Hostname: page-component-7c8c6479df-nwzlb Total loading time: 0 Render date: 2024-03-28T23:20:29.672Z Has data issue: false hasContentIssue false

Borderline personality disorder: health service use and social functioning among a national household population

Published online by Cambridge University Press:  02 March 2009

J. Coid*
Affiliation:
Forensic Psychiatry Research Unit, Queen Mary College, University of London, UK
M. Yang
Affiliation:
Forensic Psychiatry Research Unit, Queen Mary College, University of London, UK
P. Bebbington
Affiliation:
Department of Mental Sciences, University College London, London, UK
P. Moran
Affiliation:
Institute of Psychiatry, King's College London, London, UK
T. Brugha
Affiliation:
Department of Health Sciences, University of Leicester, Leicester, UK
R. Jenkins
Affiliation:
Institute of Psychiatry, London, UK
M. Farrell
Affiliation:
Institute of Psychiatry, London, UK
N. Singleton
Affiliation:
UK Drug Policy Commission, London, UK
S. Ullrich
Affiliation:
Forensic Psychiatry Research Unit, Queen Mary College, University of London, UK
*
*Address for correspondence: Professor J. Coid, Forensic Psychiatry Research Unit, St Bartholomew's Hospital, William Harvey House, 61 Bartholomew Close, London EC1A 7BE, UK. (Email: j.w.coid@qmul.ac.uk)

Abstract

Background

It is unclear whether Axis II psychopathology or co-morbid clinical syndromes result in the treatment-seeking behaviour and social impairment of patients with borderline personality disorder (BPD). This study examined the independent associations between social functioning and service use and Axis I and Axis II disorders in persons with BPD in the national household population of Britain.

Method

The study was a cross-sectional survey of adults aged 16–74 years in households (n=8397). Data included self-reported consultations with health-care professionals and behavioural problems. Diagnosis was determined by computer-assisted interviews. Analyses included logistic regression adjusting for demography, co-morbid Axis I clinical syndromes and other Axis II disorders.

Results

Consultation in the past year was reported by 57.5% of persons with BPD but only 13.4% reported lifetime psychiatric admission. BPD was not independently associated with impaired functioning but was associated with co-morbid psychotic, depressive and anxiety disorders. Only general practitioners (GPs) were consulted for problems independently due to BPD.

Conclusions

Functional effects of BPD are mediated through co-morbid clinical syndromes, not Axis II psychopathology. A subgroup do not have co-morbid disorders or seek treatment, and are high functioning.

