Borderline psychopathology and recurrences of clinical disorders

This prospective cohort study of patients with borderline psychopathology reports on the clinical disorders occurring during the course and at 7-year follow-up. Subjects with persistent versus remitted borderline personality disorder (BPD) are compared. The relationship between the initial levels of borderline psychopathology and the occurrence of clinical disorders on follow-up is examined. Consecutive admissions to inpatient units were screened for borderline characteristics. This resulted in a sample of 130 subjects, 88 of whom were positive for BPD based on the Diagnostic Interview for Borderlines. At 7-year follow-up, 81 (62.3%) subjects were reinterviewed in person, 6 (4.6%) suicided, 2 (1.6%) were decreased, 36 (27.7%) refused to participate, and 5 (3.8%) could not be located. Twenty-seven of 57 (47.4%) who initially were positive for BPD were rediagnosed at 7-year follow-up (the persistent group) and 30 (52.6%) were no longer diagnosed as BPD (the remitted group). The persistent individuals were significantly more likely to be diagnosed as having major depression, dysthymia, and other psychiatric disorders than the remitted group. The persistent group had significantly more episodes of substance abuse over the follow-up period compared with the remitted group. Individuals with persistent BPD suffered more episodes of clinical disorders over the follow-up period and the initial level of borderline psychopathology predicted the recurrence of major depression.