Zanarini2006DBT827

Zanarini2006DBT827 - Article Prediction of the 10-Year...

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Am J Psychiatry 163:5, May 2006 827 Article ajp.psychiatryonline.org Prediction of the 10-Year Course of Borderline Personality Disorder Mary C. Zanarini, Ed.D. Frances R. Frankenburg, M.D. John Hennen, Ph.D. D. Bradford Reich, M.D. Kenneth R. Silk, M.D. Objective: The purpose of this study was to determine the most clinically relevant baseline predictors of time to remission for patients with borderline personality disorder. Method: A total of 290 inpatients meet- ing criteria for both the Revised Diagnos- tic Interview for Borderlines and DSM-III-R for borderline personality disorder were assessed during their index admission with a series of semistructured interviews and self-report measures. Diagnostic sta- tus was reassessed at five contiguous 2- year time periods. Discrete survival ana- lytic methods, which controlled for base- line severity of borderline psychopathol- ogy and time, were used to estimate hazard ratios. Results: Eighty-eight percent of the pa- tients with borderline personality disor- der studied achieved remission. In terms of time to remission, 39.3% of the 242 pa- tients who experienced a remission of their disorder first remitted by their 2- year follow-up, an additional 22.3% first remitted by their 4-year follow-up, an ad- ditional 21.9% by their 6-year follow-up, an additional 12.8% by their 8-year fol- low-up, and another 3.7% by their 10-year follow-up. Sixteen variables were found to be significant bivariate predictors of ear- lier time to remission. Seven of these re- mained significant in multivariate analy- ses: younger age, absence of childhood sexual abuse, no family history of sub- stance use disorder, good vocational record, absence of an anxious cluster per- sonality disorder, low neuroticism, and high agreeableness. Conclusions: The results of this study suggest that prediction of time to remis- sion from borderline personality disorder is multifactorial in nature, involving fac- tors that are routinely assessed in clinical practice and factors, particularly aspects of temperament, that are not. (Am J Psychiatry 2006; 163:827–832) A ll of the currently available information on the long- term course and outcome of borderline personality disor- der comes from four large-scale, long-term, follow-back studies that were conducted in the 1980s (1–4). These studies found that the average patient with borderline personality disorder was functioning reasonably well a mean 14–16 years after his or her index admission. Each of these studies (2, 4–7) also tried to determine the best pre- dictors of general outcome. A substantial number of fac- tors were found to be associated with a good long-term outcome: high IQ (4, 5), being unusually talented or phys- ically attractive (if female) (4), the absence of parental di- vorce and narcissistic entitlement (7), and the presence of physically self-destructive acts during the index admis- sion (5). A larger number of factors were found to be asso- ciated with a poor long-term outcome: affective instability (5), chronic dysphoria (2), younger age at first treatment
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Zanarini2006DBT827 - Article Prediction of the 10-Year...

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