPD have higher odds for multiple physical health conditions and co-occurrence of mental health disorders.
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Affiliation(s)
- L H Hastrup
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - P Jennum
- Faculty of Health Sciences, Danish Center for Sleep Medicine, Neurophysiology Clinic, University of Copenhagen, Copenhagen, Denmark
| | | | - J Kjellberg
- Danish Center for Social Science Research (VIVE), Copenhagen, Denmark
| | - E Simonsen
- Mental Health Service East, Psychiatry Region Zealand, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Aloi MS, Poblete GF, Oldham J, Patriquin MA, Nielsen DA, Kosten TR, Salas R. miR-124-3p target genes identify globus pallidus role in suicide ideation recovery in borderline personality disorder. NPJ MENTAL HEALTH RESEARCH 2023; 2:8. [PMID: 37712050 PMCID: PMC10500603 DOI: 10.1038/s44184-023-00027-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/11/2023] [Indexed: 09/16/2023]
Abstract
Borderline personality disorder (BPD) is characterized by patterns of unstable affect, unstable interpersonal relationships, and chronic suicidal tendencies. Research on the genetics, epigenetics, and brain function of BPD is lacking. MicroRNA-124-3p (miR-124-3p) was recently identified in a Genome-Wide Association Study as likely associated with BPD. Here, we identified the anatomical brain expression of genes likely modulated by miR-124-3p and compared morphometry in those brain regions in BPD inpatients vs. controls matched for psychiatric comorbidities. We isolated lists of targets likely modulated by miR-124-3p from TargetScan (v 8.0) by their preferentially conserved targeting (Aggregate PCT > 0.99, see Supplementary Table 1). We applied Process Genes List (PGL) to identify regions of interest associated with the co-expression of miR-124-3p target genes. We compared the gray matter volume of the top region of interest co-expressing those genes between BPD inpatients (n = 111, 46% female) and psychiatric controls (n = 111, 54% female) at The Menninger Clinic in Houston, Texas. We then correlated personality measures, suicidal ideation intensity, and recovery from suicidal ideation with volumetrics. Gene targets of miR-124-3p were significantly co-expressed in the left Globus Pallidus (GP), which was smaller in BPD than in psychiatric controls. Smaller GP volume was negatively correlated with agreeableness and with recovery from suicidal ideation post-treatment. In BPD, GP volume may be reduced through miR-124-3p regulation and suppression of its target genes. Importantly, we identified that a reduction of the GP in BPD could serve as a potential biomarker for recovery from suicidal ideation.
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Affiliation(s)
- Macarena S. Aloi
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
- These authors contributed equally: Macarena S. Aloi, Guillermo F. Poblete
| | - Guillermo F. Poblete
- The Menninger Clinic, Baylor College of Medicine, Houston, TX, USA
- These authors contributed equally: Macarena S. Aloi, Guillermo F. Poblete
| | - John Oldham
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
- The Menninger Clinic, Baylor College of Medicine, Houston, TX, USA
| | - Michelle A. Patriquin
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
- The Menninger Clinic, Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical Center, Houston, TX, USA
| | - David A. Nielsen
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical Center, Houston, TX, USA
| | - Thomas R. Kosten
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical Center, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Ramiro Salas
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
- The Menninger Clinic, Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical Center, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Center for Translational Research on Inflammatory Diseases, Michael E DeBakey VA Medical Center, Houston, TX, USA
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d'Huart D, Seker S, Bürgin D, Birkhölzer M, Boonmann C, Schmid M, Schmeck K. The stability of personality disorders and personality disorder criteria: A systematic review and meta-analysis. Clin Psychol Rev 2023; 102:102284. [PMID: 37116251 DOI: 10.1016/j.cpr.2023.102284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/29/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
The aim of this systematic review and meta-analysis was to investigate the diagnostic, the dimensional mean-level, and rank-order stability of personality disorders (PDs) and PD criteria over time. EMBASE, PsycInfo, PubMed, and Web of Science were searched for peer-reviewed studies published in either English, German, or French between the first publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 and December 20, 2022. Inclusion criteria were a prospective longitudinal study design, assessing the stability of PDs or PD criteria over at least two measurement occasions at least one month apart, and using the same assessment at baseline and follow-up. Effect sizes included proportion of enduring cases (i.e., diagnostic stability), test-retest correlations (i.e., dimensional rank-order stability), and within-group standardized mean differences (i.e., dimensional mean-level stability), based on the first and last available measurement occasion. From an initial pool of 1473 studies, 40 were included in our analyses, covering 38,432 participants. 56.7% maintained the diagnosis of any PD, and 45.2% maintained the diagnosis of borderline PD over time. Findings on the dimensional mean-level stability indicate that most PD criteria significantly decreased from baseline to follow-up, except for antisocial, obsessive-compulsive, and schizoid PD criteria. Findings on the dimensional rank-order stability suggested moderate estimates, except for antisocial PD criteria, which were found to be high. Findings indicated that both PDs and PD criteria were only moderately stable, although between study heterogeneity was high, and stability itself depended on several methodological factors.
