title: The relationship of chronic medical illnesses, poor health-related lifestyle choices, and health care utilization to recovery status in borderline patients over a decade of prospective follow-up.
abstract: BACKGROUND
  The interaction of borderline personality disorder (BPD) with physical health has not been well characterized. In this longitudinal study, we investigated the long-term relationship of chronic medical illnesses, health-related lifestyle choices, and health services utilization to recovery status in borderline patients over a decade of prospective follow-up.
  
  
  METHODS
  264 borderline patients were interviewed concerning their physical health at 6-year follow-up in a longitudinal study of the course of BPD. This sample was then reinterviewed five times at two-year intervals over the next ten years. We defined recovery from BPD based on a Global Assessment of Functioning score of 61 or higher, which required BPD remission, one close relationship, and full-time competent and consistent work or school attendance. We controlled for potentially confounding effects of time-varying major depressive disorder.
  
  
  RESULTS
  Never-recovered borderline patients were significantly more likely than ever-recovered borderline patients to have a medical syndrome, obesity, osteoarthritis, diabetes, urinary incontinence, or multiple medical conditions (p<0.0063). They were also significantly more likely to report pack-per-day smoking, weekly alcohol use, no regular exercise, daily sleep medication use, or pain medication overuse (p<0.0083). In addition, never-recovered borderline patients were significantly more likely than ever-recovered borderline patients to undergo a medical emergency room visit, medical hospitalization, X-ray, CT scan, or MRI scan (p<0.0063).
  
  
  CONCLUSIONS
  Over a decade of prospective follow-up, failure to recover from BPD seems to be associated with a heightened risk of chronic medical illnesses, poor health-related lifestyle choices, and costly health services utilization.
authors.affiliation: Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA 02478, USA. akeuroghlian@partners.org
authors.forename: Alex S
authors.initials: AS
authors.lastname: Keuroghlian
authors.forename: Frances R
authors.initials: FR
authors.lastname: Frankenburg
authors.forename: Mary C
authors.initials: MC
authors.lastname: Zanarini
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D002755:Choice Behavior / Q000502:physiology*; D002908:Chronic Disease / Q000523:psychology*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Borderline personality disorder; Chronic medical illness; Health care utilization; Longitudinal course; Major depressive disorder; Recovery