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Journal of Personality Disorders, 5(2), 93-101, 1991
1991 The Guilford Press
PREDICTION OF OUTCOME IN BORDERLINE PERSONALITY DISORDER
Eric M. Plakun, MD
In order to study outcome heterogeneity in borderline personality disorder (BPD), the author performed correlations of more than 50 predictor variables with 7 independent
outcome dimensions, assessed at a mean of 14 years after the
index hospitalization, in a group of 33 BPD patients selected for minimal comorbidity with affective illness, substance
dependence, or other personality disorders. Predictors are
reported that achieved statistical significance, generally across multiple outcome dimensions. Results suggest that outcome prediction in BPD differs from outcome prediction in
schizophrenia. A history of parental divorce, long duration of prior hospitalization, and the presence oi specinc personality disorder criteria predicted poor outcome in BPD. The presence of self-destructive acts during the index treatment predicted good outcome.
The publication of the third edition of the American Psychiatric Associa
tion's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM
III) in 1980, with its uniform diagnostic criteria, led to an explosion of
empirical knowledge about personality disorders, especially borderline per
sonality disorder (BPD). Four long-term retrospective follow-up studies by
McGlashan (1983, 1986), Plakun et al. (Plakun, Burkhardt, & Muller, 1985; Plakun, Muller, Si Burkhardt, 1987), Stone et al. (Stone, Hurt, & Stone,
1987), and Paris et al. (Paris, Brown, & Nowlis, 1987) have contributed valuable longitudinal course and outcome data. Comparisons of BPD to
other diagnoses have supported the validity of this diagnostic entity, have
contributed to revisions of diagnostic criteria published in DSM-III-R (APA, 1987) and are contributing to revisions in criteria for DSM-IV. These long-
term retrospective follow-up studies suggest that BPD is a valid diagnostic
entityand has a substantial risk of suicide approximating 5-10%", but that
approximately 75% ofpatients who siirvive over the long term function well
at follow-up.
All four studies have demonstrated substantial heterogeneity of outcome
in BPD, with a tendency for more difference in longitudinal course and
From the Austen Riggs Center, Stockbridge. Massachusetts 01262.
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94 PLAKUN
outcome within each study than between them. A search for factors
accounting for this hetero^eneity_has ensued. Axis I comorbidity with a
malol^afTective disorder (McGlashaiTT9B3ri~90G. Plakun el al.. 1985) or
subsT^trice'abuse (Stone et al.. 19871 ancTAxTs II comorbidirywith schizotyp
al personality...