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Affiliation(s)
- Delfine d'Huart
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland. Delfine.d'
| | - Süheyla Seker
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - David Bürgin
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Marc Birkhölzer
- Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Cyril Boonmann
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland; Department of Forensic Child and Adolescent Psychiatry, University Psychiatric Clinics Basel, Basel, Switzerland; LUMC Curium - Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Marc Schmid
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Hospitals Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Clinical Research, Medical Faculty, University of Basel, Basel, Switzerland
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Høj Jørgensen TS, Osler M, Jorgensen MB, Jorgensen A. Mapping diagnostic trajectories from the first hospital diagnosis of a psychiatric disorder: a Danish nationwide cohort study using sequence analysis. Lancet Psychiatry 2023; 10:12-20. [PMID: 36450298 DOI: 10.1016/s2215-0366(22)00367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A key clinical problem in psychiatry is predicting the diagnostic future of patients presenting with psychopathology for the first time. The objective of this study was to establish a comprehensive map of subsequent diagnoses after a first psychiatric hospital diagnosis. METHODS Through the Danish National Patient Registry, we identified patients aged 18 years or older with an inpatient or outpatient psychiatric hospital contact and who had received one of the 20 most common first-time psychiatric diagnoses (defined at the ICD-10 two-cipher level, F00-F99) between Jan 1, 1995, and Dec 31, 2008. For each first-time diagnosis, the 20 most frequent subsequent psychiatric diagnoses (F00-F99), and death, occurring during 10 years of follow-up were identified as outcomes. To assess diagnostic stability, we used social sequence analyses, assigning a subsequent diagnosis to each state with a length of 6 months following each first-time diagnosis. The subsequent diagnosis was defined as the last diagnosis given within each 6-month period. We calculated the normalised entropy of each sequence to show the uncertainty of predicting the states in a given sequence. Cox proportional hazards models were used to assess the risk of receiving a subsequent diagnosis (at the one-cipher level, F0-F9) after each first-time diagnosis. FINDINGS The cohort consisted of 184 949 adult patients (77 129 [41·7%] men and 107 820 [58·3%] women, mean age 42·5 years [SD 18·5; range 18 to >100). Ethnicity data were not recorded. Over 10 years of follow-up, 86 804 (46·9%) patients had at least one subsequent diagnosis that differed from their first-time diagnosis. Measured by mean normalised entropy values, persistent delusional disorders (ICD-10 code F22), mental and behavioural disorders due to multiple drug use and use of other psychoactive substances (F19), and acute and transient psychotic disorders (F23) had the highest diagnostic variability, whereas eating disorders (F50) and non-organic sexual dysfunction (F52) had the lowest. The risk of receiving a subsequent diagnosis with a psychiatric disorder from an ICD-10 group different from that of the first-time diagnosis varied substantially among first-time diagnoses. INTERPRETATION These data provide detailed information on possible diagnostic outcomes after a first-time presentation in a psychiatric hospital. This information could help clinicians to plan relevant follow-up and inform patients and families on the degree of diagnostic uncertainty associated with receiving a first psychiatric hospital diagnosis, as well as likely and unlikely trajectories of diagnostic progression. FUNDING Mental Health Services, Capital region of Denmark. TRANSLATION For the Danish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Terese Sara Høj Jørgensen
- Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark.
