0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Cognitive Experiences Reported by Patients With Borderline Personality Disorder and Axis II Comparison Subjects: A 16-Year Prospective Follow-Up Study
Mary C. Zanarini, Ed.D.; Frances R. Frankenburg, M.D.; Michelle M. Wedig, Ph.D.; Garrett M. Fitzmaurice, Sc.D.
Am J Psychiatry 2013;170:671-679. doi:10.1176/appi.ajp.2013.13010055
View Author and Article Information

The authors report no financial relationships with commercial interests.

Supported by NIMH grants MH47588 and MH62169.

From McLean Hospital, Belmont, Mass.; and Department of Biostatistics, Harvard School of Public Health, Boston.

Address correspondence to Dr. Zanarini (zanarini@mclean.harvard.edu).

Copyright © 2013 by the American Psychiatric Association

Received August 13, 2010; Revised October 03, 2012; Revised October 14, 2012; Revised November 30, 2012; Revised January 08, 2013; Accepted January 18, 2013.

Abstract

Objective  The authors assessed three main types of disturbed cognition: nonpsychotic thought (odd thinking, unusual perceptual experiences, and nondelusional paranoia), quasi-psychotic thought, and true psychotic thought in patients with borderline personality disorder followed prospectively for 16 years. They also compared the rates of these disturbed cognitions with those reported by axis II comparison subjects.

Method  The cognitive experiences of 362 inpatients (290 borderline patients and 72 axis II comparison subjects) were assessed at study entry using the cognitive section of the Revised Diagnostic Interview for Borderlines. Participants’ cognitive experiences were reassessed every 2 years using the same interview.

Results  Each of the five main types of thought studied was reported by a significantly higher percentage of patients in the borderline group than in the axis II comparison group over time. Each of these types of thought, except true psychotic thought, declined significantly over time for participants in both groups. Eleven of the 17 more specific forms of thought studied were also reported by a significantly higher percentage of patients in the borderline group over the follow-up period: magical thinking, overvalued ideas, recurrent illusions, depersonalization, derealization, undue suspiciousness, ideas of reference, other paranoid ideation, quasi-psychotic delusions, quasi-psychotic hallucinations, and true psychotic hallucinations. Fourteen specific forms of thought were found to decline significantly over time for participants in both groups: all forms of thought mentioned above except true psychotic hallucinations plus marked superstitiousness, sixth sense, telepathy, and clairvoyance.

Conclusions  Disturbed cognitions are common in patients with borderline personality disorder and are distinguishing for the disorder. They also decline substantially over time but remain a problem, particularly those of a nonpsychotic nature.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

FIGURE 1. Scores of Borderline Patients on the Four Sections of the Revised Diagnostic Interview for Borderlines Over 16 Years of Prospective Follow-Up
Anchor for Jump
TABLE 1.Prevalence of Odd Thinking in Patients With Borderline Personality Disorder and Axis II Comparison Subjects Over 16 Years of Prospective Follow-Up
Table Footer Note

a The first relative risk ratio of each pair compares the two diagnostic groups (borderline and other axis II) over the 16 years of follow-up, and the second assesses the change from baseline to 16-year follow-up in the two groups combined.

Anchor for Jump
TABLE 2.Prevalence of Unusual Perceptual Experiences in Patients With Borderline Personality Disorder and Axis II Comparison Subjects Over 16 Years of Prospective Follow-Up
Table Footer Note

a The first relative risk ratio of each pair compares the two diagnostic groups (borderline and other axis II) over the 16 years of follow-up, and the second assesses the change from baseline to 16-year follow-up in the two groups combined.

Anchor for Jump
TABLE 3.Prevalence of Paranoid Experiences in Patients With Borderline Personality Disorder and Axis II Comparison Subjects Over 16 Years of Prospective Follow-Up
Table Footer Note

a The first relative risk ratio of each pair compares the two diagnostic groups (borderline and other axis II) over the 16 years of follow-up, and the second assesses the change from baseline to 16-year follow-up in the two groups combined.