Type
Original Articles
Copyright
Copyright © 2009 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, HS (1981). Subaffective disorders: dysthymic, cyclothymic and bipolar II disorders in the ‘borderline’ realm. Psychiatric Clinics of North America 4, 2546.CrossRefGoogle ScholarPubMed
Babor, TF, Higgins-Biddle, JC, Saunders, JB, Monteiro, MG (1992). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Healthcare. World Health Organization: Geneva.Google Scholar
Bebbington, P, Nayani, T (1994). The Psychosis Screening Questionnaire. International Journal of Methods in Psychiatric Research 5, 1119.Google Scholar
Bender, DS, Dolan, RT, Skodol, AE, Sanislow, CA, Dyck, IR, McGlashan, TH, Shea, MT, Zanarini, MC, Oldham, JM, Gunderson, JG (2001). Treatment utilization by patients with personality disorders. American Journal of Psychiatry 158, 295302.CrossRefGoogle ScholarPubMed
Bender, DS, Skodol, AE (2003). Why are women diagnosed borderline more than men? Psychiatric Quarterly 74, 349360.Google Scholar
Chiesa, M, Fonagy, P, Holmes, J, Drahorad, C, Harrison-Hall, A (2002). Health service use costs by personality disorder following specialist and nonspecialist treatment: a comparative study. Journal of Personality Disorders 16, 160173.CrossRefGoogle ScholarPubMed
Coid, J, Petruckevitch, A, Bebbington, P, Brugha, T, Bhugra, D, Farrell, M, Lewis, G, Singleton, N (2002). Ethnic differences in prisoners. II: Risk factors and psychiatric service use. British Journal of Psychiatry 181, 481487.CrossRefGoogle Scholar
Coid, J, Yang, M, Tyrer, P, Roberts, A, Ullrich, S (2006). Prevalence and correlates of personality disorder in Great Britain. British Journal of Psychiatry 188, 423431.CrossRefGoogle ScholarPubMed
Coid, JW (1993). An affective syndrome in psychopaths with borderline personality disorder? British Journal of Psychiatry 162, 641650.CrossRefGoogle ScholarPubMed
Comtois, KA, Russo, J, Snowden, M, Srebnik, D, Ries, R, Roy-Byrne, P (2003). Factors associated with high use of public mental health services by persons with borderline personality disorder. Psychiatric Services 54, 11491154.CrossRefGoogle ScholarPubMed
Connor, KM, Davidson, JRT, Hughes, DC, Swartz, MS, Blazer, DG, George, LK (2002). The impact of borderline personality disorder on post-traumatic stress in the community: a study of health status, health utilization, and functioning. Comprehensive Psychiatry 43, 4148.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Williams, JB, Gibbon, M, Benjamin, LS (1997). Structured Clinical Interviews for DSM-IV Axis-II Personality Disorders. American Psychiatric Press: Washington, DC.Google Scholar
Frankenburg-Francis, R, Zanarini, MC (2006). Personality disorders and medical comorbidity. Current Opinion in Psychiatry 19, 428431.CrossRefGoogle Scholar
Goodman, G, Hull, JW, Clarkin, JF, Yeomans, FE (1998). Comorbid mood disorders as modifiers of treatment response among inpatients with borderline personality disorder. Journal of Nervous and Mental Disease 186, 616622.Google Scholar
Gunderson, JG, Phillips, KA (1991). A current view of the interface between borderline personality disorder and depression. American Journal of Psychiatry 148, 967975.Google ScholarPubMed
Hull, JW, Yeomans, F, Clarkin, J, Li, C, Goodman, G (1996). Factors associated with multiple hospitalizations of patients with borderline personality disorder. Psychiatric Services 47, 638641.Google Scholar
Hunt, C, Gavin, A (1992). Measuring personality disorder: the use of self-report questionnaires. Journal of Personality Disorders 6, 125133.Google Scholar
Jackson, HJ, Burgess, PM (2004). Personality disorders in the community: results from the Australian National Survey of Mental Health and Well-being. Part III. Relationships between specific type of personality disorder, Axis I mental disorders and physical conditions with disability and health consultations. Social Psychiatry and Psychiatric Epidemiology 39, 765767.CrossRefGoogle ScholarPubMed
Jonas, JM, Pope, HG (1984). Psychosis in borderline personality disorder. Psychiatric Developments 2, 295308.Google Scholar
Kernberg, OF (1984). Severe Personality Disorders: Psychotherapeutic Strategies. Yale University Press: New Haven, CT.Google Scholar
Kish, L (1965). Survey Sampling. John Wiley & Sons: London.Google Scholar
Koenigsberg, HW, Anwunah, I, New, AS, Mitropoulou, V, Schopick, F, Siever, LJ (1999). Relationship between depression and borderline personality disorder. Depression and Anxiety 10, 158167.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Lenzenweger, MF, Lane, MC, Loranger, AW, Kessler, RC (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62, 553564.CrossRefGoogle ScholarPubMed
Lewis, G, Pelosi, A, Araya, R, Dunn, G (1992). Measuring psychiatric disorder in the community: a standardised assessment for lay-interviewers. Psychological Medicine 22, 465486.CrossRefGoogle ScholarPubMed
Links, PS, Steiner, M, Mitton, J (1989). Characteristics of psychosis in borderline personality disorder. Psychopathology 22, 188193.Google Scholar
Loranger, AW (1999). International Personality Disorder Examination: DSM-IV and ICD-10 Interviews. Psychological Assessment Resources: Odessa, FL.Google Scholar
