Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years.
OBJECTIVE
The purpose of this study was to describe the psychiatric treatment received by a well-defined sample of patients with borderline personality disorder and Axis II comparison subjects over 6 years of prospective follow-up.


METHODS
362 inpatients were interviewed about their treatment histories during their index admission (1992-1995). 290 patients met both Revised Diagnostic Interview for Borderlines and DSM-III-R criteria for borderline personality disorder and 72 met DSM-III-R criteria for at least 1 nonborderline Axis II disorder (and neither criteria set for borderline personality disorder). Over 94% of surviving patients were re-interviewed about their psychiatric treatment histories 2, 4, and 6 years later.


RESULTS
Only 33% of borderline patients were hospitalized during the final 2 years of the 6-year follow-up, a substantial decline from the 79% who had prior hospitalizations at baseline. Much the same pattern emerged for day and/or residential treatment (from 55% to 22%). In contrast, about three quarters of borderline patients were still in psychotherapy and taking psychotropic medications after 6 years of follow-up. Additionally, over 70% of borderline patients participating in these outpatient modalities did so for at least 75% of each follow-up period. While rates of intensive psychotherapy declined significantly over time (from 36% to 16%), rates of intensive polypharmacy remained relatively stable over time, with about 40% of borderline patients taking 3 or more concurrent standing medications during each follow-up period, about 20% taking 4 or more, and about 10% taking 5 or more.


CONCLUSIONS
The results of this study suggest that the majority of borderline patients continue to use outpatient treatment in a sustained manner through 6 years of follow-up, but only a declining minority use more restrictive and costly forms of treatment.
Zanarini
Mary C
MC
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA 02478, USA. zanarini@mclean.harvard.edu
Frankenburg
Frances R
FR
Hennen
John
J
Silk
Kenneth R
KR
D000293:Adolescent; D000328:Adult; D001883:Borderline Personality Disorder / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004358:Drug Therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010045:Outpatients; D011446:Prospective Studies; D011613:Psychotherapy