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We examined which items on the Borderline Evaluation of Severity Over Time and the Zanarini Rating Scale for Borderline Personality Disorder improved during participation in Systems Training for Emotional Predictability and Problem Solving (STEPPS). Data on 193 subjects from two independent sources were included: (1) a randomized controlled trial at an academic medical centre and (2) uncontrolled data from Iowa's correctional system. STEPPS effect size was estimated by contrasting effect size for those in the randomized controlled trial assigned to STEPPS + treatment as usual to effect size for those assigned to treatment as usual alone. Items from the Borderline Evaluation of Severity Over Time scale showing the greatest improvement assessed affective instability, 'taking steps to avoid/prevent problems', 'choosing to use a positive activity', identity disturbance and abandonment fears. The Zanarini Rating Scale for Borderline Personality Disorder items showing the greatest improvement assessed mood instability, chronic feelings of emptiness and identity disturbance. STEPPS effect size was significant for the Borderline Evaluation of Severity Over Time items rating paranoia and 'taking steps to avoid/prevent problems' and the Zanarini Rating Scale for Borderline Personality Disorder items assessing paranoia, impulsivity, chronic emptiness and unstable relationships. This, and future work, could eventually help in matching patients to particular treatment programmes that target their preponderant symptoms. © 2018 John Wiley & Sons, Ltd.

We report the treatment experience of 164 subjects with BPD who participated in a randomized clinical trial testing the Systems Training for Emotional Predictability and Problem Solving group treatment programme. Participation in psychotherapy, use of psychotropic medication, use of emergency services and hospitalization were carefully tracked. Nearly all (96%) subjects were prescribed psychotropic medication; 74% took antidepressants at baseline; the figures were 41% for anxiolytics, 39% for mood stabilizers and 32% for antipsychotics. Sixty-four percent reported taking ≥2 medications, and 39% took ≥3 medications. Most subjects (73%) participated in individual psychotherapy; 24% had been hospitalized at least once in the month prior to study entry. Importantly, medication usage at baseline was not associated with clinical severity. Medication usage declined during the 20-week clinical trial and 1-year follow-up. Few patients (6%) had ever received electroconvulsive therapy. In conclusion, data show that many persons with BPD are prescribed multiple medications and frequently participate in individual and other types of psychotherapy. Medication usage at baseline does not explain variation in clinical symptoms. Implications of the findings are discussed. Copyright © 2011 John Wiley & Sons, Ltd.

Few predictors of treatment outcome or early discontinuation have been identified in persons with borderline personality disorder (BPD).The aim of the study was to examine the relationship between baseline clinical variables and treatment response and early discontinuation in a randomized controlled trial of System Training for Emotional Predictability and Problem Solving, a new cognitive group treatment.Improvement was rated using the Zanarini Rating Scale for BPD, the Clinical Global Impression Scale, the Global Assessment Scale and the Beck Depression Inventory. Subjects were assessed during the 20 week trial and a 1-year follow-up.Higher baseline severity was associated with greater improvement in global functioning and BPD-related symptoms. Higher impulsivity was predictive of early discontinuation. Optimal improvement was associated with attendingor = 15 sessions.Subjects likely to improve have the more severe BPD symptoms at baseline, while high levels of impulsivity are associated with early discontinuation.

Borderline personality disorder (BPD) has been associated both with frontolimbic dysfunction and maladaptive personality traits such as impulsivity and neuroticism. The purpose of this study was to examine whether there are differences in predictive variance between neuropsychological variables and selected personality traits in persons with BPD. We compared persons with DSM-IV BPD (n = 25) to individuals without BPD or substance abuse (n = 20). All subjects completed a battery of neuropsychological tests, Cloninger's Temperament and Character Inventory, and the Barratt Impulsiveness Scale. BPD subjects had evidence of cognitive inhibition, and deficits in working memory, perseveration, and decision-making not accounted for by IQ differences between groups. In particular, Stroop Interference remained significant after controlling for IQ, depression and alcohol use (p = 0.043). They also had higher levels of impulsivity, novelty seeking and harm avoidance, but lower levels of self-directedness and cooperativeness than the comparison group. Logistic regression analyses indicated that both personality traits (Nagelkerke R2 = 0.74, Model χ2 = 36.21, p < 0.001) and neuropsychological tests (Nagelkerke R2 = 0. 47, Model χ2 = 19.22, p < 0.001) were significant predictors of BPD. However, neuropsychological tests did not add significant incremental variance over selected personality trait dimensions in predicting BPD (Block χ2 = 6.45, p = 0.168), whereas personality traits added significant incremental variance over neuropsychological tests in predicting BPD (Block χ2 = 3.44, p < 0.001). This study suggests that persons with BPD have impaired neuropsychological performance, but that impulsivity and other selected personality traits have a primary role in predicting BPD over and above neuropsychological test abnormalities. Copyright © 2009 John Wiley & Sons, Ltd.

Background The objective of the study was to test the association of age with symptom severity, frequency and pattern of psychiatric comorbidity, health care utilization and quality of life in subjects with borderline personality disorder (BPD). Methods The analysis is based on a sample of subjects with Diagnostic and Statistical Manual of Mental Disroders, Fourth Edition (DSM-IV) BPD (n = 163) recruited for participation in a clinical trial at an academic medical center. The subjects were assessed using structured and semi-structured instruments of known reliability. Results Tests of trend with age showed relationships with important variables assessing symptom severity, comorbidity, quality of life and health care utilization. As expected, younger subjects were less likely to be married, to be employed or to receive disability payments. The frequency of most lifetime comorbid Axis I disorders was not related to age, although posttraumatic stress disorder was more frequent in the 35- to 44-year age group, and younger patients were more likely to have comorbid histrionic and narcissistic personality disorders. Baseline severity variables were mostly unrelated to age, with the exception of impulsivity, which was more common in younger patients, as were acts of deliberate self-harm. As expected, older patients reported poorer quality of life in categories indicating worse health perception and greater pain levels, and tended to use more health care resources than younger patients. Conclusion Most characteristics of patients with BPD are unrelated to age, yet impulsivity and acts of deliberate self-harm were less frequent in older patients. Expected age-related changes, such as reports of worse physical health, greater pain levels and greater health care utilization, were observed in older subjects. Copyright © 2008 John Wiley & Sons, Ltd.