Borderline personality disorder features and utilization of treatment over two years

This study assessed the relationship between borderline personality disorder (BPD) features and treatment utilization over a 2-year time period. Participants included 349 18-year-old nonclinical young adults, approximately one-half of whom endorsed significant borderline features. The laboratory phase of the study involved the administration of self-report and interview-based assessments of BPD psychopathology at Wave 1, as well as interviews targeting Axis I psychopathology and treatment utilization history at Wave 2 (2 years later). Results indicated that borderline features prospectively predicted utilization of psychopharmacological treatment above and beyond what was accounted for by gender, lifetime Axis I psychopathology, and nonBPD Axis II psychopathology. The borderline feature most strongly associated with treatment utilization was affective instability.     

Borderline personality disorder features predict negative outcomes 2 years later

In a sample of 351 young adults, the authors assessed whether borderline personality disorder (BPD) features prospectively predicted negative outcomes (poorer academic achievement and social maladjustment) over the subsequent 2 years, over and above gender and both Axis I and Axis II psychopathology. Borderline traits were significantly related to these outcomes, with impulsivity and affective instability the most highly associated. The present findings suggest that the impulsivity and affective instability associated with BPD leads to impairment in relating well with others, in meeting social role obligations, and in academic or occupational achievement. Therefore, these may be especially important features to target in interventions for BPD.     

Structural relations between borderline personality disorder features and putative etiological correlates

This study assessed the structural relations between borderline personality disorder (BPD) features and purported etiological correlates. Approximately 5,000 18-year-old nonclinical young adults were screened for BPD features, and 2 cohorts of participants (total N = 421; approximately one half of whom endorsed significant borderline features) completed the laboratory phase of the study. Measures included self-report and interview-based assessments of BPD psychopathology, personality, psychopathology in biological parents, and childhood physical and sexual abuse. Significant relations between BPD features and purported etiological correlates of BPD were found. A multivariate model that included parental psychopathology, childhood abuse, and personality factors provided an adequate fit to the data and supported the contention that the personality traits disinhibition and negative affectivity underlie BPD features.     

Predicting recurrence of major depressive disorder in young adults: a prospective study.

Sixty-five young adults with remitted major depressive disorder (MDD) were followed for 18 months. Recurrence of MDD was reported by 41.5% of the initial sample and 49.1% of those who completed the study (n = 53). Survival analyses were used to identify predictors of recurrence so that individuals at greatest risk could be targeted for intervention. Potential predictors included measures of comorbid psychopathology (Axis II pathology, and current and lifetime nonmood Axis I diagnoses), depression-specific clinical features (number of episodes, past treatment, and suicidality), and self-reported cognitive and interpersonal constructs (hope, dysfunctional attitudes, and interpersonal problems). Only personality pathology (specifically, the total dimensional and Cluster B dimensional scores on the International Personality Disorder Examination) significantly predicted hazard of recurrence.     

Axis I and axis II disorders as predictors of prospective suicide attempts: findings from the collaborative longitudinal personality disorders study

This study examined diagnostic predictors of prospectively observed suicide attempts in a personality disorder (PD) sample. During 2 years of follow-up, 58 participants (9%) reported at least 1 definitive suicide attempt. Predictors that were examined include 4 PD diagnoses and selected Axis I diagnoses (baseline and course). Multivariate logistic regression analyses indicated that baseline borderline personality disorder (BPD) and drug use disorders significantly predicted prospective suicide attempts. Controlling for baseline BPD diagnosis, proportional hazards analyses showed that worsening in the course of major depressive disorder (MDD) and of substance use disorders in the month preceding the attempt were also significant predictors. Therefore, among individuals diagnosed with PDs. exacerbation of Axis I conditions, particularly MDD and substance use, heightens risk for a suicide attempt.     