| | - Merete Osler
- Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Denmark
| | - Martin Balslev Jorgensen
- Department of Public Health, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Anders Jorgensen
- Department of Public Health, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Bliton CF, Rosenstein LK, Pincus AL. Trading Patients: Applying the Alternative Model for Personality Disorders to Two Cases of DSM-5 Borderline Personality Disorder Over Time and Across Therapists. Front Psychol 2022; 13:794624. [PMID: 35237208 PMCID: PMC8884405 DOI: 10.3389/fpsyg.2022.794624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
The DSM-5 Alternative Model for Personality Disorders (AMPD) dimensionally defines personality pathology using severity of dysfunction and maladaptive style. As the empirical literature on the clinical utility of the AMPD grows, there is a need to examine changes in diagnostic profiles and personality expression in treatment over time. Assessing these changes in individuals diagnosed with borderline personality disorder (BPD) is complicated by the tendency for patients to cycle through multiple therapists over the course of treatment leaving the potential for muddled diagnostic clarity and disjointed case conceptualizations. Following patient trajectories across therapists offers a unique opportunity to examine the AMPD’s sensitivity to and utility for capturing personality stability and change over time for patients with BPD. This article demonstrates the utility of the AMPD for two clinical cases in three distinct ways: (i) highlighting heterogeneity in BPD between patients, (ii) comparing improvements in personality severity and style over time, and (iii) elucidating profile change across therapist ratings. We present two patients diagnosed with DSM-5 Section II BPD, crossing between two therapists over the course of 3 years of psychodynamic psychotherapy. Treating clinicians rated patients for their respective treatment phases using the Level of Personality Functioning Scale (LPFS), capturing severity, and the Personality Inventory for the DSM-5 (PID-5), capturing style. AMPD diagnostic profiles differentiated patients with BPD in both severity and style, and captured within-patient change beyond within-therapist response bias. Results indicated greater improvements in personality severity while personality style remained more stable. Implications for the patients’ treatment progress and associated challenges are discussed, as are considerations for the utility of the AMPD in therapy.
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Affiliation(s)
- Chloe F Bliton
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
| | - Lia K Rosenstein
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
| | - Aaron L Pincus
- Department of Psychology, The Pennsylvania State University, University Park, PA, United States
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6
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Hastrup LH, Jennum P, Ibsen R, Kjellberg J, Simonsen E. Welfare consequences of early-onset Borderline Personality Disorder: a nationwide register-based case-control study. Eur Child Adolesc Psychiatry 2022; 31:253-260. [PMID: 33231787 DOI: 10.1007/s00787-020-01683-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022]
Abstract
Information regarding welfare consequences of early onset of Borderline Personality Disorder (BPD) is limited. This nationwide study aimed to estimate the educational and employment outcome and health care costs of patients with early-onset BPD compared with matched controls. All patients (< 19 years) with first diagnosis of BPD in the Danish Patient Register (NPR) during the period 1983-2015 were included. Health care costs and socioeconomic variables were extracted from national registers. A total of 171 patients was compared with 677 controls. At the age of 20 years, BPD patients had reached a statistically significantly lower educational level (including lower primary school grades) and employment status compared with the controls. When adjusting for the parents' educational level, BPD patients were nearly 22 times more likely to be unemployed (OR = 21.7, 95% CI 11.9, 39.6), and nearly 15 times more likely to be on disability pension (OR = 14.8, 95% CI 5.0, 43.9) than controls. Furthermore, the total health care costs were more than 8 times higher in the BPD group. Early onset of BPD was associated with lower educational and vocational outcome and increased health care costs as early as at the age of 20 years. Even after controlling for parents' lower socioeconomic status, the patients have poorer outcome than the control group. This underlines that initiatives to support patients in finishing school and secondary education is highly needed. Future prevention and early intervention programs should target patients with early-onset BPD and their families.
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Affiliation(s)
- Lene Halling Hastrup
- Psychiatric Research Unit, Psychiatry Region Zealand, Faelledvej 6, 4200, Slagelse, Denmark.
| | - Poul Jennum
- Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Jakob Kjellberg
- VIVE The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Faelledvej 6, 4200, Slagelse, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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7
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West ML, Guest RM, Carmel A. Comorbid early psychosis and borderline personality disorder: Conceptualizing clinical overlap, etiology, and treatment. Personal Ment Health 2021; 15:208-222. [PMID: 33955194 DOI: 10.1002/pmh.1509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 03/14/2021] [Indexed: 12/15/2022]
Abstract
Despite substantial efforts aimed at the detection and intervention for early symptoms of mental illness, there is relatively limited research on the clinical overlap between borderline personality disorder (BPD) and early psychosis, for example, clinical high risk (CHR) for psychosis, in young people. We present a narrative review of the clinical overlap between BPD and psychosis spectrum symptoms. Both conditions have unstable temporal course, and both are marked by functional impairment, increased suicide risk, and higher rates of psychiatric inpatient services. We then review evidence-based treatments for psychosis and BPD, emphasizing treatments for early presentations of these symptoms and initial research considering treatments for the overlap. Psychotherapies with the strongest empirical support include cognitive behavioral models, with BPD showing limited response to adjunctive pharmacotherapy. We end by discussing specific recommendations for future research, including longitudinal studies to determine the predictors of the course of illness and the development of treatments to target comorbid BPD and CHR symptoms.
