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

Abstract

Objective The goal of this study was to delineate the course of 16 treatment modalities reported by 290 patients with borderline personality disorder and 72 with other axis II disorders over 16 years of prospective follow-up. Methods Treatment use was assessed at baseline and at eight two-year follow-up periods using a semistructured interview of proven reliability and validity. Results Patients with borderline personality disorder reported significantly higher rates of use of 12 of the 16 treatment modalities studied. Only individual therapy, intensive individual therapy, couples/family therapy, and ECT were used by roughly the same percentage of patients with borderline personality disorder and those with other axis II disorders. In addition, rates of participation in 13 treatment modalities declined significantly over the first eight years of follow-up for those in both treatment groups. However, the rates of participation in 15 of 16 treatment modalities did not decline significantly over the second eight years of follow-up for those in either study group Conclusions The results of this study suggest that rates of treatment use by patients with borderline personality disorder decline significantly over the short and midterm. They also suggest that these rates remain stable or fail to decline further over the longer term.

Fluidity of the Subsyndromal Phenomenology of Borderline Personality Disorder Over 16 Years of Prospective Follow-Up

“…It may be that these dysphoric affects are in this stubborn group of symptoms because they represent inadequately treated mood and/or anxiety disorders, which are common co-occurring disorders among borderline patients (18). However, a high proportion of borderline patients used psychosocial treatments (19) and psychotropic medications (20) over time. It may also be that these symptoms represent a reasonable response to the limited lives led by a substantial percentage of borderline patients—lives marked by social isolation and serious vocational impairment (21).…”

“…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 (19). More specifically, 65% of borderline patients were in individual therapy and 71% were taking standing medications at 16-year follow-up, with 58% taking antidepressants, 26% taking anxiolytics, 28% taking antipsychotics, and 29% taking mood stabilizers (20).…”

Management and Effectiveness of Psychopharmacology in Emotionally Unstable and Borderline Personality Disorder

“…1 Unfortunately, this is not dissimilar to the 16-year data recently reported from the McLean Study of Adult Development. 9 After 16 years of prospective follow-up, 71% were still taking psychotropic medication, with 35.5% taking 3 or more concurrent medications, 18.6% taking 4 or more, and 6.9% taking 5 or more psychotropic medications. 9 Rates of some categories of medications such as antidepressants fell over those 16 years (for SSRIs, tricyclic antidepressants, and monoamine oxidase inhibitors).…”

“…9 After 16 years of prospective follow-up, 71% were still taking psychotropic medication, with 35.5% taking 3 or more concurrent medications, 18.6% taking 4 or more, and 6.9% taking 5 or more psychotropic medications. 9 Rates of some categories of medications such as antidepressants fell over those 16 years (for SSRIs, tricyclic antidepressants, and monoamine oxidase inhibitors). Use of conventional antipsychotic medications fell, while atypical antipsychotic medication grew but then leveled off.…”

“…9,11 But are they being used correctly? There is little evidence for the effectiveness of any single medication in this population and no evidence for the use of multiple medications.…”