Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders

Abstract

Objective This study has two main objectives. The first is to detail the prevalence rates of three key treatment modalities reported by patients with borderline personality disorder and axis II comparison participants over a decade of follow-up. The second is to determine time-to-cessation and time-to resumption of these three treatment modalities reported by patients with borderline personality disorder. Methods The treatment history of 290 reliably diagnosed inpatients with borderline personality disorder and 72 axis II comparison participants was assessed using an interview of proven reliability during their index admission. Treatment history was reassessed at five contiguous two-year follow-up periods. Results In terms of prevalence rates, there was a significant decrease in the percentage of patients with borderline personality disorder (and axis II comparison participants) participating in the three treatment modalities studied. In terms of time-to-cessation and resumption, 52% of patients with borderline personality disorder stopped individual therapy and 44% stopped taking standing medications for a period of two years or more. However, 85% of those who had stopped psychotherapy resumed it and 67% of those who stopped taking medications later resumed taking them. In contrast, 88% had no hospitalizations for at least two years but almost half of these patients were subsequently rehospitalized. Conclusions Taken together, these results suggest that patients with borderline personality disorder tend to use outpatient treatment without interruption over prolonged periods of time. They also suggest that inpatient treatment is used far more intermittently and by only a relative small minority of those with borderline personality disorder.

The Course of Marriage/Sustained Cohabitation and Parenthood Among Borderline Patients Followed Prospectively for 16 Years

“…One limitation of this study is that all of the patients were seriously ill inpatients at the start of the study. Another limitation is that about 90% of those in both patient groups were in individual therapy and taking psychotropic medications at baseline and about 70% were participating in each of these outpatient modalities during each follow-up period (Hörz, Zanarini, Frankenburg, Reich, & Fitzmaurice, 2010). Thus, it is difficult to know if these results would generalize to a less disturbed group of patients or people meeting criteria for borderline personality disorder who were not in treatment, which was typically non-intensive outpatient treatment as usual in the community.…”

Effectiveness and Cost-Effectiveness of Dialectical Behaviour Therapy for Self-Harming Patients with Personality Disorder: A Pragmatic Randomised Controlled Trial

“…A recent study demonstrated that patients who engaged in 5 or more episodes of self-harm had the highest level of resource costs in the 6-month period around an episode [17]. Patients with BPD, a diagnosis for which self-harming is a diagnostic criterion, have more frequent attendances in Accident and Emergency Departments and psychiatric hospitalisations [18] and make more use of outpatient mental health services compared to patients with other axis II disorders [19] or patients with common mental illness [20]. Consequently, the treatment of self-harm, especially in the context of borderline and other personality disorders, has been identified as a priority for the National Health Service (NHS) in the UK [5,21].…”

Efficacy and cost-effectiveness of an experimental short-term inpatient Dialectical Behavior Therapy (DBT) program: study protocol for a randomized controlled trial

“…A recent meta-analysis showed that psychotherapy for BPD yielded an overall drop-out rate of 25% [13]. Previous research also demonstrated that BPD patients are hospitalized and readmitted more than those with other disorders [14,15]. This is troublesome, since dropping out of treatment, as well as a pattern of inpatient treatments, adds to the suicide risk [16,17].…”