Continuities of Diagnosis in Children/Adults?
Personality Disorders in Children and Adolescents
Book by Karen K. Bardenstein, Paulina F. Kernberg, Alan S. Weiner, 2000
Borderline Personality Disorder & Pediatrics
Excellent informative overview by Elizabeth A Finley-Belgrad, MD, eMedicine Journal, July 3, 2001
Multiple complex developmental disorder: the "multiple and complex" evolution of the "childhood borderline syndrome" construct
Abstract of a survey by Ad-Dab'bagh Y, Greenfield B., 2001
Dramatic-erratic personality disorder symptoms: I. Continuity from early adolescence into adulthood
Abstract of a longitudinal study by Crawford TN, Cohen P, Brook JS. 2001
Obect Relations and Referential Activity in Physically Abused Adolescents
Full-text write-up of a study by Lisa Jepson, Winter 1999
"[...] abused adolescents tended to have higher levels of
two elements of referential activity (concreteness,
imagery), indicating increased verbal ability to express
emotional experience. While predicted correlations were
found between object relations and referential activity
for the nonabused group, the abused group showed higher
symbolizing and verbalizing capacity, associated with
more malevolent representations of relationships." The
findings do not support the view that physically abused
adolescents experience developmental lags, instead
suggesting that they organize and use emotional and
symbolizing processes differently from nonabused
adolescents."
Diatheses and Stressors in Borderline Pathology of Childhood: The Role of Neuropsychological Risk and Trauma
Abstract of a study by PHYLLIS ZELKOWITZ, ED.D.; JOEL PARIS, M.D.; JASWANT GUZDER, M.D.; RONALD FELDMAN, M.D., 2001
"Both deficits in executive function and psychological
trauma made significant and independent contributions to
the variance in borderline pathology. Inclusion of both
sets of risk factors produced a model that explained 48%
of the variance in borderline diagnosis."
Identity disturbance in borderline personality disorder: an empirical investigation
Abstract of an article by Wilkinson-Ryan T, Westen D., 2000
Influence of child and adolescent psychiatric disorders on young adult personality disorder
Abstract of a study by Kasen S, Cohen P, Skodol AE, Johnson JG, Brook JS. 1999
Suggests that
"Childhood or adolescent axis I disorders may set in
motion a chain of maladaptive behaviors and environmental
responses that foster more persistent psychopathology
over time."
Neuropsychological factors associated with
borderline pathology in childrenby Joel Paris, June 1999
Full text article.
From the article:
"Borderline pathology in children is a syndrome
characterized by a combination of externalizing and
internalizing symptoms, accompanied by cognitive deficits
(Bemporad et al., 1987; Kernberg, 1997). Although these
symptoms resemble adult borderline personality, it is not
clear whether they represent a unique disorder or a
heterogeneous group better described by other diagnoses
(Petri and Vela, 1990). However, a long-term follow-up
study (Lofgren et al., 1991) has shown that borderline
pathology in children is a precursor of adult personality
disorders."
Applicability of personality disorder criteria to hospitalized adolescents: evaluation of internal consistency and criterion overlap
Full-text article by Daniel F. Becker, 1999
"Personality disorders are prevalent in adolescents and
[...]they have concurrent validity (i.e., they are valid
indicators of distress and dysfunction) but that they are
relatively unstable over time."
Antecedents of Personality Disorders
in Young Adultsby Joseph M. Rey, M.D., 1999
Practice Parameters for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder
Excellent, very informative full-text article by Jon McClellan. M.D., and John Werry, M.D.
Posttraumatic Stress Disorder in
Childrenby Roy Lubit, MD, PhD, October 2001
Provides an excellent overview, as well as a detailed summary of the medications used in treating PTSD in children. Article may require registration (it's free) to read.
Sexual Obsessions in Obsessive-Compulsive Disorder
Jennifer B. Freeman,Ph.D.; Leonard, Henrietta L. M.D., 2000
This study examines the:
"[...] risk factors for the development of OCD and PTSD.
Premorbid anxiety disorders may place children at higher
risk for developing PTSD-type reactions after traumatic
events as described by Asarnow and colleagues (1999). In
some cases, exposure to trauma, depending on severity,
may play a role in the development of some cases of OCD.
