'Unstable' Personality Disorders: Prognostic Implications for Major Depression

Sixty-nine depressed inpatients assessed for DSM-III personality disorders (PDs) were followed up after 4 years. Patients with unstable PDs (USPD; borderline, narcissistic, histrionic, and antisocial PDs) were compared with all other depressives. Considering patients of all ages, USPD was unrelated to course and weakly related to suicidal behavior. In post hoc analyses, patients were divided into “younger” (aged 18—25) and “older” (over 25). USPD but not other PDs predicted more episodes of depression, more manipulative suicidal behavior, and more medically serious suicide attempts among older depressives. USPD was unrelated to prognosis among younger depressives. This may be because many young USPDs will reach higher levels of adaptive functioning over several years, whereas USPDs still requiring hospitalization beyond their mid-20s tend to have more intractable character pathology with poorer long-term prognosis.