Psychological Phenomena and Processes Commons^™

Long-Term Outcomes In Borderline Psychopathology: Old Assumptions, Current Findings, And New Directions, Charles A. Sanislow, Katherine L. Marcus, Elizabeth M. Reagan

Charles A. Sanislow, Ph.D.

Borderline personality disorder (BPD) and historical variants of the diagnosis were long held to represent an intractable syndrome of psychopathology consisting of interpersonal, intrapsychic, and affective disturbances. For years, patients labeled “borderline” were regarded pejoratively due at least in part to the lack of effective treatments. Prospective data from recent naturalistic follow-along studies along with the development of treatments with empirically demonstrated efficacy have changed how BPD is viewed. It is now less common to hide the diagnosis from the patient, and BPD has become a useful label to guide the treatment process and help the patient make sense of …

Interpersonal Pathoplasticity In The Course Of Major Depression, Nicole M. Cain, Emily B. Ansell, Aidan G. C. Wright, Christopher J. Hopwood, Katherine M. Thomas, Anthony Pinto, John C. Markowitz, Charles A. Sanislow, Mary C. Zanarini, M. Tracie Shea, Leslie C. Morey, Thomas H. Mcglashan, Andrew E. Skodol, Carlos M. Grilo

Charles A. Sanislow, Ph.D.

Objective: The identification of reliable predictors of course in major depressive disorder (MDD) has been difficult. Evidence suggests that the co-occurrence of personality pathology is associated with longer time to MDD remission. Interpersonal pathoplasticity, the mutually influencing nonetiological relationship between psychopathology and interpersonal traits, offers an avenue for examining specific personality vulnerabilities that may be associated with depressive course. Method: This study examined 312 participants with and without a cooccurring personality disorder diagnosis who met criteria for a current MDD episode at baseline and who were followed for 10 years in the Collaborative Longitudinal Personality Disorders Study. Results: Latent profile …

Ten-Year Course Of Borderline Personality Disorder: Psychopathology And Function From The Collaborative Longitudinal Personality Study, John G. Gunderson, Robert L. Stout, Thomas H. Mcglashan, M. Tracie Shea, Leslie C. Morey, Carlos M. Grilo, Mary C. Zanarini, Shirley Yen, John C. Markowitz, Charles A. Sanislow, Emily B. Ansell, Anthony Pinto, Andrew E. Skodol

Charles A. Sanislow, Ph.D.

Context: Borderline personality disorder (BPD) is traditionally considered chronic and intractable.

Objective: To compare the course of BPD’s psychopathology and social function with that of other personality disorders and with major depressive disorder (MDD) over 10 years. Design: A collaborative study of treatment-seeking, 18- to 45-year-old patients followed up with standardized, reliable, and repeated measures of diagnostic remission and relapse and of both global social functioning and subtypes of social functioning.

Setting: Nineteen clinical settings (hospital and outpatient) in 4 northeastern US cities.

Participants: Three study groups, including 175 patients with BPD, 312 with cluster C personality disorders, and 95 …

The Association Of Personality Disorders With The Prospective 7-Year Course Of Anxiety Disorders, Emily B. Ansell, Anthony Pinto, Maria O. Edelen, John C. Markowitz, Charles A. Sanislow, Shirley Yen, Mary C. Zanarini, Andrew E. Skodol, M. Tracie Shea, Leslie C. Morey, John G. Gunderson, Thomas H. Mcglashan, Carlos M. Grilo

Charles A. Sanislow, Ph.D.

Background. This study prospectively examined the natural clinical course of six anxiety disorders over 7 years of follow-up in individuals with personality disorders (PDs) and/or major depressive disorder. Rates of remission, relapse, new episode onset and chronicity of anxiety disorders were examined for specific associations with PDs.

Method. Participants were 499 patients with anxiety disorders in the Collaborative Longitudinal Personality Disorders Study, who were assessed with structured interviews for psychiatric disorders at yearly intervals throughout 7 years of follow-up. These data were used to determine probabilities of changes in disorder status for social phobia (SP), generalized anxiety disorder (GAD), obsessive-compulsive …

State Effects Of Major Depression On The Assessment Of Personality And Personality Disorder, Leslie C. Morey, M. Tracie Shea, John C. Markowitz, Robert L. Stout, Christopher J. Hopwood, John G. Gunderson, Carlos M. Grilo, Thomas H. Mcglashan, Shirley Yen, Charles A. Sanislow, Andrew E. Skodol

Charles A. Sanislow, Ph.D.

OBJECTIVE: The authors sought to determine whether personality disorders diagnosed during a depressive episode have long-term outcomes more typical of those of other patients with personality disorders or those of patients with noncomorbid major depression.

METHOD: The authors used 6-year outcome data collected from the multisite Collaborative Longitudinal Personality Disorders Study (CLPS). Diagnoses and personality measures gathered from the study cohort at the index assessment using interview and self-report methods were associated with symptomatic, functional, and personality measures at 6-year follow-up. Of 668 patients initially recruited to the CLPS, 522 were followed for 6 years. All participants had either a …

New Episodes And New Onsets Of Major Depression In Borderline And Other Personality Disorders, John G. Gunderson, Robert L. Stout, Charles A. Sanislow, M. Tracie Shea, Thomas H. Mcglashan, Mary C. Zanarini, Maria T. Daversa, Carlos M. Grilo, Shirley Yen, Andrew E. Skodol

Charles A. Sanislow, Ph.D.

