Long-term outcome in personality disorders (BL)

• Main Author: Coid, B
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.1997
• Subjects: Neurosciences

Objectives - A retrospective follow-up study, mean 13 years, of patients with a clinical diagnosis of personality disorder (PD), attending the Maudsley Hospital between 1967-89, to describe long-term outcome and identify predictors of outcome.Subjects - 197 patients of twin birth and a control group of 153 living co-twins. Two patient cohorts: (i) Broadly-defined - clinician's diagnosis of PD, (ii) Narrowly-defined - DSM-II-R axis II categories.Method - In two stages: independent data collection at index (casenote ratings) and at follow-up (research diagnostic interview) followed by multi-dimensional descriptive presentation of outcome data on individual PD categories. Identification of predictive variables, controlling for confounding diagnostic variables using logistic regression.Results - Follow-up information on 79% of subjects confirmed a chronic course of PD for most cases, remaining stable over time. However, outcome could range from complete remission to suicide. Approximately one-third of the broadly-defined cohort and one-fourth of the narrowly-defined no longer qualified for an Axis II category at follow-up. Improvement correlated with length of follow-up. Global outcome indicated that 50% of the broadly-defined cohort functioned normally for more than 75% of the follow-up period, 22% continued to experience problems for 50% of the follow-up period, 14% were chronically impaired, and 10% were dead, most through suicide. In contrast, 80% co-twins had normal global functioning throughout the follow-up period and mortality was only 3.5%, mainly through natural causes. Robust predictors of poor global outcome included diagnoses of borderline and schizoid PD, comorbid major depression, lower educational standard, childhood sexual abuse, and delayed developmental milestones.