Treatment histories of borderline inpatients

In this study, we describe the types and amounts of psychiatric treatment r eceived by a well-defined sample of borderline personality disorder (BPD) i npatients, and compare these parameters with those of a group of carefully diagnosed personality-disordered controls. Finally, we assess the risk fact ors associated with a history of intensive, high-cost treatment, which we d efined as having had two or more prior psychiatric hospitalizations. The tr eatment histories of 290 borderline inpatients and 72 axis II controls were assessed using a reliable semistructured interview. All nine forms of trea tment studied except electroconvulsive therapy (ECT) were common among bord erline patients (36% to 96%). In addition, a significantly higher percentag e of borderline patients than axis II controls reported a history of indivi dual and group therapy, day and residential treatment, psychiatric hospital ization, participating in self-help groups, and taking standing medications . They were also significantly younger when they first entered individual t herapy and began to take standing medications. In addition, borderline pati ents spent more time than axis II controls in individual therapy and psychi atric hospitals, and were on standing medications for a significantly longe r period of time. They also reported a significantly higher number of psych iatric hospitalizations, lifetime number of standing medications, and numbe r of psychotropic medications taken at the same time. In addition, we found a highly significant multivariate predictive model for multiple prior hosp italizations. The six significant predictors were age 26 or older, a histor y of quasi psychotic thought, lifetime number of self-mutilative efforts an d suicide attempts, a childhood history of reported sexual abuse, and an ad ult history of being physically and/or sexually assaulted. Taken together, these results confirm clinical impressions concerning the high rates of men tal health services used by borderline patients. They also suggest that par ticularly high rates of costly inpatient treatment are associated with a co mplex admixture of older age, BPD symptoms in the cognitive and impulse rea lms, and traumatic life experiences occurring in both childhood and adultho od. Copyright (C) 2001 by W.B. Saunders Company.