Two-year follow-up of borderline personality disorder patients in Italy: A preliminary report on prognosis and prediction of outcome

Abstract

Background and Aims: Few naturalistic studies have examined the course of borderline personality disorder (BPD) outside North American countries. The aim of this prospective study was to investigate remission rate, changes in the level of BPD psychopathology and outcome prediction in a sample ( n = 46) of Italian BPD outpatients over a two-year follow-up. Method: Two years after baseline, remission rate from BPD and changes in the severity of BPD psychopathology were investigated. Initial measures of borderline, comorbid Axis I and II psychopathology and clinical severity, as well as historical and socio-demographic variables, were used to predict the number of BPD criteria met at follow-up. Results: At the two-year interview, the mean number of BPD criteria endorsed decreased ( p = 0.04) and 12 participants (26.1%) fell below the diagnostic threshold for BPD. Borderline psychopathology at follow-up was predicted by the presence, at baseline, of substance use disorders and self-defeating personality traits, and by the absence of dependent traits ( R2 = 0.409; p < 0.001). However, these results cannot be generalized to patients lost to follow-up (15 out of an initial sample of 61), who may exhibit a more severe psychopathology at baseline and therefore a poorer prognosis. Conclusions: Borderline individuals seeking treatment at Italian public psychiatric centres may show some improvement in BPD psychopathology over a two-year follow-up; however, the remission rate seems to be lower than that found in North American samples. Furthermore, outcome predictors overlap only partially with those detected by North American studies.