Pub Date : 2018-10-01DOI: 10.1093/med-psych/9780195370607.003.0010
M. Zanarini
Social and vocational functioning are extremely important outcomes. This chapter details the findings of four sub-studies concerning this area. In all of these studies, borderline patients showed areas of strength. However, remitted borderline patients functioned better than non-remitted borderline patients at six-year follow-up, while the borderline patients on disability functioned more poorly than borderline patients never on disability at 10-year follow-up. Believing that we had been too optimistic about the psychosocial functioning of borderline patients early in the study, we changed the definition to include full-time work or school at 10-year follow-up. This change resulted in 60% rather than 82% achieving this goal. Finally, we compared the rates of marriage and being a parent of recovered and non-recovered borderline patients at 16-year follow-up, finding that recovered borderline patients were more likely to achieve stability in these areas.
{"title":"Psychosocial Functioning over Time","authors":"M. Zanarini","doi":"10.1093/med-psych/9780195370607.003.0010","DOIUrl":"https://doi.org/10.1093/med-psych/9780195370607.003.0010","url":null,"abstract":"Social and vocational functioning are extremely important outcomes. This chapter details the findings of four sub-studies concerning this area. In all of these studies, borderline patients showed areas of strength. However, remitted borderline patients functioned better than non-remitted borderline patients at six-year follow-up, while the borderline patients on disability functioned more poorly than borderline patients never on disability at 10-year follow-up. Believing that we had been too optimistic about the psychosocial functioning of borderline patients early in the study, we changed the definition to include full-time work or school at 10-year follow-up. This change resulted in 60% rather than 82% achieving this goal. Finally, we compared the rates of marriage and being a parent of recovered and non-recovered borderline patients at 16-year follow-up, finding that recovered borderline patients were more likely to achieve stability in these areas.","PeriodicalId":275647,"journal":{"name":"In the Fullness of Time","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115150172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED-PSYCH/9780195370607.003.0017
M. Zanarini
We studied two types of sexual issues over time. The first issue was sexual relationship difficulties, which we defined as avoiding sex for fear of becoming symptomatic, or becoming symptomatic after having sex. The second issue was sexual orientation and gender of relationship choice. At six-year follow-up, we found that sexual relationship difficulties were significantly more common among borderline patients than among Axis II comparison subjects, although the rate was declining in both study groups. At 16-year follow-up, the same pattern was found for non-recovered versus recovered borderline patients. In terms of the second issue, patients with BPD were significantly more likely than Axis II comparison subjects to report homosexual or bisexual orientation and intimate same-sex relationships. In addition, patients with BPD were significantly more likely than Axis II comparison subjects to report changing the gender of intimate partners, but not sexual orientation, at some point during the follow-up period.
{"title":"Sexual Issues over Time","authors":"M. Zanarini","doi":"10.1093/MED-PSYCH/9780195370607.003.0017","DOIUrl":"https://doi.org/10.1093/MED-PSYCH/9780195370607.003.0017","url":null,"abstract":"We studied two types of sexual issues over time. The first issue was sexual relationship difficulties, which we defined as avoiding sex for fear of becoming symptomatic, or becoming symptomatic after having sex. The second issue was sexual orientation and gender of relationship choice. At six-year follow-up, we found that sexual relationship difficulties were significantly more common among borderline patients than among Axis II comparison subjects, although the rate was declining in both study groups. At 16-year follow-up, the same pattern was found for non-recovered versus recovered borderline patients. In terms of the second issue, patients with BPD were significantly more likely than Axis II comparison subjects to report homosexual or bisexual orientation and intimate same-sex relationships. In addition, patients with BPD were significantly more likely than Axis II comparison subjects to report changing the gender of intimate partners, but not sexual orientation, at some point during the follow-up period.","PeriodicalId":275647,"journal":{"name":"In the Fullness of Time","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114346696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED-PSYCH/9780195370607.003.0016
M. Zanarini
At baseline, borderline patients reported higher rates of adult rape and physical assault by a partner than Axis II comparison subjects. Four risk factors were found to significantly predict whether borderline patients had an adult history of being a victim of physical and/or sexual violence before their index admission: female gender, a substance use disorder that began before the age of 18, childhood sexual abuse, and emotional withdrawal by a caretaker (a form of neglect). At six-year and 10-year follow-up, borderline patients reported higher rates of being verbally, emotionally, physically, and sexually abused or assaulted than did Axis II comparison subjects. However, each of these forms of abuse declined significantly over time. The clinical implications of these prevalence and predictive findings are discussed.