One might speculate that this may be particularly
relevant in those patients who are "at risk" to develop
OCD."
Ten-Year Follow-up of Adolescent-Onset Anorexia Nervosa: Personality Disorders
by Elisabet Wentz Nilsson, 1999
"Personality disorder (PD) in clinical AN samples has
been estimated to occur in 23% through 80% [...]
Borderline PD (cluster B) is the PD most frequently
associated with eating disorders."
A 6 year follow-up of childhood enuresis [bedwetting]: prevalence in adolescence and consequences for mental health
by Feehan M, McGee R, Stanton W, Silva PA., 1990
"Recent studies have shown an association between
enuresis [bedwetting] and behavioural or emotional
problems. The direction or causality of the association
and its duration, however, remain unclear. This study
followed a large group of children from ages 11 to 15
years and reported the prevalence of enuresis to age 13
years. The enuretic status of the sample at age 11 years
was established relative to the history of enuresis at
age 9 years. At age 11 years a significant association
was found between enuresis and measures of
psychopathology."
Association between behaviour at age 3 years and adult criminality
Abstract of British research by Stevenson J, Goodman R., 2001
(Interesting results, but bear in mind that this information is regressively extrapolated from already-convicted patients.)
"The risk of having any adult conviction was related to
soiling, daytime enuresis, activity level and management
difficulties, and that of having an adult violent offence
to recent-onset daytime enuresis, management difficulties
and temper tantrums. The only other predictors of later
convictions were the child's gender and social competence
at age 3 years."
History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: A controlled study
Abstract of Italian research by Fossati A, Novella L, Donati D, Donini M, Maffei C., 2002
Psychophysiological
Responses in ADHD Boys With and Without Conduct Disorder:
Implications for Adult Antisocial Behaviorby Sabine C. Herpertz in Psychiatric Times February 1996
"These findings give further support for a high
persistence of antisocial behavior from childhood to
adulthood, while no evidence was found that ADHD itself
is associated with a predisposition to antisocial
behavior."
Continuities between psychiatric disorders in adolescents and personality disorders in young adults
Abstract of a study by JM Rey, A Morris-Yates, M Singh, G Andrews and GW Stewart 1995
Continuity and discontinuity of psychopathology: a study of patients examined as children and as adults: The infancy of "adult personality disorders"
Abstract of a study by Manzano, et al, 1994
Development of personality disorders in children and adolescents with obsessive-compulsive disorder. A 6- to 22-year follow-up study.
Abstract of a study by Thomsen PH, Mikkelsen HU. 1993
Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders
Abstract of a study by J Biederman, J Newcorn and S Sprich, 1991
A prospective follow-up study of so-called borderline children
Abstract of a study by DP Lofgren, J Bemporad, J King, K Lindem and G O'Driscoll, 1991
Comorbidity of conduct disorder and personality disorders in an incarcerated juvenile population
Abstract of a study by TD Eppright, JH Kashani, BD Robison and JC Reid, 1993
Older Borderlines
Long-term Outcome in Personality Disorders
Abstract of 1993 study results by Michael H Stone, Columbia College of Physicians and Surgeons
This is the landmark study so often referred to when
folks talk about BPs spontaneously "cooling off" with
age. (The results of Stone's study are not proven anecdotally
by the community of online nonBorderline spouses and loved ones, but this is probably a matter of statistics and self-selection.)Stone published his results in the book: The Fate of Borderline Patients
Diminished Impulsivity in Older Patients With Borderline Personality Disorder
Abstract of a research study by Stevenson, Meares, and Comerford, Jan 2003
OBJECTIVE: The aim of this study was to test, in terms of
impulsivity, the hypothesis that borderline personality disorder "burns out"
with age. METHOD: Linear regression analyses, with age as a predictor variable,
were conducted on subsection scores of the Revised Diagnostic Interview for Borderlines
(DIB-R) for 123 individuals with a diagnosis of borderline personality disorder who
were accepted into an outpatient-based psychotherapy program. The subsection scores
of the DIB-R allow quantification of the core features of the disorder: affective
disturbance, relationship disturbance, cognitive disturbance, and impulsive behavior.