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Affiliation(s)
- Michelle L West
- CEDAR Clinic and Research Program, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, University of Colorado School of Medicine (CUSOM), Aurora, Colorado, USA
| | - Ryan M Guest
- Department of Psychology, Emory University, Atlanta, Georgia, USA
| | - Adam Carmel
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Zandersen M, Parnas J. Exploring schizophrenia spectrum psychopathology in borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2020; 270:969-978. [PMID: 31289925 PMCID: PMC7599140 DOI: 10.1007/s00406-019-01039-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/03/2019] [Indexed: 12/15/2022]
Abstract
We have previously argued that the current borderline personality disorder (BPD) diagnosis is over-inclusive and clinically and conceptually impossible to distinguish from the schizophrenia spectrum disorders. This study involves 30 patients clinically diagnosed with BPD as their main diagnosis by three BPD dedicated outpatient treatment facilities in Denmark. The patients underwent a careful and time-consuming psychiatric evaluation involving several senior level clinical psychiatrists and researchers and a comprehensive battery of psychopathological scales. The study found that the vast majority of patients (67% in DSM-5 and 77% in ICD-10) in fact met the criteria for a schizophrenia spectrum disorder, i.e., schizophrenia (20%) or schizotypal (personality) disorder (SPD). The schizophrenia spectrum group scored significantly higher on the level of disorders of core self as measured by the Examination of Anomalous Self-Experiences Scale (EASE). The BPD criterion of "identity disturbance" was significantly correlated with the mean total score of EASE. These findings are discussed in the light of changes from prototypical to polythetic diagnostic systems. We argue that the original prototypes/gestalts informing the creation of BPD and SPD have gone into oblivion during the evolution of polythetic criteria.
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Affiliation(s)
- Maja Zandersen
- Mental Health Centre Glostrup, University Hospital of Copenhagen, Broendbyoestervej 160, 2605, Broendby, Denmark.
| | - Josef Parnas
- Mental Health Centre Glostrup, University Hospital of Copenhagen, Broendbyoestervej 160, 2605, Broendby, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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9
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Kjær JNR, Biskin R, Vestergaard C, Munk-J Rgensen P. All-Cause Mortality of Hospital-Treated Borderline Personality Disorder: A Nationwide Cohort Study. J Pers Disord 2020; 34:723-735. [PMID: 30307824 DOI: 10.1521/pedi_2018_32_403] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients with borderline personality disorder (BPD) are known to present frequently in emergency rooms, and they have a high rate of suicide. The mortality rate of patients with BPD is still unclear. The Danish Psychiatric Central Research Register and The Danish Register for Causes of Death were used to identify patients with a first-ever diagnosis of BPD (ICD-10: F60.31) from 1995 through 2011 together with time and cause of death. A total of 10,545 patients with a BPD diagnosis were followed for a mean time of 7.98 years. A total of 547 deaths were registered. The standardized mortality ratio of patients with BPD compared to the general population was 8.3 (95% CI [7.6, 9.1]). More than three inpatient admissions per year or a comorbid diagnosis of substance use disorder correlated with a higher mortality rate. The increased mortality rate in patients with BPD treated in secondary care emphasizes that it is a severe mental disorder.
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Affiliation(s)
- Jesper N Rgaard Kjær
- Psychiatric Research Academy, Department of Affective Disorders, Aarhus University Hospital, Risskov, Denmark
| | - Robert Biskin
- Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
| | - Claus Vestergaard
- Psychiatric Research Academy, Department of Affective Disorders, Aarhus University Hospital, Risskov, Denmark
| | - Povl Munk-J Rgensen
- Department of Psychiatry Odense, Mental Health Services Region of Southern Denmark, Odense, Denmark
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10
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Emergency psychiatric management of borderline personality disorder: Towards an articulation of modalities for personalised integrative care. Encephale 2020; 46:463-470. [PMID: 32571544 DOI: 10.1016/j.encep.2020.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 11/20/2022]
Abstract
Building on existing literature, the authors draw the landscape of psychiatric emergencies, and focus on borderline personality disorder, frequently encountered, and strongly linked to death by suicide. A review of knowledge in terms of diagnosis, prognosis, etiology, and treatment, as well as their own experiences, lead them to propose areas of progress that would secure the patient's care pathway. The evolution of society has led psychiatric emergency departments to play the role of a safety net and an entry point to the mental health system. Borderline personality disorder is one of the most common pathologies encountered in psychiatric emergencies. It represents a major concern, long characterized by an often dramatic evolution, and by the human and economic stress it generates. However, since the 1990s, knowledge of this disorder has been refined, and today there are various means of evaluation, good clinical practices and psychotherapeutic treatments, thanks to which significant and lasting improvement is possible. Recent studies highlight the crucial role of hospital caregivers, and the benefit of consolidating their skills by providing them with the knowledge and tools specific to this disorder. They also converge on the interest of setting up specific emergency treatment modalities, particularly highly structured, safe and empowering for the patient, in order to improve their effectiveness. The authors suggest that a case formulation model for persons with borderline personality disorder in emergency would make it possible to activate these two levers of progress, while improving collaboration between hospital and outpatient care. This would also address their main concern of optimizing the patient's therapeutic pathway and reinforcing adherence to treatment that could bring remission, and should be supported by data from empirical research.