Relationships of borderline features to parental mental illness, childhood abuse, Axis I disorder, and current functioning

Although a number of studies have investigated single, putative etiological factors for borderline personality disorder (BPD), few studies have assessed the relations between multiple etiological factors and borderline features within the same study. Borderline features, parental psychopathology, childhood physical and sexual abuse, lifetime Axis I disorder, and current functioning were assessed in 65 nonclinical participants, a portion of which exhibited significant BPD features. Multivariate models were tested and results indicated that parental mental illness and lifetime Axis I disorder were significant and unique predictors of borderline scores. Borderline features accounted for significant variance in current functioning beyond what was accounted for by other predictors; borderline scores mediated the relations between lifetime Axis I disorder and current functioning.     

Interpersonal perception and pathological personality features: consistency across peer groups

This study investigated the consistency of interpersonal perceptions regarding people who exhibit features of personality disorders. The participants (N=82) were college students who were assessed for features of personality disorders, using both self-report and peer nominations at Time 1. Two years later, participants attended four meetings in groups of 7 to 12 people for a total of 2 hours. Group discussions were designed to encourage interaction and give participants an opportunity to behave in ways that might be expected from people with personality problems. After Meetings 1 and 4, group members ranked their impressions of each other with regard to several personality traits and behavioral attributes. We observed important consistencies between the peer nominations collected at Time 1 and personality rankings made by a different peer group at Time 2. There was considerable convergence between personality disorder features and negative evaluations by others, with participants high in detachment eliciting the most negative reactions from peers in the lab.     

Heterogeneity of borderline personality disorder: do the number of criteria met make a difference?

Many studies have compared the demographic and clinical characteristics of patients with and without borderline personality disorder (BPD), but there is limited knowledge on differences within the population of borderline patients. One potential index of heterogeneity is disorder severity. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined whether the severity of borderline personality disorder, as measured by the number of criteria present, is associated with co-morbidity of Axis I and Axis II diagnoses, as well as demographic factors and psychosocial functioning. Two thousand three hundred psychiatric outpatients were interviewed with the Structured Interview for DSM-IV Personality (SIDP-IV). Approximately ten percent (n = 237) of the patients were diagnosed with BPD, and they were divided into four groups based on the number of DSM-IV criteria met, 5 (n = 89), 6 (n = 70), 7 (n = 46), and 8 or 9 (n = 32). There were greater rates of drug use disorders and comorbid Axis II disorders, as well as a greater number of suicidal gestures, in patients meeting seven or more BPD criteria. There were no significant differences between the groups in the number and specific rates of other co-morbid Axis I disorders, other measures of psychosocial functioning, or demographic correlates. Sub-typing of borderline patients by the number of criteria met provides a limited explanation for heterogeneity within BPD patients.     

Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity

The relationships between romantic relationship dysfunction and symptoms of borderline personality disorder (BPD), other personality disorders, and depression were examined prospectively in a community sample of 142 late adolescent women. Although BPD symptoms predicted 4-year romantic dysfunction (romantic chronic stress, conflicts, partner satisfaction, abuse, and unwanted pregnancy), the associations were not unique to BPD. Instead, relationship dysfunction was better predicted by a cumulative index of non-BPD Axis II pathology. Depression did not predict outcomes uniquely when Axis II symptoms were included, except in the case of unplanned pregnancy. The results suggest that although BPD is associated with relationship dysfunction, the effect is a more general phenomenon applying rather broadly to Axis II pathology. The results also highlight the importance of subclinical psychopathology in the construction of early intimate relationships.     

Associations in the course of personality disorders and Axis I disorders over time

In this study, the authors examined time-varying associations between schizotypal (STPD), borderline (BPD), avoidant (AVPD), or obsessive-compulsive (OCPD) personality disorders and co-occurring Axis I disorders in 544 adult participants from the Collaborative Longitudinal Personality Disorders Study. The authors tested predictions of specific longitudinal associations derived from a model of crosscutting psychobiological dimensions (L. J. Siever & K. L. Davis, 1991) with participants with the relevant Axis I disorders. The authors assessed participants at baseline and at 6-, 12-, and 24-month follow-up evaluations. BPD showed significant longitudinal associations with major depressive disorder and posttraumatic stress disorder. AVPD was significantly associated with anxiety disorders (specifically social phobia and obsessive-compulsive disorder). Two of the four personality disorders under examination (STPD and OCPD) showed little or no association with Axis I disorders.     

