Borderline personality may influence course of Axis I disorders

SAN FRANCISCO — The presence of borderline personality disorder may affect the time to remission and relapse of a number of Axis I disorders, particularly anxiety disorders, eating disorders and drug use, according to new data presented here at the 2013 American Psychiatric Association Annual Meeting.

"The results suggest that [borderline-personality disorder] BPD-focused treatment could perhaps expedite remission from PTSD and generalized anxiety in cases that are resistant to treatment focused solely on the anxiety disorders," David W. Preven, MD, of Albert Einstein College of Medicine, said during a presentation here.

Preven and colleagues analyzed data from the McLean Study of Adult Development, a prospective longitudinal study of comorbidity in BPD. The researchers examined interactions between BPD and anxiety disorders, eating disorders and substance use disorders in 668 patients aged 18 to 45 years who had at least one of four personality disorders (schizotypal, borderline, avoidant and obsessive-compulsive) over a 10-year period.

Diagnoses of BPD and Axis I disorders were based on DSM-IV criteria. Regression analyses were conducted to assess the influence of BPD on the time to remission and relapse of Axis I disorders, and vice versa.

At baseline, 16% of the patients were diagnosed with schizotypal personality disorder, 59% with avoidant personality disorder and 34% with obsessive-compulsive disorder.

BPD appeared to exert greater influence over Axis I disorders than Axis I disorders had over BPD. For example, over the 10-year study period, BPD lengthened time to remission of generalized anxiety disorder, PTSD and eating disorders, but no anxiety disorders, eating disorders or alcohol use disorders affected time to remission of BPD. Drug use and PTSD did appear to have some influence over the course of BPD, however.

"In treatment, strategies focused on improving symptoms of BPD are also likely to decrease time to remission and increase time to relapse of several anxiety disorders, as well as eating disorders and drug use disorders," Preven said.

For more information:

Preven DW. #SCR08. Presented at: American Psychiatric Association 166th Annual Meeting; May 18-22, 2013; San Francisco.

Disclosure: The researchers report no relevant financial disclosures.