Two-year follow-up of borderline personality disorder patients in Italy: A preliminary report on prognosis and prediction of outcome

Panfilis, Chiara De; Politi, Virginia; Fortunati, Renata; Cazzolla, Roberto; Scaramuzzino, Mariafrancesca; Marchesi, Carlo; Maggini, Carlo

doi:10.1177/0020764010368619

Cited by 9 publications

(3 citation statements)

References 55 publications

(60 reference statements)

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“…For instance, a large community sample of adolescent females reported that increasing BPD symptoms were associated with worsening social and mental health outcomes (Wright, Zalewski, Hallquist, Hipwell, & Stepp, 2015). Likewise, adult clinical samples report that the rate of decline in BPD traits is associated with the rate of decline for the personality trait of neuroticism (Wright, Hopwood, & Zanarini, 2015), as well as decline in co-occurring MDD, AUD, and DUD symptoms (De Panfilis et al, 2011; Gunderson et al, 2008; Zanarini Frankenburg, Hennen, Reich, & Silk, 2004; Zanarini et al, 2011). Data from the Collaborative Longitudinal Personality Disorder Study, for instance, indicated that patients with BPD and MDD negatively impacted each other's time to remission and accelerated time to relapse (Grilo et al, 2005; Gunderson et al, 2014); similar results have been reported for substance use disorders (Walter et al, 2009).…”

Section: Evidence For Common Cause Predisposition and Pathoplasty Mmentioning

confidence: 99%

Genetic and environmental influences on the codevelopment among borderline personality disorder traits, major depression symptoms, and substance use disorder symptoms from adolescence to young adulthood

et al. 2017

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Although borderline personality disorder (BPD) traits decline from adolescence to adulthood, comorbid psychopathology such as symptoms of major depressive disorder (MDD), alcohol use disorder (AUD), and drug use disorders (DUDs) likely disrupt this normative decline. Using a longitudinal sample of female twins (N = 1,763), we examined if levels of BPD traits were correlated with changes in MDD, AUD, and DUD symptoms from ages 14–24. A parallel process biometric latent growth model examined the contributions of genetic and environmental factors to the relationships between developmental components of these phenotypes. Higher BPD trait-levels predicted a greater rate of increase in AUD and DUD symptoms, and higher AUD and DUD symptoms predicted a slower rate of decline of BPD traits from ages 14–24. Common genetic influences accounted for the associations between BPD traits and each disorder, as well as the interrelationships of AUD and DUD symptoms. Both genetic and nonshared environmental influences accounted for the correlated levels between BPD traits and MDD symptoms, but solely environmental influences accounted for the correlated changes between the two over time. Results indicate that higher levels of BPD traits may contribute to an earlier onset and faster escalation of AUD and DUD symptoms, and substance use problems slow the normative decline in BPD traits. Overall, our data suggests that primarily genetic influences contribute to the comorbidity between BPD features and substance use disorder symptoms. We discuss our data in the context of two major theories of developmental psychopathology and comorbidity.

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Section: Evidence For Common Cause Predisposition and Pathoplasty Mmentioning

confidence: 99%

Genetic and environmental influences on the codevelopment among borderline personality disorder traits, major depression symptoms, and substance use disorder symptoms from adolescence to young adulthood

et al. 2017

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“…Remission rates in BPD were found to be higher in patients with no history of childhood sexual abuse and no family history of substance use disorder (Zanarini, Frankenburg, Hennen, Reich, & Silk, ; Zanarini, Frankenburg, Hennen, Reich, & Silk, ), whereas a recent study found that a specialist approach (mentalization‐based treatment) did better than structured general psychiatric management in a BPD sample with more severe features, such as a higher number of co‐morbid PD (Bateman & Fonagy, ). A recent studies found that higher severity of presentation predicted lower 2‐year recovery rates in a group of borderline PD (Zanarini et al, ) and poorer prognosis (De Panfilis et al, ). Another study found that high hostility, childhood abuse, and in‐session dissociation were associated with discontinuation of treatment and lower chances of recovery (Arntz, Stupar‐Rutenfrans, Bloo, van Dyck, & Spinhoven, ).…”

Section: Introductionmentioning

confidence: 99%

Four years comparative follow‐up evaluation of community‐based, step‐down, and residential specialist psychodynamic programmes for personality disorders