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11
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Kouppis E, Ekselius L. Validity of the personality disorder diagnosis in the Swedish National Patient Register. Acta Psychiatr Scand 2020; 141:432-438. [PMID: 32092153 DOI: 10.1111/acps.13166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 12/28/2022]
Abstract
AIMS The Swedish National Patient Register (NPR) is an exceptional source of information in clinical epidemiological research. The register is, however, not validated for the diagnosis of personality disorder (PD). We therefore assessed its validity in this patient group, and the group with emotionally unstable PD (EUPD)/borderline personality disorder (BPD). METHODS Records from 100 random adult patients (aged 15-65 years) diagnosed with any PD in the NPR between 1987 and 2015 were analysed using a protocol based on general diagnostic criteria for PD, as well as specific criteria for EUPD/BPD in both ICD and DSM classification systems. RESULTS Of the 100 patients, 27 had been given a diagnosis of EUPD, 23 another specific PD and 50 an unspecified PD. Using ICD criteria, 88 of 95 evaluable patients could be confirmed to have a PD, that is an agreement rate of 93%. Using DSM criteria, the agreement was lower (77 patients or 81%). Of 26 evaluable patients with a diagnosis of EUPD/BPD, the diagnosis was confirmed in all cases when using the ICD criteria, but in only 20 when using the DSM criteria. CONCLUSIONS The NPR is a valid source of data for the diagnosis of PD per se and also of EUPD in women.
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Affiliation(s)
- E Kouppis
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - L Ekselius
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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12
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Lyng J, Swales MA, Hastings RP, Millar T, Duffy DJ, Booth R. Standalone DBT Group Skills Training Versus Standard (i.e. All Modes) DBT for Borderline Personality Disorder: A Natural Quasi-experiment in Routine Clinical Practice. Community Ment Health J 2020; 56:238-250. [PMID: 31673877 DOI: 10.1007/s10597-019-00485-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/25/2019] [Indexed: 11/26/2022]
Abstract
We describe a naturally occurring, real-world comparison of outcomes following 6 months in standalone DBT skills training group for adults with Borderline Personality Disorder (BPD) without recent suicidal or severe self-harming behaviours and standard (i.e. all modes) DBT for BPD including patients with recent high-risk behaviours. 34 patients chose standalone skills over waiting for standard DBT and 54 were offered standard DBT. Dropout was higher for standalone skills than standard DBT (38.2% vs. 16.7%). No statistically or clinically significant differences were found among completers between conditions on borderline symptoms, general psychopathology, and suicide ideation. There was a moderate effect for standalone skills on hopelessness and emotion regulation difficulties which may have reflected non-equivalence of treatment groups. Significant methodological factors limit generalisability of findings which offer support for feasibility of standalone DBT skills as an effective alternative to waitlist for standard DBT for at least some patients with BPD in the community.
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Affiliation(s)
- Jim Lyng
- Department of Psychology, Cluain Mhuire Community Mental Health Services, Blackrock, Co. Dublin, Ireland.
- School of Psychology, Bangor University, Adeilad Brigantia, Bangor, Gwynedd, LL57 2AS, UK.
