The Longitudinal Course of Borderline Psychopathology: 6-Year Prospective Follow-Up of the Phenomenology of Borderline Personality Disorder

Zanarini, Mary C.; Frankenburg, Frances R.; Hennen, John; Silk, Kenneth R.

doi:10.1176/appi.ajp.160.2.274

Cited by 555 publications

(408 citation statements)

References 32 publications

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“…A global comparison of our temporal stability findings (at threshold for diagnosis) is possible for BPD (several studies reviewed by McDavid & Pilkonis, 1996;Zanarini, Frankenburg, Hennen, & Silk, 2003) and for one study of AVPD (Ferro, Klein, Schwartz, Kasch, & Leader, 1998). For AVPD, our kappa of .37 for the 2-year follow-up is higher than that reported in a 30-month Note.…”

Section: Discussionmentioning

confidence: 71%

Two-Year Stability and Change of Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders.

Grilo

Sanislow

Gunderson

et al. 2004

Journal of Consulting and Clinical Psychology

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236

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The authors examined the stability of schizotypal (STPD), borderline (BPD), avoidant (AVPD) and obsessive-compulsive (OCPD) personality disorders (PDs) over 2 years of prospective multiwave follow-up. Six hundred thirty-three participants recruited at 4 collaborating sites who met criteria for 1 or more of the 4 PDs or for major depressive disorder (MDD) without PD were assessed with semistructured interviews at baseline, 6, 12, and 24 months. Lifetable survival analyses revealed that the PD groups had slower time to remission than the MDD group. Categorically, PD remission rates range from 50% (AVPD) to 61% (STPD) for dropping below diagnostic threshold on a blind 24-month reassessment but range from 23% (STPD) to 38% (OCPD) for a more stringent definition of improvement. Dimensionally, these findings suggest that PDs may be characterized by maladaptive trait constellations that are stable in their structure (individual differences) but can change in severity or expression over time.

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Section: Discussionmentioning

confidence: 71%

Two-Year Stability and Change of Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders.

Grilo

Sanislow

Gunderson

et al. 2004

Journal of Consulting and Clinical Psychology

Self Cite

236

180

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“…This study also aims to extend the findings of Zanarini et al , 18,22 in validating the distinction between BPD temperamental and acute symptoms. Another aim of this paper was to replicate the data found by Hopwood et al 24 that linked the FFM “normal” personality traits to subsyndromal symptoms of BPD.…”

mentioning

confidence: 62%

“…47,48 It should also be noted that the majority of patients in the McLean Study of Adult Development were female, and we based our symptom classifications on these remission rates. 22 …”

Section: Discussionmentioning

confidence: 99%

“…18,22 Part of the study procedures includes measuring borderline personality symptomatology every two years using the Revised Diagnostic Interview for Borderlines (DIB-R). Items on the DIB-R measure 15 subsyndromal symptoms and cover a much broader scope of BPD than DSM-IV diagnostic criteria.…”

Section: Methodsmentioning

confidence: 99%

“…However, levels of emotional distress were consistent across all age groups. Likewise, Zanarini and colleagues 18,22 followed patients with borderline personality disorder over ten years and reported marked improvement in some symptoms while others remained stable. Stable symptoms included inappropriate and chronic anger, feelings of emptiness, fears of abandonment, and dysphoric affect while identity disturbance, suicidal gestures, unstable relationships, and stress related paranoid ideation were more likely to remit.…”

mentioning

confidence: 95%

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The Relationship Between Borderline Personality Disorder and Major Depression in Later Life: Acute Versus Temperamental Symptoms

Galione

Oltmanns

2013

The American Journal of Geriatric Psychiatry

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Objective A recent issue in the personality disorder field is the prevalence and course of Axis II symptoms in later life. Focusing on the presentation of personality disorder criteria over time may have some utility in exploring the relationship between borderline personality disorder (BPD) and major depression in older adults. Temperamental personality symptoms are relatively resistant to change but tend to be nonspecific to disorders, while acute symptoms remit relatively quickly. We predicted that temperamental BPD symptoms would be positively correlated with a history of depression and did not expect to find a relationship between major depression and acute BPD symptoms. Method One thousand six hundred and thirty participants between the ages of 55 and 64 were recruited to participate in a community-based longitudinal study representative of the St. Louis area. Participants completed a battery of assessments at baseline, including diagnostic interviews for all ten personality disorders and major depressive disorder. Results Temperamental and acute BPD symptoms were significantly correlated with a history of major depression. After adjustments were made for the effects of temperamental symptoms on depression, acute symptoms were no longer correlated with a history of depression. As predicted, temperamental symptoms remained significantly related to depression, even after controlling for the effects of acute symptoms. BPD acute symptoms showed a unique negative correlation with the amount of time following remission from a depressive episode. Conclusions Overall, this study supports associations between major depression and borderline personality in older adults. The findings indicate that a history of major depression is primarily related to stable BPD symptoms related to emotional distress, which are more prevalent in older adults compared to acute features.

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Ten-Year Course of Borderline Personality Disorder

Gunderson

Stout

McGlashan

et al. 2011

Arch Gen Psychiatry

596

201

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Context Borderline personality disorder (BPD) is traditionally considered chronic and intractable. Objective To compare the course of BPD’s psychopathology and social function with that of other personality disorders and with major depressive disorder (MDD) over 10 years. Design A collaborative study of treatment-seeking, 18-to 45-year-old patients followed up with standardized, reliable, and repeated measures of diagnostic remission and relapse and of both global social functioning and subtypes of social functioning. Setting Nineteen clinical settings (hospital and outpatient) in 4 northeastern US cities. Participants Three study groups, including 175 patients with BPD, 312 with cluster C personality disorders, and 95 with MDD but no personality disorder. Main Outcome Measures The Diagnostic Interview for DSM-IV Personality Disorders and its follow-along version (the Diagnostic Interview for DSM-IV Personality Disorders–Follow-Along Version) were used to diagnose personality disorders and assess changes in them. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Longitudinal Interval Follow-up Evaluation were used to diagnose MDD and assess changes in MDD and in social function. Results Eighty-five percent of patients with BPD remitted. Remission of BPD was slower than for MDD (P<.001) and minimally slower than for other personality disorders (P<.03). Twelve percent of patients with BPD relapsed, a rate less frequent and slower than for patients with MDD (P<.001) and other personality disorders (P=.008). All BPD criteria declined at similar rates. Social function scores showed severe impairment with only modest albeit statistically significant improvement; patients with BPD remained persistently more dysfunctional than the other 2 groups (P<.001). Reductions in criteria predicted subsequent improvements in DSM-IV Axis V Global Assessment of Functioning scores (P<.001). Conclusions The 10-year course of BPD is characterized by high rates of remission, low rates of relapse, and severe and persistent impairment in social functioning. These results inform expectations of patients, families, and clinicians and document the severe public health burden of this disorder.

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The Longitudinal Course of Borderline Psychopathology: 6-Year Prospective Follow-Up of the Phenomenology of Borderline Personality Disorder

Abstract: These results suggest that symptomatic improvement is both common and stable, even among the most disturbed borderline patients, and that the symptomatic prognosis for most, but not all, severely ill borderline patients is better than previously recognized.

Cited by 555 publications

References 32 publications

Two-Year Stability and Change of Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders.

Two-Year Stability and Change of Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders.

The Relationship Between Borderline Personality Disorder and Major Depression in Later Life: Acute Versus Temperamental Symptoms

Ten-Year Course of Borderline Personality Disorder

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