{"title":"Adult Victimization over Time","authors":"M. Zanarini","doi":"10.1093/MED-PSYCH/9780195370607.003.0016","DOIUrl":"https://doi.org/10.1093/MED-PSYCH/9780195370607.003.0016","url":null,"abstract":"At baseline, borderline patients reported higher rates of adult rape and physical assault by a partner than Axis II comparison subjects. Four risk factors were found to significantly predict whether borderline patients had an adult history of being a victim of physical and/or sexual violence before their index admission: female gender, a substance use disorder that began before the age of 18, childhood sexual abuse, and emotional withdrawal by a caretaker (a form of neglect). At six-year and 10-year follow-up, borderline patients reported higher rates of being verbally, emotionally, physically, and sexually abused or assaulted than did Axis II comparison subjects. However, each of these forms of abuse declined significantly over time. The clinical implications of these prevalence and predictive findings are discussed.","PeriodicalId":275647,"journal":{"name":"In the Fullness of Time","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128704497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED-PSYCH/9780195370607.003.0014
M. Zanarini
At baseline, borderline patients reported using high rates of outpatient treatment and more restrictive forms of treatment, such as inpatient psychiatric treatment. Over time, these rates have declined, particularly for more restrictive and costly forms of treatment. However, high rates of borderline patients remain in outpatient psychotherapy and continue taking standing medications in all major classes of psychotropic medications. Perhaps most concerning is that a substantial percentage of borderline patients have been treated with aggressive polypharmacy (three or more standing medications) despite the health consequences, such as obesity, and despite there being no empirical evidence for this common practice. Evidence-based psychosocial treatments are reviewed, and suggestions are made for treatment as usual.
{"title":"Mental Health Treatment over Time","authors":"M. Zanarini","doi":"10.1093/MED-PSYCH/9780195370607.003.0014","DOIUrl":"https://doi.org/10.1093/MED-PSYCH/9780195370607.003.0014","url":null,"abstract":"At baseline, borderline patients reported using high rates of outpatient treatment and more restrictive forms of treatment, such as inpatient psychiatric treatment. Over time, these rates have declined, particularly for more restrictive and costly forms of treatment. However, high rates of borderline patients remain in outpatient psychotherapy and continue taking standing medications in all major classes of psychotropic medications. Perhaps most concerning is that a substantial percentage of borderline patients have been treated with aggressive polypharmacy (three or more standing medications) despite the health consequences, such as obesity, and despite there being no empirical evidence for this common practice. Evidence-based psychosocial treatments are reviewed, and suggestions are made for treatment as usual.","PeriodicalId":275647,"journal":{"name":"In the Fullness of Time","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126087144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED-PSYCH/9780195370607.003.0009
M. Zanarini
This chapter details the course of symptom areas that were not covered in Chapter 6, or were covered in a non-comprehensive manner. These symptom areas are anxiety, shame, dissociation, and 17 specific cognitions (e.g., overvalued ideas, ideas of reference). These symptoms tended to decrease over time, but they also tended to remain significantly more severe or more common among borderline patients than among Axis II comparison subjects. Multivariate predictive models were also found for the severity of anxiety and the severity of shame. Taken together, these symptoms represent areas of suffering that would benefit from more clinical attention and support.