Chiesa

Cirasola

Fonagy

2017

Clin Psychology and Psychoth

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Although the fulcrum of service provision for personality disorder (PD) has shifted from hospital-based to psychodynamically- and cognitively-oriented outpatient programmes, very few studies have attempted to compare specialist moderate intensity outpatient programmes with specialist high-intensity residential models, or to explore whether a period of inpatient treatment may be necessary to improve outcome and prognosis. In this article, we prospectively compare changes over a 4-year period in 3 groups of patients with personality disorders (N = 162) treated in a specialist community-based (CBP, N = 30), a step-down (RT-CBP, N = 87), and a specialist residential programme (RT, N = 45) in psychiatric distress, deliberate self-injury, and suicide attempt using multilevel modelling and multivariate logistic regression analyses. The results showed that percentages of early-dropout were significantly different (p = .0001) for the 3 programmes (CBP = 13.4%, RT-CBP = 10.2%, and RT = 41.4%). A significant interaction between treatment model and time was found for psychiatric distress (p = .001), with CBP and RT-CBP achieving more marked changes (g = 1.20 and g = 0.68, respectively) compared to RT (g = 0.30) at 48-month follow-up. CBP and RT-CBP were found to significantly reduce impulsive behaviour (deliberate self-injury and suicide attempt) compared to RT. Severity of presentation was not found to be a significant predictor of outcome. Long-term RT showed no advantage over long-term CBP, either as stand-alone or as step-down treatment. Replication may be needed to confirm generalizability of results, and a number of limitations in the study design may moderate the inferences that can be drawn from the results.

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“…In borderline personality disorder (PD), meta-analyses show that well-structured psychotherapies have a completion rate of about 63% to 75%, which means that a minimum of one in four patients dropped out of treatment before the full potential benefit of treatment was achieved (Barnicot et al, 2012;Barnicot, Katsakou, Marougka, & Priebe, 2011;McMurran, Huband, & Overton, 2010). Although treatment model or treatment setting did not explain differences in dropout in borderline PDs (Barnicot et al, 2011), commitment to change, the therapeutic relationship, and the trait impulsivity appeared to be predicting factors (Barnicot et al, 2012), as also a history of more suicide attempts (De Panfilis et al, 2011;McMurran et al, 2010;Wnuk et al, 2013). Nonetheless, outcomes strongly depend on the operational definitions of dropout, which are quite diverse (Barrett, Chua, Crits-Christoph, Gibbons, & Thompson, 2008;Charnas, Hilsenroth, Zodan, & Blais, 2010;Swift, Greenberg, Whipple, & Kominiak, 2012).…”

mentioning

confidence: 95%

Predicting dropout using DSM–5 Section II personality disorders, and DSM–5 Section III personality traits, in a (day)clinical sample of personality disorders.

Berghuis¹,

Bandell²,

Krueger³

2021

Personality Disorders: Theory, Research, and Treatment

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Despite the availability of structured treatments for personality disorders (PDs), still 1 in 4 patients drop out of treatment. Knowledge of whether maladaptive personality traits can lead to dropout in psychotherapeutic treatment programs of PDs is important for the purpose of a suitable indication for such treatments, especially in the light of the new alternative model of personality disorders (AMPD), which is used more and more in clinical practice. The current study investigated whether pathological personality traits of the alternative model of personality disorders, as operationalized with the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PID-5), and dimensional scores of PDs on the Personality Diagnostic Questionnaire-4ϩ, could serve as predictors for dropout in an intensive (day)clinical setting for the treatment of mainly Cluster C and mild Cluster B PDs. The main finding of this study was that high scores on the PID-5 trait scales Perceptual Dysregulation, Unusual Belief and Experiences, Suspiciousness, and Rigid Perfectionism, and low scores on Restricted Affectivity and the Personality Diagnostic Questionnaire-4ϩ avoidant PD dimensional score, were significantly predictive for dropout from treatment.

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Two-year follow-up of borderline personality disorder patients in Italy: A preliminary report on prognosis and prediction of outcome

Cited by 9 publications

References 55 publications

Genetic and environmental influences on the codevelopment among borderline personality disorder traits, major depression symptoms, and substance use disorder symptoms from adolescence to young adulthood

Genetic and environmental influences on the codevelopment among borderline personality disorder traits, major depression symptoms, and substance use disorder symptoms from adolescence to young adulthood

Four years comparative follow‐up evaluation of community‐based, step‐down, and residential specialist psychodynamic programmes for personality disorders

Predicting dropout using DSM–5 Section II personality disorders, and DSM–5 Section III personality traits, in a (day)clinical sample of personality disorders.

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