Background: In the context of much literature and conjecture about the relationship of personality disorders (PD) and major depressive disorder (MDD), this paper uses longitudinal data to assess the frequency with which PD patients, and especially those with borderline personality disorder (BPD), have recurrences (for patients with lifetime histories), or new onsets (for patients without lifetime histories) of MDD. Methods: A sample of 478 PD patients received reliable repeated follow-up assessments over a period of 6 years. The rates of new onsets and recurrences of MDD in all PD patients, and in BPD patients compared to OPD patients were analyzed. …

Ethnicity And Mental Health Treatment Utilization By Patients With Personality Disorders, Donna S. Bender, Andrew E. Skodol, Ingrid R. Dyck, John C. Markowitz, M. Tracie Shea, Shirley Yen, Charles A. Sanislow, Anthony Pinto, Mary C. Zanarini, Thomas H. Mcglashan, John G. Gunderson, Maria T. Daversa, Carlos M. Grilo

Charles A. Sanislow, Ph.D.

The authors examined the relationship between ethnicity and treatment utilization by individuals with personality disorders (PDs). Lifetime and prospectively determined rates and amounts of mental health treatments received were compared in over 500 White, African American, and Hispanic participants with PDs in a naturalistic longitudinal study. Minority, especially Hispanic, participants were significantly less likely than White participants to receive a range of outpatient and inpatient psychosocial treatments and psychotropic medications. This pattern was especially pronounced for minority participants with more severe PDs. A positive support alliance factor significantly predicted the amount of individual psychotherapy used by African American and Hispanic …

Positive Childhood Experiences: Resilience And Recovery From Personality Disorder In Early Adulthood, Andrew E. Skodol, Donna S. Bender, Maria E. Pagano, M. Tracie Shea, Shirley Yen, Charles A. Sanislow, Carlos M. Grilo, Maria T. Daversa, Robert L. Stout, Mary C. Zanarini, Thomas H. Mcglashan, John G. Gunderson

Charles A. Sanislow, Ph.D.

OBJECTIVE: Recent follow-along studies of personality disorders have shown significant improvement in psychopathology over time. The purpose of this study was to prospectively investigate the association between positive childhood experiences related to resiliency and remission from personality disorder.

METHOD: Five hundred twenty patients with DSM-IV-based semistructured interview diagnoses of schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders were evaluated 6 times over 4 years between September 1996 and June 2002. Positive childhood experiences, including achievements, positive interpersonal relationships with others, and caretaker competencies, were measured using the Childhood Experiences Questionnaire-Revised. The effects of positive childhood experiences on clinically significant remission from …

Descriptive And Longitudinal Observations On The Relationship Of Borderline Personality Disorder And Bipolar Disorder, John G. Gunderson, Igor Weinberg, Maria T. Daversa, Karsten D. Kueppenbender, Mary C. Zanarini, M. Tracie Shea, Andrew E. Skodol, Charles A. Sanislow, Shirley Yen, Leslie C. Morey, Carlos M. Grilo, Thomas H. Mcglashan, Robert L. Stout, Ingrid R. Dyck

Charles A. Sanislow, Ph.D.

OBJECTIVE: The purpose of this study was to test whether borderline personality disorder is a variant of bipolar disorder by examining the rates of co-occurrence in both disorders, the effects of co-occurrence on a longitudinal course, and whether the presence of either disorder confers the risk for new onsets of the other.

METHOD: A prospective repeated-measures design with reliable independent diagnostic measures and 4 years of follow-up was used to assess 196 patients with borderline personality disorder and 433 patients with other personality disorders.

RESULTS: Patients with borderline personality disorder had a significantly higher co-occurrence of bipolar disorder (19.4%) than …

Predictors Of 2-Year Outcome For Patients With Borderline Personality Disorder, John G. Gunderson, Maria T. Daversa, Carlos M. Grilo, Thomas H. Mcglashan, Mary C. Zanarini, M. Tracie Shea, Andrew E. Skodol, Shirley Yen, Charles A. Sanislow, Donna S. Bender, Ingrid R. Dyck, Leslie C. Morey, Robert L. Stout

Charles A. Sanislow, Ph.D.

OBJECTIVE: The primary purpose of this report was to investigate whether characteristics of subjects with borderline personality disorder observed at baseline can predict variations in outcome at the 2-year follow-up.

METHOD: Hypothesized predictor variables were selected from prior studies. The patients (N=160) were recruited from the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. Patients were assessed at baseline and at 6, 12, and 24 months with the Structured Clinical Interview for DSM-IV Axis I Disorders; the Diagnostic Interview for DSM-IV Personality Disorders, a modified version of that instrument; the Longitudinal Interval Follow-Up Evaluation; and the Childhood Experiences …

Major Depressive Disorder And Borderline Personality Disorder Revisited: Longitudinal Interactions, John G. Gunderson, Leslie C. Morey, Robert L. Stout, Andrew E. Skodol, M. Tracie Shea, Thomas H. Mcglashan, Mary C. Zanarini, Carlos M. Grilo, Charles A. Sanislow, Shirley Yen, Maria T. Daversa, Donna S. Bender

Charles A. Sanislow, Ph.D.