Co-occurrence of personality disorders with mood, anxiety, and substance use disorders in a young adult population

The purpose of this study was to determine the co-occurrence of DSM- III-R personality disorders (PDs) with mood, anxiety, and substance use disorders in a young adult population. The members of the Northern Finland 1966 Birth Cohort Project, living in the city of Oulu with an age of 31 years (N = 1,609) were invited to participate in a two-phase field study. The SCID I and II were used as diagnostic instruments. One hundred and seventy-seven out of 321 interviewed subjects met the criteria for mood, anxiety, or substance use disorders. Altogether 72 (41%) of the subjects with an Axis I disorder met the criteria for at least one PD. The weighted co-occurrence rate of any PD varied from 28% for mood disorders to 47% for anxiety disorders. PDs, especially those in Cluster C, are highly associated with Axis I psychiatric disorders in population.     

Gender differences in a clinical sample of patients with borderline personality disorder

The aim of the study was to investigate gender differences and similarities in patients with borderline personality disorder (BPD) with respect to Axis I comorbidity, Axis II comorbidity, general psychopathology (Symptom Checklist 90-Revised), and dimensional personality traits (NEO-Personality-Inventory Revised [NEO-PI-R] and the Dimensional Assessment of Personality Profile Basic questionnaire [DAPP-BQ]). Fifty-seven men and 114 women with BPD were included in the study. Regarding Axis I and II disorders in an exploratory analysis, men with BPD more often fulfilled the diagnostic criteria for binge eating disorder, antisocial personality disorder, narcissistic personality disorder, and conduct disorder in childhood, whereas women had higher frequencies of bulimia nervosa, posttraumatic stress disorder, and panic disorder with agoraphobia. After correcting for multiple tests, only the gender differences in narcissistic and antisocial personality disorder remained significant. In the SCL-90-R profile, no significant gender differences could be identified. In the exploratory analysis of the dimensional personality traits, women showed higher rates on the NEO-PI-R main factors (Neuroticism and Agreeableness) compared to men. In the DAPP-BQ profile, men reached higher sores on the main factor, Dissocial Behavior. When correcting for multiple tests, gender differences still existed for Neuroticism and Dissocial Behavior. Our results argue for gender differences in Axis I and II comorbidity and dimensional personality traits in BPD. However, in general, more similarities than differences were shown in this study.     

Diagnostic profiles of offenders in substance abuse treatment programs

This study examined the association of Axis I and Axis II disorders among offenders who were in prison-based substance abuse treatment in a national multi-site study. Participants (N = 280) received a psychosocial assessment and a structured diagnostic interview in two separate sessions. Logistic regression models examined the association between lifetime mood and anxiety disorders with two personality disorders, and the relationship of Axis I and Axis II disorders (alone and in combination) to pre-treatment psychosocial functioning. Over two-thirds of the sample met criteria for at least one mental disorder. Borderline personality disorder was strongly associated with having a lifetime mood disorder (odds ratio = 7.5) or lifetime anxiety disorder (odds ratio = 8.7). Individuals with only an Axis II disorder, or who had both Axis I and Axis II disorders, had more severe problems in psychosocial functioning than those without any disorder. Clinical treatment approaches need to address this heterogeneity in diagnostic profiles, symptom severity, and psychosocial functioning.     