| | - Michaela A Swales
- School of Psychology, Bangor University, Adeilad Brigantia, Bangor, Gwynedd, LL57 2AS, UK
| | - Richard P Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, West Midlands, CV4 7AL, UK
| | - Tracy Millar
- South Eastern Health and Social Care Trust, Dundonald, BT16 1RH, UK
| | - Daniel J Duffy
- Department of Psychology, Cluain Mhuire Community Mental Health Services, Blackrock, Co. Dublin, Ireland
| | - Richard Booth
- Department of Psychology, St Patrick's University Hospital, Dublin, D08 K7YW, Ireland
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13
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Lyng J, Swales MA, Hastings RP, Millar T, Duffy DJ. Outcomes for 18 to 25-year-olds with borderline personality disorder in a dedicated young adult only DBT programme compared to a general adult DBT programme for all ages 18. Early Interv Psychiatry 2020; 14:61-68. [PMID: 31044536 DOI: 10.1111/eip.12808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/14/2018] [Accepted: 02/17/2019] [Indexed: 11/28/2022]
Abstract
AIM Targeting young adults with borderline personality disorder (BPD) for treatment may carry significant social and clinical benefits. We aimed to evaluate a community-based Dialectical Behaviour Therapy (DBT) programme delivered exclusively to young adults with BPD. METHODS We describe a naturally occurring non-equivalent, quasi-experimental comparison of outcomes for young adults (18-25 years) with BPD following 1 year of treatment in either a young adult only DBT programme or a general adult DBT programme (18+ years). Twenty-four young adults enrolled in a community-based young adult DBT programme open only to 18- to 25-year-olds with BPD. Another 13 young adults, also 18-25 years, enrolled in a general adult DBT programme open to all ages above 18 years. Both treatment conditions offered all modes of standard DBT for 1 year. Participants completed a battery of self-report measures on mental health symptoms at baseline and again at treatment completion after 1 year. Discharge rates at 2 years post-treatment completion were also recorded. RESULTS Better outcomes were found on borderline symptom severity and general psychopathology among completers of young adult DBT, with a large effect size for treatment condition as well as greater clinically significant change. Discharge rates from mental health services 24 months later were also higher for completers of young adult DBT. CONCLUSIONS There may be advantages in delivering DBT to young adults in an age-specific programme, possibly due to group cohesion. Methodological limitations apply, such as small sample size and non-randomization. Further controlled research is needed.
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Affiliation(s)
- Jim Lyng
- School of Psychology, Trinity College, Dublin, Ireland.,School of Psychology, Bangor University, Bangor, UK
| | | | - Richard P Hastings
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
| | - Tracy Millar
- South Eastern Health and Social Care Trust, DBT Team, Dundonald, UK
| | - Daniel J Duffy
- School of Psychology, Trinity College Dublin, Dublin, Ireland
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14
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Hastrup LH, Jennum P, Ibsen R, Kjellberg J, Simonsen E. Societal costs of Borderline Personality Disorders: a matched-controlled nationwide study of patients and spouses. Acta Psychiatr Scand 2019; 140:458-467. [PMID: 31483859 DOI: 10.1111/acps.13094] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Information on societal cost of patients with Borderline Personality Disorder (BPD) and spouses is limited. The aim was to investigate factual societal costs before and after initial BPD diagnosis. METHOD A register-based cohort study of 2756 patients with incident BPD (ICD F60.3) with spouses and 11 024 matched controls, during 2002-2016. RESULTS Total direct healthcare costs and lost productivity costs amounted €40 441 for patients with BPD, which was more than 16 times higher than the matched controls. Somatic and psychiatric health care costs and costs of lost productivity were increased during 5 years before initial diagnosis of BPD. Before and after initial diagnosis, health care costs and lost productivity were increased among spouses of patients with BPD. CONCLUSION Patients with BPD differed substantially from the general population with respect to all included costs. The study documented a significant burden on their spouses. Besides the early onset of BPD, which implies that patients are affected before they finish school and enter labor market, the neurocognitive impairment and fundamental symptoms of BPD, e.g. unstable, intense relationships, impulsivity, and lack of stable sense of self together with psychiatric and somatic comorbidity are part of explanation of the excess costs of BPD.
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Affiliation(s)
- L H Hastrup
- Psychiatric Research Unit, Psychiatry in Region Zealand, Slagelse, Denmark
| | - P Jennum
- Faculty of Health Sciences, Danish Center for Sleep Medicine, Neurophysiology Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - J Kjellberg
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - E Simonsen
- Psychiatric Research Unit, Psychiatry in Region Zealand, Slagelse, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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15
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Hastrup LH, Kongerslev MT, Simonsen E. Low Vocational Outcome Among People Diagnosed With Borderline Personality Disorder During First Admission to Mental Health Services in Denmark: A Nationwide 9-Year Register-Based Study. J Pers Disord 2019; 33:326-340. [PMID: 29505387 DOI: 10.1521/pedi_2018_32_344] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Earlier studies report that although people with borderline personality disorder (BPD) experience symptom reduction in the long term, they continue to have difficulties in work recovery. This nationwide 9-year register-based study (N = 67,075) investigated the long-term labor-market attachment of all individuals diagnosed with BPD during first admission to Danish mental health services in comparison with other psychiatric disorders. Controlling for baseline characteristics and co-occurring secondary psychiatric diagnoses, the BPD group had 32% lower odds (OR = 0.68; 95% CI [0.61, 0.76]) of being in work/under education after 9 years. Individuals diagnosed with BPD also showed more impairment in long-term vocational outcome than other personality disorders, and lower labor-market attachment than other psychiatric disorders except for schizophrenia, schizotypal and delusional disorders, and mental and behavioral disorders due to psychoactive substance use. Intervention programs addressing social psychiatric aspects of BPD in terms of work functioning is henceforth an important area for future research.
