We propose a 5-year (and final) renewal of the McLean Study of Adult Development (MSAD), the first large-scale, prospective study of the long-term course of borderline personality disorder (BPD). We will obtain a maximum of 20 years of follow-up data on 290 patients who met DIB-R and DSM-III-R criteria for BPD and 72 axis II comparison subjects who met DSM-III-R criteria for another personality disorder (and neither criteria set for BPD). After 14 years of follow-up, we are still following 88% of the surviving borderline patients (and 81% of the surviving axis II comparison subjects). During the years of follow-up, we have found that symptomatic remissions of BPD are far more common and stable than expected. We have also found that these remissions were driven more by the relatively rapid resolution of acute symptoms than the relatively slow resolution of temperamental symptoms. Taken together, these findings suggest that BPD has a better symptomatic prognosis than previously known. However, we have found more guarded and complex outcomes in other areas of investigation. More specifically, we found that recovery from BPD involving good social and vocational functioning as well as symptomatic remission from BPD was more difficult to achieve and maintain than symptomatic remission alone. In addition, we found that the physical health of many borderline patients has continued to decline, with obesity-related and smoking-related illnesses becoming more common over time, particularly among borderline patients who have not recovered from BPD (i.e., those with compromised psychosocial functioning). We believe that these findings warrant further investigation into the course of borderline psychopathology (particularly sustained remissions of BPD and its constituent symptoms), psychosocial functioning, recovery from BPD, co-occurring axis I and II disorders, psychiatric treatment, changes in temperament, and medical conditions and medical treatments (AIM 1: Description). We also believe that these findings warrant further investigation into the predictors of three main outcomes: recurrence of BPD, recovery from BPD, and completed suicide (AIM 2: Prediction). Subjects will be assessed at two-year intervals by raters who are blind to all previously collected information using semistructured interviews and self-report measures, including three new instruments assessing physical pain and sleep. This proposed continuation will result in crucial knowledge about the long-term course of BPD, with direct implications for patients, their families, and the clinicians treating them.

Public Health Relevance

Borderline personality disorder (BPD) is a common and serious psychiatric disorder. The McLean Study of Adult Development (MSAD) is the first large-scale, prospective study of the long-term course and outcome of BPD. This study will provide patients, their families, and those treating them with crucial information they need to plan for the future.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH062169-13
Application #
8281503
Study Section
Adult Psychopathology and Disorders of Aging Study Section (APDA)
Program Officer
Shoham, Varda
Project Start
2000-09-30
Project End
2015-03-31
Budget Start
2012-04-01
Budget End
2013-03-31
Support Year
13
Fiscal Year
2012
Total Cost
$509,623
Indirect Cost
$187,077
Name
Mclean Hospital
Department
Type
DUNS #
046514535
City
Belmont
State
MA
Country
United States
Zip Code
02478
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Zanarini, Mary C; Frankenburg, Frances R; Reich, D Bradford et al. (2015) The course of marriage/sustained cohabitation and parenthood among borderline patients followed prospectively for 16 years. J Pers Disord 29:62-70
Wright, Aidan G C; Hopwood, Christopher J; Zanarini, Mary C (2015) Associations between changes in normal personality traits and borderline personality disorder symptoms over 16 years. Personal Disord 6:11-Jan
Frankenburg, Frances R; Fitzmaurice, Garrett M; Zanarini, Mary C (2014) The use of prescription opioid medication by patients with borderline personality disorder and axis II comparison subjects: a 10-year follow-up study. J Clin Psychiatry 75:357-61
Karan, Esen; Niesten, Isabella J M; Frankenburg, Frances R et al. (2014) The 16-year course of shame and its risk factors in patients with borderline personality disorder. Personal Ment Health 8:169-77
Niesten, Isabella J M; Karan, Esen; Frankenburg, Frances R et al. (2014) Prevalence and risk factors for irritable bowel syndrome in recovered and non-recovered borderline patients over 10?years of prospective follow-up. Personal Ment Health 8:14-23
Zanarini, M C; Frankenburg, F R; Reich, D B et al. (2014) Prediction of time-to-attainment of recovery for borderline patients followed prospectively for 16 years. Acta Psychiatr Scand 130:205-13
Martinho Jr, Eduardo; Fitzmaurice, Garrett M; Frankenburg, Frances R et al. (2014) Pro re nata (as needed) psychotropic medication use in patients with borderline personality disorder and subjects with other personality disorders over 14 years of prospective follow-up. J Clin Psychopharmacol 34:499-503
Zanarini, Mary C; Frankenburg, Frances R; Fitzmaurice, Garrett M (2014) Severity of anxiety symptoms reported by borderline patients and Axis II comparison subjects: description and prediction over 16 years of prospective follow-up. J Pers Disord 28:767-77
Biskin, Robert S; Frankenburg, Frances R; Fitzmaurice, Garrett M et al. (2014) Pain in patients with borderline personality disorder. Personal Ment Health 8:218-27

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