RESULTS: Older patients with borderline personality disorder showed less impulsivity
than younger patients, but there was no difference in terms of affect disturbance,
identity disturbance, and interpersonal problems. CONCLUSIONS: The view that borderline
personality disorder burns out with age is supported in terms of impulsivity."
Personality Disorders in Late Life
Jennifer Q Morse MA and Thomas R Lynch PhD, 2000
Personality Disorders in Older Adults: Emerging Issues in Diagnosis and Treatment
Volume of studies edited by Robert C. Abrams and Richard A. Zweig, 1991
Includes:
1. Conceptual Overview of Personality Disorders in the Elderly John F. Clarkin, Lisa A. Spielman, and Ellen Klausner
2. Personality and Aging: A Psychotherapist Reflects Late in His Own Life Leston Havens
3. Personality Disorders in Adults: A Review Richard A. Zweig and Jennifer Hillman
4. Personality Disorders After Age 50: A Meta-Analytic Review of the Literature Robert C. Abrams and Sandra V. Horowitz
5. Personality Disorders and Treatment Outcome Theodore J. Gradman, Larry W. Thompson, and Dolores Gallagher-Thompson
[you can also purchase access to an online version of this and many other works on BPD at questia.com].Personality Disorder Symptoms Predict Declines in Global Functioning and Quality of Life in Elderly Depressed Patients
Abstract of a research study by Robert Abrams et al, 2000
Pharmacological and psychotherapeutic treatment of personality disorders in the elderly
Abstract of research by De Leo D, Scocco P, Meneghel G.
Prospective follow-up study of borderline personality disorder: prognosis, prediction of outcome, and Axis II comorbidity
Full-text study, 1998.
"This prospective follow-up study found that almost 50%
of former inpatients with BPD continue to test positive
for BPD at 7 years follow-up, and these persistent BPD
patients also had significantly more comorbid personality
psychopathology. Borderline psychopathology at follow-up
was primarily predicted by the level of borderline
psychopathology recorded at the initial assessment."
A 27-year follow-up of patients with borderline personality disorder
Abstract of a report by Paris J. and Zweig, Frank H., Nov/Dec 2001
"Sixty-four patients with borderline personality disorder
(BPD) were followed up for a mean of 27 years. [...] Most
patients showed significant improvement as compared to a
previous 15-year follow-up, with only five currently
meeting criteria for BPD. [...] Fourteen subjects met
SCID criteria for dysthymia, and this subgroup had a
significantly poorer outcome on all measures. The total
percentage of suicides from the original cohort has
reached 10.3%, with 18.2% of all patients now deceased."
Self-harm behaviors across the life cycle: a pilot study of inpatients with borderline personality disorder
Abstract of a study by Sansone RA, Gaither GA, Songer DA., May/June 2002
"The purpose of this study was to explore, throughout the life cycle,
the prevalence of self-harm behaviors among psychiatric inpatients with and without
borderline personality disorder (BPD). Psychiatric inpatients with BPD (n = 43) were
compared to those without BPD (n = 40) with regard to self-reported self-harm behaviors
during their lifetime. The mean number of self-harm behaviors, including high-lethal
behaviors (i.e., suicide attempts, cutting oneself, overdosing), among those with BPD
dramatically increased between the ages of 18 and 24 years and was sustained through ages
50 to 59 years. Non-BPD patients showed a similar pattern, but the means were notably
less. These data suggest that the behavioral "burn out" theory of personality disorders
does not necessarily occur among inpatients with BPD."
Borderline Personality Disorder In The Elderly
Abstract of a study by Hill, E.L., Hersen, M., Van Hasselt, V., Journal of Clinical Geropsychology, Oct 1998
"Few studies have investigated borderline personality disorder (bpd) among the elderly. This paper suggests that bpd persists into older adulthood."
Clinical Characteristics
of Older Psychiatric Inpatients with Borderline Personality
Disorderby Brian Trappler and Jill Backfield, Spring 2001
Unfortunately this is only an abstract (full-text article requires subscription) but it's still quite interesting information:
"Rather than suggesting a diminution of psychopathology
as BPD patients age, the results of this investigation
indicate that their persistent difficulties may only be
altering in content and in pathological adaptation to
changing needs."