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Affiliation(s)
| | - Mickey T Kongerslev
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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Balestri M, Porcelli S, Souery D, Kasper S, Dikeos D, Ferentinos P, Papadimitriou GN, Rujescu D, Martinotti G, Di Nicola M, Janiri L, Caletti E, Mandolini GM, Pigoni A, Paoli RA, Lazzaretti M, Brambilla P, Sala M, Abbiati V, Bellani M, Perlini C, Rossetti MG, Piccin S, Bonivento C, Fabbro D, Damante G, Ferrari C, Rossi R, Pedrini L, Benedetti F, Montgomery S, Zohar J, Mendlewicz J, Serretti A. Temperament and character influence on depression treatment outcome. J Affect Disord 2019; 252:464-474. [PMID: 31005789 DOI: 10.1016/j.jad.2019.04.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/07/2019] [Accepted: 04/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND personality features have been repeatedly associated with depression treatment outcome in Major Depressive Disorder (MDD), however conclusive results are still lacking. Moreover, as for Bipolar Disorder (BD), results are only few and preliminary. AIM the aim of the present study was to perform an exploratory investigation of the influence of personality traits as assessed by the Temperament and Character Inventory (TCI), on principal depression treatment outcomes (non remission, non response and resistance). METHODS 743 mood disorders patients (455 MDD (61.24%) and 288 BD (38.76%)) were recruited in the context of 6 European studies. Generalized logit models were performed to test the effects of TCI dimensions on treatment outcomes, considering possible confounders such as age, gender and education. Positive results were controlled for comorbidities (anxiety and substance use disorders) as well. RESULTS MDD Non-Remitters showed high Harm Avoidance (HA) and Self Transcendence (ST) (p = 0.0004, d = 0.40; p = 0.007, d = 0.36 respectively) and low Persistence (P) and Self Directedness (SD) (p = 0.05; d = 0.18; p = 0.002, d = 0.40, respectively); MDD Non-Responders showed a slightly different profile with high HA and low Reward Dependence (RD) and SD; finally, MDD Resistants showed low RD, P and Cooperativeness (C). In BD patients, only higher HA in non response was observed. LIMITATIONS the retrospective cross-sectional design, the TCI assessment regardless of the mood state and the small number of bipolar patients represent the main limitations. CONCLUSION specific TCI personality traits are associated with depression treatment outcome in MDD patients. The inclusion of such personality traits, together with other socio-demographic and clinical predictors, could ameliorate the accuracy of the prediction models available to date.
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Affiliation(s)
- Martina Balestri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
| | - Stefano Porcelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
| | - Daniel Souery
- Laboratoire de Psychologie Médicale, Université Libre de Bruxelles, Centre Européen de Psychologie Médicale-PsyPluriel, Brussels, Belgium
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Dimitris Dikeos
- Department of Psychiatry, Athens University Medical School, Athens, Greece
| | | | | | - Dan Rujescu
- University Clinic for Psychiatry, Psychotherapy and Psychosomatic, Martin-Luther-University Halle-Wittenberg, Germany
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, Scienze Cliniche, University "G.d'Annunzio", Chieti, Italy
| | - Marco Di Nicola
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Luigi Janiri
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Elisabetta Caletti
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Gian Mario Mandolini
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alessandro Pigoni
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Riccardo Augusto Paoli
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Matteo Lazzaretti
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Michela Sala
- Department of Mental Health, Azienda Sanitaria Locale Alessandria, Alessandria, Italy
| | - Vera Abbiati
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marcella Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy; UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy
| | - Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy; UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy
| | - Maria Gloria Rossetti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy; UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Italy
| | - Sara Piccin
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Carolina Bonivento
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Dora Fabbro
- Department of Laboratory Medicine, Institute of Medical Genetics, University of Udine, Italy
| | - Giuseppe Damante
- Department of Laboratory Medicine, Institute of Medical Genetics, University of Udine, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio FBF, Brescia, Italy
| | - Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio FBF, Brescia, Italy
| | - Laura Pedrini
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio FBF, Brescia, Italy
| | - Francesco Benedetti
- Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy, University Vita-Salute San Raffaele, Milan, Italy
| | | | - Joseph Zohar
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy.
