Impact Of Bpd On Outcomes Of Depressive Disorders

The level of dysfunction and overall prognosis are generally worse for BPD than those for MDD, with high rates of psychiatric inpatient service utilization, self-injury, suicide attempts, and completed suicides. Most patients with

BPD enter treatment for relief from depressive symptoms, yet patients with BPD have poorer outcomes for depression than those without BPD (Mulder, 2002).

Surprisingly, we could locate no reports on the influence of BPD on effects of psychotherapy for depression in a controlled treatment study, only in naturalistic studies. Meyer, Pilkonis, Proietti, Heape, and Egan (2001) reported that BPD features predicted less improvement in depressive symptoms and overall level of functioning over 1 year of treatment (95% received psychotherapy, 65% received medications), whereas other Cluster B and Cluster C disorder features did not. Grilo et al. (2005) found that, among 302 patients with major depression, those with BPD had a lower remission rate (60 vs. 89%) and a longer interval until remission than those without BPD, even when controlling for many parameters of depression course and history. McGlashan (1987) reported that depressed patients with BPD were more likely over a 15-year follow-up to commit suicide, to abuse substances, and to use more psychiatric services. Regarding other measures of functioning, poorer academic and social outcomes have been found over 2-4 years for depressed high school and college students with BPD features (especially affective lability and impulsivity) than for those without such features (e.g., Bagge et al., 2004; Daley, Burge, & Hammen, 2000). What about rates of relapse and recurrence for patients who actually achieve remission from a depressive episode? Ilardi, Craighead, and Evans (1997) found that presence of Cluster B symptoms, but not Cluster A or Cluster C symptoms, predicted shorter periods of remission before relapse/recurrence of depression during a 33- to 84-month follow-up of depressed inpatients. Hart, Craighead, and Craighead (2001) reported similar findings for undergraduates in remission from major depression.

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