{"title":"Additional Symptom Areas over Time","authors":"M. Zanarini","doi":"10.1093/MED-PSYCH/9780195370607.003.0009","DOIUrl":"https://doi.org/10.1093/MED-PSYCH/9780195370607.003.0009","url":null,"abstract":"This chapter details the course of symptom areas that were not covered in Chapter 6, or were covered in a non-comprehensive manner. These symptom areas are anxiety, shame, dissociation, and 17 specific cognitions (e.g., overvalued ideas, ideas of reference). These symptoms tended to decrease over time, but they also tended to remain significantly more severe or more common among borderline patients than among Axis II comparison subjects. Multivariate predictive models were also found for the severity of anxiety and the severity of shame. Taken together, these symptoms represent areas of suffering that would benefit from more clinical attention and support.","PeriodicalId":275647,"journal":{"name":"In the Fullness of Time","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131258501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/med-psych/9780195370607.003.0006
M. Zanarini
This chapter reports on the prevalence rates of the 24 symptoms of BPD assessed in this study; prevalence rates that are declining over time. It also reports on rates of remission of each of these symptoms and rates of recurrence following periods of remission. The 24 symptoms are divided into 12 acute symptoms (e.g., self-mutilation, suicide efforts) and 12 temperamental symptoms (e.g., chronic feelings of anger, intolerance of aloneness). It was found that acute symptoms remit more rapidly and are less likely to recur. The clinical implications of these different symptom trajectories are discussed in detail.
{"title":"The Long-Term Course of the Symptoms of Borderline Personality Disorder","authors":"M. Zanarini","doi":"10.1093/med-psych/9780195370607.003.0006","DOIUrl":"https://doi.org/10.1093/med-psych/9780195370607.003.0006","url":null,"abstract":"This chapter reports on the prevalence rates of the 24 symptoms of BPD assessed in this study; prevalence rates that are declining over time. It also reports on rates of remission of each of these symptoms and rates of recurrence following periods of remission. The 24 symptoms are divided into 12 acute symptoms (e.g., self-mutilation, suicide efforts) and 12 temperamental symptoms (e.g., chronic feelings of anger, intolerance of aloneness). It was found that acute symptoms remit more rapidly and are less likely to recur. The clinical implications of these different symptom trajectories are discussed in detail.","PeriodicalId":275647,"journal":{"name":"In the Fullness of Time","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126686434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED-PSYCH/9780195370607.003.0015
M. Zanarini
Remitted borderline patients were found to have better physical health, make better health-related lifestyle choices, and use fewer costly forms of treatment, such as ER visits, than non-remitted borderline patients. This same pattern was found 10 years later for recovered vs. non-recovered borderline patients. At both time points, obesity was the most common serious health problem, and smoking and lack of exercise were the most common poor lifestyle choices. Obesity was found to be related to poor psychosocial functioning in most realms. Recovered borderline patients had better sleep quality and were not as troubled by dysfunctional attitudes about sleep as non-recovered borderline patients. Borderline patients also reported higher levels of physical pain than Axis II comparison subjects. However, a substantial minority were able to use opioid medications responsibly over time.
{"title":"Physical Health and Medical Treatment","authors":"M. Zanarini","doi":"10.1093/MED-PSYCH/9780195370607.003.0015","DOIUrl":"https://doi.org/10.1093/MED-PSYCH/9780195370607.003.0015","url":null,"abstract":"Remitted borderline patients were found to have better physical health, make better health-related lifestyle choices, and use fewer costly forms of treatment, such as ER visits, than non-remitted borderline patients. This same pattern was found 10 years later for recovered vs. non-recovered borderline patients. At both time points, obesity was the most common serious health problem, and smoking and lack of exercise were the most common poor lifestyle choices. Obesity was found to be related to poor psychosocial functioning in most realms. Recovered borderline patients had better sleep quality and were not as troubled by dysfunctional attitudes about sleep as non-recovered borderline patients. Borderline patients also reported higher levels of physical pain than Axis II comparison subjects. However, a substantial minority were able to use opioid medications responsibly over time.","PeriodicalId":275647,"journal":{"name":"In the Fullness of Time","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116102891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED-PSYCH/9780195370607.003.0013
M. Zanarini
This chapter concerns the co-occurring Axis I and II disorders reported by borderline patients. It was found at baseline that mood, PTSD, other anxiety, substance use, and eating disorders, as well as anxious cluster Axis II disorders, were all common. Prevalence rates of these disorders declined over time. It was also found that substance use disorders were the disorders that most interfered with remission from BPD. Using survival analyses, we also studied time-to-remission, time-to-recurrence, and time-to-new-onsets of specific disorders in each of these areas of psychopathology. None of the disorders studied was chronic in nature. All exhibited fluidity over time.