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Abstract
The status of borderline personality disorder (BPD) as a diagnostic category is a matter of continuing controversy. In the United States, BPD is one of the most frequent diagnoses of psychiatric inpatients, and a similar tendency emerges in Europe. Nearly all theoretical aspects of BPD have been questioned, including its very position as a personality disorder. In this article, we trace the evolution of the borderline concept from the beginning of the 20th century to the current psychometric research. We argue that the status of BPD is fraught with conceptual difficulties, including an unrecognized semantic drift of major phenomenological terms (e.g., identity), a lack of general principles for the distinction of BPD and the major psychiatric syndromes (e.g., schizophrenia spectrum disorders), and insufficient definitions of key nosological concepts. These difficulties illustrate general problems in today's psychiatry that require consideration.
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Affiliation(s)
- Maja Zandersen
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Denmark
| | - Mads Gram Henriksen
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Denmark
| | - Josef Parnas
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Denmark
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18
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Zandersen M, Parnas J. Borderline personality disorder or a disorder within the schizophrenia spectrum? A psychopathological study. World Psychiatry 2019; 18:109-110. [PMID: 30600641 PMCID: PMC6313234 DOI: 10.1002/wps.20598] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Maja Zandersen
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Josef Parnas
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Copenhagen, Denmark
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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19
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Affiliation(s)
- Peter Tyrer
- Centre for Psychiatry, Imperial College, London, UK
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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20
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Frías Á, Palma C, Solves L, Martínez B, Salvador A. Differential symptomatology and functioning in borderline personality disorder across age groups. Psychiatry Res 2017; 258:44-50. [PMID: 28985552 DOI: 10.1016/j.psychres.2017.09.081] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
There is increasing research aimed at addressing whether patients with borderline personality disorder (BPD) may exhibit variations in symptomatology and functioning according to their chronological age. The current study consisted of 169 outpatients diagnosed with BPD, who were divided into four age groups as follows: 16-25 years (n = 41), 26-35 years (n = 43), 36-45 years (n = 45), and 46 and more years (n = 40). Age groups were compared for symptomatology, normal personality traits, psychiatric comorbidities, functioning, and treatment-related features. The younger group had significantly higher levels of physical/verbal aggression and suicide attempts relative to the older group. Conversely, the older group had significantly greater severity of somatization, depression, and anxiety symptoms. In addition, the older group showed significantly greater functional impairment overall and across physical/psychological domains, specifically when compared to the younger group. Overall, these findings may suggest that age-related symptoms should be considered when diagnosing BPD. Also, functional impairments should be the target interventions for older BPD patients.
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Affiliation(s)
- Álvaro Frías
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain; Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain.
| | - Carol Palma
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain; Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| | - Laia Solves
- Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| | - Bárbara Martínez
- Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
| | - Ana Salvador
- Facultad de Psicologia, Ciencias de la Educación y el Deporte Blanquerna, University of Ramon-Llull, Barcelona, Spain; Consorci Sanitari del Maresme, Department of Psychiatry, Hospital of Mataró, Mataró, Spain
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21
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Prevalence of borderline personality disorder and its risk factors in female prison inmates in China. Psychiatry Res 2017; 250:200-203. [PMID: 28167433 DOI: 10.1016/j.psychres.2017.01.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/22/2017] [Accepted: 01/22/2017] [Indexed: 11/24/2022]
Abstract
High prevalence of borderline personality disorder (BPD) has been found in Western prisons but no such data exists in China. The objective of this study was to determine the lifetime prevalence of BPD in Chinese female prison inmates and its associated risk factors. This cross-sectional study was conducted in Hunan Provincial Female Prison. Data on consenting inmates' socio-demographic and clinical characteristics were collected and the diagnosis of lifetime BPD was established using the Structural Clinical Interview for DSM-IV. The prevalence of BPD was 10.6% in the cohort of 2709 participating inmates. Multiple logistic regression analysis revealed that younger age, unmarried marital status, higher education level, fewer major medical conditions, more frequent personal and family members' drug use, more frequent comorbid psychiatric disorders and family history of psychiatric disorders were positively and independently associated with BPD. BPD is common in Chinese female prison inmates. Considering its adverse social consequences and impact on physical and mental well-being, serious attempts should be made to diagnose BPD early and improve access to treatment in women prisons.
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