The overall goal of this study is to continue a prospective study of the long-term course and outcome of borderline personality disorder (BPD). BPD is a common, symptomatically severe disorder associated with marked levels of psychosocial impairment and high levels of mental health and other social service utilization. Initial assessment data are available for a sample of 362 inpatients between the ages of 18 and 35; 290 borderline patients and 72 Axis II controls. In addition, the 95 percent of the surviving patients currently eligible for their 2, 4, and 6-year follow-up evaluations have been re-interviewed. The first specific aim is to prospectively assess the six, eight, and ten-year course and outcome of these patients. Four main aspects of the course and outcome will be studied: (1) severity of borderline symptoms, (2) impairment in psychosocial functioning, (3) prevalence of comorbid Axis I and Axis II disorders, and (4) type and amount of psychiatric and medical treatment received. The second specific aim is to determine the best predictive model for each of four outcomes: remission of BPD, recurrence of BPD, the attainment of good psychosocial functioning, and suicide. The third specific aim is to assess the pathways to health reported by those borderline patients who improve substantially. The fourth specific aim is to compare the predictive power of three models of BPD: the categorical model, the severity model of dimensionality, and the 5-Factor Model of dimensionality. Demographic data, social and vocational functioning, psychiatric and medical treatment, borderline symptoms, Axis I and Axis II comorbidity, life stress, basic aspects of temperament, and pathways to health will be assessed at each follow-up period by one of two masters level research assistants blind to all previously collected data. In addition, knowledgeable informants will be interviewed concerning each patient's psychosocial functioning, and medical, work, and school records will be collected and reviewed.
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