Personality Disorders in Elderly Patients With Dysthymic Disorder
Abstract of an article by D.P. Devanand, M.D., et al, Aug 2000
Borderline personality disorder in the elderly: a case study
by Siegel DJ, Small GW, 1986
Previous psychiatric history as a risk factor for late-life dementia: a population-based case-control study
by Brian Cooper, 1998
Long-Term Outcome Studies
Long-term Outcome in
Personality DisordersAbstract of 1993 study results by Michael H Stone, Columbia College of Physicians and Surgeons
This is the landmark study so often referred to when folks talk about BPs spontaneously "cooling off" with age; remains to be proven anecdotally by the community of online nonBorderline spouses and loved ones.
Stone published his results in the book: The Fate of Borderline Patients
Day treatment for personality disorders: a review of research findings.
Abstract of a study by Ogrodniczuk JS, Piper WE. 2001
Full-text article may be purchased for a fee
The 'therapeutic community'; outcome evaluation
by Kingsley Norton and Fiona Warren
"It is now evident that people with personality disorder can sometimes be helped to change. The notion that personality disorder is immutable is outmoded and unacceptable."
Excellent, detailed article discussing the problems with 'treatment outcome' studies and personality disorders.
Outcome in borderline disorders. A literature review
Abstract of a study by Rothenhausler HB, Kapfhammer HP., 1999
Full-text article may be purchased for a fee
Prospective follow-up study of borderline personality disorder: prognosis, prediction of outcome, and Axis II comorbidity
Full-text study, 1998. "This prospective follow-up study found that almost 50% of former inpatients with BPD continue to test positive for BPD at 7 years follow-up, and these persistent BPD patients also had significantly more comorbid personality psychopathology. Borderline psychopathology at follow-up was primarily predicted by the level of borderline psychopathology recorded at the initial assessment."
A 27-year follow-up of patients with borderline personality disorder
Abstract of a report by Paris J. and Zweig, Frank H., Nov/Dec 2001
"Sixty-four patients with borderline personality disorder (BPD) were followed up for a mean of 27 years. [...] Most patients showed significant improvement as compared to a previous 15-year follow-up, with only five currently meeting criteria for BPD. [...] Fourteen subjects met SCID criteria for dysthymia, and this subgroup had a significantly poorer outcome on all measures. The total percentage of suicides from the original cohort has reached 10.3%, with 18.2% of all patients now deceased."
Effects of Client-Centered Psychotherapy for Personality Disorders Alone and in Combination with Psychopharmacological Treatment. an empirical follow-up study
British study by Teusch L; Bohme H; Finke J; Gastpar M., 2001
"There is an increasing interest concerning the
treatment of patients with personality disorders (PD)
in data on the efficacy of psychotherapeutic strategies
especially when combined with medication. Methods: The
efficacy of an inpatient client-centered treatment
program (CCT) was studied prospectively in 142 patients
with PD and additional depressive, anxiety or eating
disorders (ICD-10). Results: Significant improvements
in depression, self-esteem and social adjustment were
achieved up to discharge, which remained stable at the
1-year follow-up. The efficacy with regard to
individual variables or the total result could not be
further enhanced by a combination with
psychopharmacological treatment (CCT + MED), consisting
mainly of antidepressants. Within the subgroups of
patients with socially deviant (F60.0-2), emotionally
unstable/borderline (F60.3) and histrionic/narcissistic
PD (F60.4, F60.8), CCT was significantly superior to
CCT + MED in the reduction of depression
(Bech-Rafaelsen Melancholia Scale ratings), whereas the
response was enhanced by medication in the subgroup of
patients with socially dependent 'cluster C' PD
(F60.5-7). Conclusions: The results are discussed with
regard to client-centered therapeutic concepts and to
the further development of differential combination
strategies."
Treatment of Personality Disorders in an Era of Limited Resources
by Eric Plakun, M.D.
This Page Last Updated: May 26, 2003
Helen's World of BPD Resources