Borderline Personality Disorder (BPD) is a common psychiatric disorder in both treated and community samples. It is also associated with high levels of mental health and other social service utilization. Despite previous research in this area, relatively little is known about either the short- term or the long-term course of the disorder. Our overall aim is to lay the groundwork for the first prospective study of the long-term course and outcome of BPD. Our first specific aim is to prospectively assess the short-term course and outcome of 300 consecutively admitted McLean inpatients between the ages of 18-30: 150 borderline patients, 75 antisocial patients, and 75 patients with Dysthymia plus some other form of Axis II disorder. Our second specific aim is to assess the relationship between an array of clinically meaningful predictor and outcome variables. Our third specific aim is to assess the pathways to health taken by those borderline patients who improve substantially. Our previous research has shown that the attainment of stable sobriety is the only major factor significantly associated with good overall short-term follow-up functioning. However, five other pathways to health will be studied: 1) sustaining close relationships, 2) sustained vocational performance, 3) sustained but not necessarily intensive psychotherapy, 4) sustained participation in self-help or religious groups, and 5) pharmacotherapy. Demographic data, premorbid functioning, and past psychiatric treatment will be assessed at baseline by the Principal Investigator. The PI (or one of her Co-investigators for a subset of the sample) will also assess Axis I and Axis II phenomenology at baseline. In addition, family history of psychiatric disorder, and both pathological and protective childhood experiences will be assessed at baseline by a clinically experienced research assistant blind to all background and diagnostic information. Axis I and Axis II phenomenology, social and vocational functioning, physical health, psychiatric treatment, and pathways to health will be assessed at two year follow-up by another clinically experienced research assistant blind to all previously collected data.
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