Prediction of time-to-attainment of recovery for borderline patients followed prospectively for 16 years
| Autor: | Frances R. Frankenburg, Lindsey C. Conkey, D. B. Reich, Garrett M. Fitzmaurice, Mary C. Zanarini, Michelle M. Wedig |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Employment Male medicine.medical_specialty Time Factors Younger age media_common.quotation_subject Intelligence Dysphoria Article Young Adult Borderline Personality Disorder medicine Humans Longitudinal Studies Family history Young adult Temperament Psychiatry Borderline personality disorder media_common Adult development Remission Induction Prognosis medicine.disease Hospitalization Substance abuse Psychiatry and Mental health Female medicine.symptom Psychology Clinical psychology |
| Zdroj: | Acta Psychiatrica Scandinavica. 130:205-213 |
| ISSN: | 0001-690X |
| DOI: | 10.1111/acps.12255 |
| Popis: | Two recent large-scale, long-term studies of the prospective course of borderline personality disorder (BPD) have documented high rates of symptomatic remission (1–3). However, one of these studies also assessed the more complex outcome of recovery—which was defined as symptomatic remission that was concurrent with good social and good full-time vocational functioning (3). In this study—the McLean Study of Adult Development (MSAD)—99% of borderline patients had attained a two-year remission of their BPD and 60% had attained a two-year recovery after 16 years of prospective follow-up. However, the only information on predictors of the overall outcome of borderline personality disorder comes from four large-scale, long-term, follow-back studies that were conducted in the 1980s (4–7). Each of these studies (5,7–10) tried to determine the best predictors of general outcome a mean of 14–16 years after index admission. Five factors were found to be associated with a good long-term outcome: high IQ (7,8), being unusually talented or physically attractive (if female) (7), the absence of parental divorce and narcissistic entitlement (10), and the presence of physically self-destructive acts during the index admission (8). Nine factors were found to be associated with a poor long-term outcome: affective instability (8), chronic dysphoria (5), younger age at first treatment (5), length of prior hospitalization (8), antisocial behavior (7), substance abuse (7), parental brutality (7), a family history of psychiatric illness (5), and a problematic relationship with one's mother (but not one's father) (9). While all of these studies of the course of BPD provided useful information and were considered state of the art at the time that they were conducted, all of them also suffered from one or more methodological problems that limited what could be generalized from their results. Chief among these limitations were the following: use of chart reviews to diagnose BPD, no comparison group or the use of less than optimal comparison subjects, many important predictor variables were either not assessed at all or were only assessed in the most rudimentary manner, typically only one post-baseline reassessment, non-blind post-baseline assessments, and variable number of years of follow-up in the same study. In addition, only one of these studies used a socioeconomically representative sample (5) and the results of this study may be misleading as it had a very low trace rate (32%). In addition, none of these studies assessed change from baseline. And none operationally defined the elements that comprise a good long-term outcome. |
| Databáze: | OpenAIRE |
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