Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders

Abstract

Clinical experience suggests that individuals with borderline personality disorder commonly report being in psychotherapy and taking standing psychotropic medications over substantial periods of time. Clinical experience also suggests that patients with borderline personality disorder are frequently rehospitalized. However, only two longitudinal studies have prospectively examined the long-term course of the psychiatric treatment received by these patients. In the first of these studies [1], treatment utilization of patients with borderline personality disorder and axis II comparison participants was studied over six years of prospective follow-up in the McLean Study of Adult Development (MSAD). It was found that prevalence rates of individual therapy, standing medications, and psychiatric hospitalizations declined significantly for those in both study groups but remained significantly higher among patients with borderline personality disorder than axis II comparison participants. Perhaps most striking was the finding that 70% of patients with borderline personality disorder participated in individual therapy and 70% took standing medications in all three follow-up periods. In the second longitudinal study (the Collaborative Longitudinal Personality Disorders Study or CLPS), the treatment use of patients with borderline personality disorder was compared to that of patients with major depressive disorder and no personality disorder over the course of three years [2]. It was found that patients with borderline personality disorder were significantly more likely to be in individual therapy, have had a medication consultation, and been hospitalized for psychiatric reasons than those with major depressive disorder. The current study, which is an extension of the MSAD study mentioned above, has two purposes. The first is to describe the prevalence of three key treatment modalities reported by a large and well-defined sample of patients with borderline personality disorder and axis II comparison participants over 10 years of prospective follow-up. The second purpose is to detail time-to-cessation and time-to-resumption of these three forms of treatment by patients with borderline personality disorder.