Axis I and II comorbidity in adults with ADHD

Ongoing debate over the validity of the attention-deficit/hyperactivity disorder (ADHD) construct in adulthood is fueled in part by uncertainty regarding implications of potentially extensive yet incompletely described comorbid Axis I and II psychopathology. Three hundred sixty-three adults ages 18 to 37 completed semistructured clinical interviews; informants were also interviewed, and best estimate diagnoses were obtained. Results were as follows: First, ADHD combined type (ADHD-C) had an excess of externalizing and internalizing Axis I disorders, suggesting a gradient-of-severity relationship between it and ADHD inattentive type (ADHD-I). Second, ADHD-C and ADHD-I did not differ in frequency of Axis II disorders. Third, however, ADHD overall was associated with increased rates of Axis II disorders, compared with rates in non-ADHD control participants, including both Cluster B (primarily borderline personality disorder) and Cluster C disorders. Fourth, ADHD incrementally accounted for clinician-rated global assessment of functioning scores above and beyond comorbid conditions or symptoms on either Axis I or Axis II. Results further inform nosology of ADHD in adults.     

The enduring impact of borderline personality pathology: risk for threatening life events in later middle-age

Both neuroticism and borderline personality disorder (BPD) are associated with increased frequency of stressful life events in young adults. It is not clear, however, whether this effect extends to later life because BPD is apparently diminished in frequency and severity when people reach middle adulthood. This issue was examined in a representative, community sample of men and women between the ages of 55 and 64 (N = 1,234). Ten DSM-IV PDs and neuroticism were assessed at baseline using a semistructured interview (SIDP-IV) and questionnaire (NEO-PI-R). Life events were measured 6 months later with a self-report questionnaire (LTE-Q) followed by a telephone interview. BPD features and neuroticism predicted increased frequency of life events, based on both self and interviewer-adjusted reports of negative life events. Avoidant and paranoid PD features predicted decreased frequency of negative life events. Approximately 42% of events reported on the LTE-Q were discounted following the telephone interview; higher scores on BPD symptoms were associated with more adjustments to self-report of threatening experiences. These findings indicate that symptoms of BPD and neuroticism continue to have a harmful impact on the lives of older adults.     

Personality Dysfunction, Coping Styles, and Clinical Symptoms in Younger and Older Adults

This study examined age-related differences in personality disorders, dispositional coping strategies, and clinical symptoms between younger (n = 79; age range = 18–29; M age = 21.2 years) and older (n = 79; age range = 55–89; M age = 65.5 years) persons (matched on gender and ethnicity). Participants completed the Coolidge Axis II Inventory (CATI), Coping Orientations to Problems Experienced Scale (COPE), and Brief Symptom Inventory (BSI). Personality results (t tests) based on the CATI revealed that older persons were significantly more obsessive–compulsive and schizoid than younger adults but significantly lower on 7 scales, including antisocial, borderline, histrionic, and sadistic. As assessed by the COPE, older adults reported lower levels of dysfunctional coping strategies than younger adults. Specifically, older persons were less likely to use mental disengagement, venting of emotions, and alcohol/drugs to cope with problems. BSI results for clinical symptoms revealed that younger adults were significantly higher on 5 of 9 scales, including anxiety, depression, and hostility. Results suggest that younger adults experience higher levels of personality and clinical symptoms and use more dysfunctional coping strategies than older adults, dispelling the myth that old age is associated with inevitable psychological impairment. Theoretical considerations, clinical implications, and future research ideas are discussed.     

The relationship of borderline personality disorder, life events and functioning in an Australian psychiatric sample

Studies have documented poor functioning and higher rates of negative life events in association with personality disorders (PDs), in particular with borderline personality disorder (BPD). The current study investigated the impact of recent life events, daily hassles and uplifts on psychosocial functioning in patients with PDs, while extending previous research by examining the role of perceived coping effectiveness and perceived stress of recent life events. Ninety-seven participants (Axis I group, N = 30; BPD group, N = 23; Other PD group, N = 44) completed measures of functioning, recent life events, daily hassles and uplifts. Results indicated that the BPD group reported the poorest levels of functioning, especially interpersonal functioning. The BPD group also reported more negative life events, particularly in the interpersonal relationships, personal health, crime, and financial domains. The BPD group experienced less uplifts, more hassles and found employment circumstances particularly stressful and difficult to cope with. Intensity of hassles was a predictor of functioning independent of a BPD diagnosis. A greater frequency of life events was closely associated with a non-BPD diagnosis in predicting a decrease in psychosocial functioning.     