BACKGROUND: This report investigates the longitudinal association of changes in major depressive disorder (MDD) and borderline personality disorder.

METHOD: A DSM-IV-diagnosed sample of 161 patients with borderline personality disorder who have been followed with repeated measures at 6, 12, 24, and 36 months are investigated to see whether those with co-occurring MDD differ at baseline and in their course. Proportional hazard regression and cross-lagged panel analyses are used to demonstrate whether changes in the course of either disorder have predictable effects on the course of the other.

RESULTS: The rate of remissions of borderline personality disorder was not affected by …

Testing An Apa Practice Guideline: Symptom-Targeted Medication Utilization For Patients With Borderline Personality Disorder, John M. Oldham, Donna S. Bender, Andrew E. Skodol, Ingrid R. Dyck, Charles A. Sanislow, Shirley Yen, Carlos M. Grilo, M. Tracie Shea, Mary C. Zanarini, John G. Gunderson, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

BACKGROUND: The goal of this study was to test whether the use of psychotropic medication treatment for borderline personality disorder (BPD) was consistent with proposals in the recently published American Psychiatric Association's Practice Guideline for the Treatment of Patients with Borderline Personality Disorder.

METHOD: Medication utilization by patients with BPD was assessed prospectively over a 2-year period prior to the publication of the Guideline. Three BPD symptom clusters--cognitive-perceptual, affective dysregulation, and impulsive-behavioral dyscontrol--along with demographic and functioning variables were used to predict the use of five classes of medication.

RESULTS: Symptoms of impulsive-behavioral dyscontrol significantly predicted use of both neuroleptics …

Psychophysiological Reactivity To Traumatic And Abandonment Scripts In Borderline Personality And Posttraumatic Stress Disorders: A Preliminary Report, Christian G. Schmahl, Bernet M. Elzinga, Ulrich W. Ebner, Timothy Simms, Charles A. Sanislow, Eric Vermetten, Thomas H. Mcglashan, J. Douglas Bremner

Charles A. Sanislow, Ph.D.

Borderline personality disorder (BPD) is a highly prevalent and disabling condition linked to early stressors including traumatic abuse and abandonment. While much work has addressed traumatic events in childhood, little is known about the biological sequelae of BPD including how this disorder may be differentiated from other stressrelated disorders such as posttraumatic stress disorder (PTSD). The purpose of this study was to investigate psychophysiological effects of different types of stressful reminders in BPD and in PTSD. Psychophysiological measures including heart rate, skin conductance responses, systolic and diastolic blood pressure in response to standardized neutral scripts, and personalized scripts of traumatic …

Borderline Personality Disorder Criteria Associated With Prospectively Observed Suicidal Behavior, Shirley Yen, M. Tracie Shea, Charles A. Sanislow, Carlos M. Grilo, Andrew E. Skodol, John G. Gunderson, Thomas H. Mcglashan, Mary C. Zanarini, Leslie C. Morey

Charles A. Sanislow, Ph.D.

OBJECTIVE: The authors prospectively examined associations between each DSM-IV borderline personality disorder criterion and suicidal behaviors.

METHOD: Borderline personality disorder diagnosis and criteria, major depressive disorder, substance use disorders, and history of childhood sexual abuse were assessed with semistructured interviews. Participants (N=621) were followed for 2 years with repeated structured evaluations that included assessments of suicidality.

RESULTS: With the self-injury criterion excluded, the borderline personality disorder criteria of affective instability, identity disturbance, and impulsivity significantly predicted suicidal behaviors. Only affective instability and childhood sexual abuse were significantly associated with suicide attempts (i.e., behavior with some intent to die).

CONCLUSIONS: Affective …

Amygdala Hyperreactivity In Borderline Personality Disorder: Implications For Emotional Dysregulation, Nelson H. Donegan, Charles A. Sanislow, Hilary P. Blumberg, Robert K. Fulbright, Cheryl Lacadie, Pawel Skudlarski, John C. Gore, Ingrid R. Olson, Thomas H. Mcglashan, Bruce E. Wexler

Charles A. Sanislow, Ph.D.

BACKGROUND: Disturbed interpersonal relations and emotional dysregulation are fundamental aspects of borderline personality disorder (BPD). The amygdala plays important roles in modulating vigilance and generating negative emotional states and is often abnormally reactive in disorders of mood and emotion. The aim of this study was to assess amygdala reactivity in BPD patients relative to normal control subjects. We hypothesized that amygdala hyperreactivity contributes to hypervigilance, emotional dysregulation, and disturbed interpersonal relations in BPD.

METHODS: Using functional magnetic resonance imaging, we examined neural responses to 20-sec blocks of neutral, happy, sad, and fearful facial expression (or a fixation point) in 15 …