{"title":"Co-occurring Disorders over Time","authors":"M. Zanarini","doi":"10.1093/MED-PSYCH/9780195370607.003.0013","DOIUrl":"https://doi.org/10.1093/MED-PSYCH/9780195370607.003.0013","url":null,"abstract":"This chapter concerns the co-occurring Axis I and II disorders reported by borderline patients. It was found at baseline that mood, PTSD, other anxiety, substance use, and eating disorders, as well as anxious cluster Axis II disorders, were all common. Prevalence rates of these disorders declined over time. It was also found that substance use disorders were the disorders that most interfered with remission from BPD. Using survival analyses, we also studied time-to-remission, time-to-recurrence, and time-to-new-onsets of specific disorders in each of these areas of psychopathology. None of the disorders studied was chronic in nature. All exhibited fluidity over time.","PeriodicalId":275647,"journal":{"name":"In the Fullness of Time","volume":"129 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128659598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/med-psych/9780195370607.003.0012
M. Zanarini
This chapter reports on the bivariate and multivariate predictors of two of our most important outcomes—remission and recovery. In terms of time-to-remission, seven variables that span five areas of prediction were found to be significant in multivariate analyses. These areas were: lack of chronicity, good premorbid vocational functioning, no history of childhood sexual abuse, no family history of substance abuse, and three aspects of temperament. In terms of time-to-recovery, five variables that span three areas of prediction were found to be significant in multivariate analyses. These areas were: lack of chronicity, competence, and temperament. The clinical implications of these significant models and the significant bivariate predictors that did not end up in these models are discussed in detail.
{"title":"Predictors of Time-to-Remission and Recovery","authors":"M. Zanarini","doi":"10.1093/med-psych/9780195370607.003.0012","DOIUrl":"https://doi.org/10.1093/med-psych/9780195370607.003.0012","url":null,"abstract":"This chapter reports on the bivariate and multivariate predictors of two of our most important outcomes—remission and recovery. In terms of time-to-remission, seven variables that span five areas of prediction were found to be significant in multivariate analyses. These areas were: lack of chronicity, good premorbid vocational functioning, no history of childhood sexual abuse, no family history of substance abuse, and three aspects of temperament. In terms of time-to-recovery, five variables that span three areas of prediction were found to be significant in multivariate analyses. These areas were: lack of chronicity, competence, and temperament. The clinical implications of these significant models and the significant bivariate predictors that did not end up in these models are discussed in detail.","PeriodicalId":275647,"journal":{"name":"In the Fullness of Time","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132120198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED-PSYCH/9780195370607.003.0011
M. Zanarini
As important as our findings concerning the high rates of symptomatic remission and low rates of symptomatic recurrence are, the rates of recovery are even more important. This is so because we defined “recovery” as concurrent symptomatic remission and good social and good full-time vocational functioning. After 10 years of prospective follow-up, 50% of borderline patients achieved this important goal. After 16 years of prospective follow-up, 60% of borderline patients achieved this key outcome. In general, recovery is more difficult to achieve and maintain than remission. Two vignettes are presented in this chapter. The first deals with a patient who remitted but never recovered, and the second deals with a patient who both remitted and recovered.
{"title":"Recovery from Borderline Personality Disorder","authors":"M. Zanarini","doi":"10.1093/MED-PSYCH/9780195370607.003.0011","DOIUrl":"https://doi.org/10.1093/MED-PSYCH/9780195370607.003.0011","url":null,"abstract":"As important as our findings concerning the high rates of symptomatic remission and low rates of symptomatic recurrence are, the rates of recovery are even more important. This is so because we defined “recovery” as concurrent symptomatic remission and good social and good full-time vocational functioning. After 10 years of prospective follow-up, 50% of borderline patients achieved this important goal. After 16 years of prospective follow-up, 60% of borderline patients achieved this key outcome. In general, recovery is more difficult to achieve and maintain than remission. Two vignettes are presented in this chapter. The first deals with a patient who remitted but never recovered, and the second deals with a patient who both remitted and recovered.","PeriodicalId":275647,"journal":{"name":"In the Fullness of Time","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125291807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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