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.

Severity of Anxiety Symptoms Reported by Borderline Patients and Axis II Comparison Subjects: Description and Prediction Over 16 Years of Prospective Follow-Up

“…First, the study was conducted on inpatients with BPD and other axis II disorders. Second, about 90% of those in both patient groups were in individual therapy and taking psychotropic medication at baseline and about 70% were in individual therapy and taking standing medications at each wave of follow-up (Hörz, Zanarini, Frankenburg, Reich, & Fitzmaurice, 2010). Therefore, the results may not generalize to less severely ill patients with BPD or to individuals with BPD who are not in treatment—which in almost all cases was treatment as usual in the community and not an evidence-based form of psychotherapy.…”

Rates of Psychotropic Medication Use Reported by Borderline Patients and Axis II Comparison Subjects Over 16 Years of Prospective Follow-Up

“…However, only eight naturalistic studies have documented this clinical practice. 1-8 Five of these studies are cross-sectional in nature. 1-5 In general, they found that rates of taking standing psychotropic medications were high for patients with BPD and often discriminating for the disorder.…”

“…6-8 Bender et al conducted a two-year follow-up study 6 of borderline patients and comparison subjects. Some of the subjects in this study—the Collaborative Longitudinal Study of Personality Disorder (CLPS)--were initially inpatients, others were outpatients, and some were seeking treatment.…”

“…Hörz and colleagues 8 also studied time-to-stopping taking standing psychotropic medication in this sample over 10 years of prospective follow-up. It was found that 44% of borderline patients were able to stop taking these medications for at least one two-year follow-up period.…”

Treatment Rates for Patients With Borderline Personality Disorder and Other Personality Disorders: A 16-Year Study

“…Treatment utilization of this sample was also studied after 10 years of prospective follow-up (8). Only three modalities were studied: individual therapy, standing medication, and psychiatric hospitalization.…”