Reliability and validity of the borderline personality disorder severity index

The psychometric properties and validity of the Borderline Personality Disorder Severity Index (BPDSI), a semistructured interview assessing the frequency and severity of manifestations of Borderline Personality Disorder (BPD) during a circumscribed period, were investigated in two studies. In study 1, patients with BPD (n = 15), with other personality disorders (PD; n = 18), and without Axis II disorders (but with Axis I disorders; n = 10) assessed with the SCID were interviewed with the BPDSI (1-yr. version). Patients also filled out a number of questionnaires. A second rater judged taped BPDSI interviews. The BPDSI appeared to yield highly reliable (ICC = .93) and internally consistent (Cronbach's alpha = .85) scores. The BPDSI strongly discriminated BPD patients from other patients, and was not related to other Axis II pathology. Concurrent and construct validity was excellent. In study 2, a version of the BPDSI suitable for use in treatment outcome research was investigated (3-month version) in a sample of 64 BPD patients, 23 Cluster C PD patients, and 20 nonpsychiatric controls. Again, reliability coefficients were excellent (ICC = 0.97; Cronbach's alpha = 0.93), and validity indices were good. Clinical norms were also derived. In a sample of 28 BPD patients, the instrument detected improvement during 6 months of psychotherapy.     

The joint structure of DSM-IV Axis I and Axis II disorders

The Diagnostic and Statistical Manual (4th ed. [DSM-IV]; American Psychiatric Association, 1994) distinction between clinical disorders on Axis I and personality disorders on Axis II has become increasingly controversial. Although substantial comorbidity between axes has been demonstrated, the structure of the liability factors underlying these two groups of disorders is poorly understood. The aim of this study was to determine the latent factor structure of a broad set of common Axis I disorders and all Axis II personality disorders and thereby to identify clusters of disorders and account for comorbidity within and between axes. Data were collected in Norway, through a population-based interview study (N = 2,794 young adult twins). Axis I and Axis II disorders were assessed with the Composite International Diagnostic Interview (CIDI) and the Structured Interview for DSM-IV Personality (SIDP-IV), respectively. Exploratory and confirmatory factor analyses were used to investigate the underlying structure of 25 disorders. A four-factor model fit the data well, suggesting a distinction between clinical and personality disorders as well as a distinction between broad groups of internalizing and externalizing disorders. The location of some disorders was not consistent with the DSM-IV classification; antisocial personality disorder belonged primarily to the Axis I externalizing spectrum, dysthymia appeared as a personality disorder, and borderline personality disorder appeared in an interspectral position. The findings have implications for a meta-structure for the DSM.     

Age-related differences in individual DSM criteria for borderline personality disorder

This study examined age-related effects of individual DSM criteria for borderline personality disorder (BPD) and symptoms of depression and anxiety in three groups: patients diagnosed with BPD, another personality disorder, or no personality disorder. The goal was to determine if distinctive age effects emerged within the BPD group. This mixed clinical and community sample (N = 380) ranged from 20-50 years old. Each participant was assessed for symptoms of axis I and II psychopathology. We found significant interactions for personality disorder group x age for the suicidal behavior and impulsivity criteria that reflected distinctive changes in the BPD group. The BPD group reported significantly more anxious and depressive symptoms. However, no main effect for age or personality disorder x age interaction emerged with symptoms. These results demonstrate that older individuals with BPD report less impulsivity and fewer suicidal behaviors, although symptoms of distress persist.