McGlashan, TH (1983). The borderline syndrome: II. Is it a variant of schizophrenia or affective disorder? Archives of General Psychiatry 40, 13191323.Google Scholar
McGlashan, TH (1987). Borderline personality disorder and unipolar affective disorder: long-term effects of comorbidity. Journal of Nervous and Mental Disease 175, 467473.CrossRefGoogle ScholarPubMed
NIMHE (2003). Personality Disorder: No Longer a Diagnosis of Exclusion. Policy Guidelines for the Development of Services for People with Personality Disorder. National Institute for Mental Health in England: Leeds.Google Scholar
O'Connell, M, Cooper, S, Perry, JC, Hoke, L (1989). The relationship between thought disorder and psychotic symptoms in borderline personality disorder. Journal of Nervous and Mental Disease 177, 273278.CrossRefGoogle ScholarPubMed
Paris, J, Zweig-Frank, H (2001). A 27-year follow-up of patients with borderline personality disorder. Comprehensive Psychiatry 42, 482487.Google Scholar
Perry, JC (1988). A prospective study of life stress, defenses, psychotic symptoms, and depression in borderline and antisocial personality disorders and bipolar type II affective disorder. Journal of Personality Disorders 2, 4959.CrossRefGoogle Scholar
Pope, HG Jr, Jonas, JM, Hudson, JI, Cohen, BM, Gunderson, JG (1983). The validity of DSM-III borderline personality disorder: a phenomenologic, family history, treatment response, and long-term follow-up study. Archives of General Psychiatry 40, 2330.CrossRefGoogle ScholarPubMed
Rendu, A, Moran, P, Patel, A, Knapp, M, Mann, A (2002). Economic impact of personality disorders in UK primary care offenders. British Journal of Psychiatry 181, 6266.Google Scholar
Singleton, N, Bumpstead, R, O'Brien, M, Lee, A, Meltzer, H (2001). Psychiatric Morbidity Among Adults Living in Private Households, 2000. The Stationery Office: London.Google Scholar
Singleton, N, Meltzer, H, Gatward, R, Coid, J, Deasy, D (1998). Psychiatric Morbidity Among Prisoners in England and Wales. The Stationery Office: London.Google Scholar
Skodol, AE, Gunderson, JG, McGlashan, TH, Dyck, IR, Stout, RL, Bender, DS, Grilo, CM, Shea, MT, Zanarini, MC, Morey, LC, Sanislow, CA, Oldham, JM (2002). Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. American Journal of Psychiatry 159, 276283.CrossRefGoogle ScholarPubMed
Skodol, AE, Oldham, JM, Hyler, SE, Stein, DJ, Hollander, E, Gallaher, PE, Lopez, AE (1995). Patterns of anxiety and personality disorder comorbidity. Journal of Psychiatric Research 29, 361374.CrossRefGoogle ScholarPubMed
Skodol, AE, Pagano, ME, Bender, DS, Shea, TM, Gunderson, JG, Yen, S, Stout, RL, Morey, LC, Sanislow, CA, Grilo, CM, Zanarini, MC, McGlashan, TH (2005). Stability of functional impairment in patients with schizotypal, borderline, avoidant and obsessive-compulsive personality disorder over two years. Psychological Medicine 35, 443451.CrossRefGoogle ScholarPubMed
Skodol, AE, Stout, RL, McGlashan, TH, Grilo, CM, Gunderson, JG, Shea, T, Morey, LC, Zanarini, MC, Dyck, IR, Oldham, JM (1999). Co-occurrence of mood and personality disorders: a report from the Collaborative Longitudinal Personality Disorders Study (CLPS). Depression and Anxiety 10, 175182.3.0.CO;2-2>CrossRefGoogle Scholar
Stockwell, T, Murphy, D, Hodgson, R (1983). The Severity of Alcohol Dependence questionnaire: its use, reliability and validity. British Journal of Addiction 78, 145155.Google Scholar
Stone, MH (1990). The Fate of Borderline Patients: Successful Outcome and Psychiatric Practice. Guilford: New York.Google Scholar
Torgersen, S, Kringlen, E, Cramer, V (2001). The prevalence of personality disorders in a community sample. Archives of General Psychiatry 58, 590596.CrossRefGoogle Scholar
Tyrer, P, Mulder, R (2006). Management of complex and severe personality disorders in community mental health services. Current Opinion in Psychiatry 19, 400404.Google Scholar
Ullrich, S, Deasy, D, Smith, J, Johnson, B, Clarke, M, Broughton, N, Coid, J (2008). Detecting personality disorders in the prison population of England and Wales: comparing case identification using the SCID-II Screen and Clinical Interview. Journal of Forensic Psychiatry and Psychology 19, 301322.Google Scholar
WHO (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. World Health Organization: Geneva.Google Scholar
Zanarini, MC, Frankenburg, FR (2001). Attainment and maintenance of reliability of Axis I and Axis II disorders over the course of a longitudinal study. Comprehensive Psychiatry 42, 369374.CrossRefGoogle ScholarPubMed
Zanarini, MC, Frankenburg, FR, Hennen, J, Reich, DB, Silk, KR (2006). Prediction of the 10-year course of borderline personality disorder. American Journal of Psychiatry 163, 827832.Google Scholar
Zanarini, MC, Frankenburg, FR, Vujanovic, AA, Hennen, J, Reich, DB, Silk, KR (2004). Axis II comorbidity of borderline personality disorder: description of 6-year course and prediction to time-to-remission. Acta Psychiatrica Scandinavica 110, 416420.CrossRefGoogle ScholarPubMed
Zimmerman, M (1994). Diagnosing personality disorders. A review of issues and research methods. Archives of General Psychiatry 51, 225245.CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI (1999). Axis I diagnostic comorbidity and borderline personality disorder. Comprehensive Psychiatry 40, 245252.Google Scholar