Demography of DSM-III borderline personality disorder (PD): a comparison with Axis II PDs, affective illness and schizophrenia convergent and discriminant validation

Long-Term Course of Borderline Personality Disorder

Information concerning the longitudinal course of Borderline Personality Disorder (BPD) derives mainly from (a) long-term (10 to 25 year) retrospective follow-up studies, primarily those conducted during the 1980s/1990s, (b) brief (1 to 3 year) follow-up studies of recent randomized controlled trials (RCTs) of several different treatment approaches, and (c) prospective follow-up studies. The patients contacted in the retrospective studies had been treated mostly by psychoanalytically informed approaches or supportive. Though there was a significant suicide rate of 3 to 9%, about two-thirds of the BPD patients eventually achieved a global assessment score in the 60s or beyond. BPD represents a heterogeneous group of patients, whose outcome is a function of many variables, including personality traits (paranoid and narcissistic conducing to less favorable outcomes), cultural differences, socio-economic level, intelligence level, gender, and age of onset. The RCT studies focused on amelioration of the symptom components of BPD, especially tendencies to self-injury and suicide. The currently favored treatment methods showed in a large percentage of patients, a lessening of these self-destructive behaviors after a year or two of treatment. The time spans were too brief to allow assessment of improvement in key life areas (attainment of self-sufficiency in work, widening of the circle of friends, and success in forming satisfactory intimate partnerships). The prospective studies are based on reassessments at regular intervals of BPD patients and a control group with other personality disorders. Over the past 16 years the BPD patients, compared with controls, were slower to achieve remission, and more apt to show cognitive peculiarities initially-though they showed appreciable improvement over time. The "recovered" BPD patients, compared with the non-recovered patients, showed twice the likelihood of achieving a successful intimate relationship. At 16 years the McLean study has shown results similar (though scientifically more precise) to those of the old retrospective studies. The studies do not demonstrate the efficacy of one or another treatment approach, since, in long-term follow-up, psychotherapy, albeit essential, becomes one of a myriad of influences affecting outcome. There is general agreement that BPD patients who have experienced severe early trauma (including incest) are at greater risk for a poor outcome-as are those with prominent antisocial traits (more common in BPD males). The personality trait of agreeableness was associated with greater likelihood of favorable outcome.

The presence of psychiatric consultations in relation to divorce

In this study all couples who during a period of 1 year were divorced at a Swedish district court, and who had children living at home, were examined for psychiatric consultations before, during and after the divorce period. Psychiatric consultation was defined as having a psychiatric record at the only psychiatric clinic in the catchment area. The divorced couples were compared with a matched group of married people. The results showed that there was a 4.1-fold higher risk for divorced men and a 2.5-fold higher risk for divorced women of acquiring a psychiatric record. The increased rate of psychiatric consultations was evident before as well as after the divorce period, but was most striking during the divorce period. A greater proportion of men than women started and continued to experience their psychiatric problems before and during the divorce period, while women more often started and continued to experience their psychiatric problems during the divorce period and afterwards.

Sociodemography of borderline personality disorder (PD): a comparison with Axis II PDs and psychiatric symptom disorders convergent validation

A theoretical objective of the present meta-analysis based upon data derived from a previously reported review (Taub, 1995), was to test two inductive hypotheses empirically regarding educational background and social class across different criteria for the DSM-III diagnosis of borderline personality disorder (PD). A secondary purpose was to determine whether comorbidity of borderline PD with other Axis II PDs would significantly delineate socioeducational variables. Across 7/8 pairwise contrasts which represented five studies, distribution of Hollingshead Redlich (H-R) social classes II-IV borderline PD (N = 326) significantly exceeded that in 457 diagnostic controls with Axis II PDs and psychiatric symptom disorders. Although average differences, as well as, interactions reflected by values of the H-R two-factor scale attained statistical significance these were were less consistent in magnitude and direction versus outcomes yielded by distribution of social classes. For the borderline PD diagnosis, the inductive hypotheses were substantiated by findings of significantly advanced scholastic achievement, as well as the younger age of most cohorts versus diagnostic controls with Axis II PDs and psychiatric symptom disorders; and in pairwise contrasts of outpatients with hospitalized cohorts. Comorbidity of the borderline PD diagnosis was associated with significantly lower social class, scholastic achievement and to a lesser extent, more severe psychopathology. Evidence for predominantly convergent validation relative to the socioeducational variables was substantiated by comparisons with (a) cohorts selected by criteria of the DSM-III-R, Gunderson's DIB and Borderline Personality Scale: (b) Norwegian females admitted to Gaustad Hospital and (c) patients with the DSM-III diagnosis of borderline PD attending an outpatient clinic in Norway.