Anchor for Jump
TABLE 4.Prevalence of Quasi-Psychotic Thought in Patients With Borderline Personality Disorder and Axis II Comparison Subject Over 16 Years of Prospective Follow-Up
Table Footer Note

a The first relative risk ratio of each pair compares the two diagnostic groups (borderline and other axis II) over the 16 years of follow-up, and the second assesses the change from baseline to 16-year follow-up in the two groups combined.

Anchor for Jump
TABLE 5.Prevalence of True Psychotic Thought in Patients With Borderline Personality Disorder and Axis II Comparison Subjects Over 16 Years of Prospective Follow-Up
Table Footer Note

a The first relative risk ratio of each pair compares the two diagnostic groups (borderline and other axis II) over the 16 years of follow-up, and the second assesses the change from baseline to 16-year follow-up in the two groups combined.

+

References

Stern  A:  Psychoanalytic investigation of and therapy in the borderline group of neuroses.  Psychoanal Q 1938; 7:467–489
 
Knight  RP:  Borderline states.  Bull Menninger Clin 1953; 17:1–12
[PubMed]
 
Frosch  J:  The psychotic character: clinical psychiatric considerations.  Psychiatr Q 1964; 38:81–96
[CrossRef] | [PubMed]
 
Kernberg  O:  Borderline Conditions and Pathological Narcissism .  New York,  Jason Aronson, 1975
 
Gunderson  J:  Borderline Personality Disorder .  Washington, DC,  American Psychiatric Press, 1984
 
Grinker  R;  Werble  B;  Drye  R:  The Borderline Syndrome .  New York,  Basic Books, 1968
 
Werble  B:  Second follow-up study of borderline patients.  Arch Gen Psychiatry 1970; 23:3–7
[CrossRef] | [PubMed]
 
Gunderson  JG;  Carpenter  WT  Jr;  Strauss  JS:  Borderline and schizophrenic patients: a comparative study.  Am J Psychiatry 1975; 132:1257–1264
[PubMed]
 
Carpenter  WT  Jr;  Gunderson  JG;  Strauss  JS:  Considerations of the borderline syndrome: a longitudinal comparative study of borderline and schizophrenic patients, in  Borderline Personality Disorders . Edited by Hartocollis  P.  New York,  International Universities Press, 1977
 
Carpenter  WT  Jr;  Gunderson  JG:  Five year follow-up comparison of borderline and schizophrenic patients.  Compr Psychiatry 1977; 18:567–571
[CrossRef] | [PubMed]
 
Gunderson  JG:  Characteristics of borderlines, in  Borderline Personality Disorders . Edited by Hartcollis  P.  New York,  International Universities Press, 1977
 
Gunderson  JG;  Kolb  JE:  Discriminating features of borderline patients.  Am J Psychiatry 1978; 135:792–796
[PubMed]
 
Spitzer  RL;  Endicott  J;  Gibbon  M:  Crossing the border into borderline personality and borderline schizophrenia: the development of criteria.  Arch Gen Psychiatry 1979; 36:17–24
[CrossRef] | [PubMed]
 
Conte  HR;  Plutchik  R;  Karasu  TB;  Jerrett  I:  A self-report borderline scale: discriminative validity and preliminary norms.  J Nerv Ment Dis 1980; 168:428–435
[CrossRef] | [PubMed]
 
Perry  JC;  Klerman  GL:  Clinical features of the borderline personality disorder.  Am J Psychiatry 1980; 137:165–173
[PubMed]
 
Sheehy  M;  Goldsmith  L;  Charles  E:  A comparative study of borderline patients in a psychiatric outpatient clinic.  Am J Psychiatry 1980; 137:1374–1379
[PubMed]
 
Soloff  PH:  Affect, impulse, and psychosis in borderline disorders: a validation study.  Compr Psychiatry 1981; 22:337–350
[CrossRef] | [PubMed]
 
Soloff  PH:  A comparison of borderline with depressed and schizophrenic patients on a new diagnostic interview.  Compr Psychiatry 1981; 22:291–300
[CrossRef] | [PubMed]
 
Soloff  PH;  Ulrich  RF:  Diagnostic Interview for Borderline Patients: a replication study.  Arch Gen Psychiatry 1981; 38:686–692
[CrossRef] | [PubMed]
 
Koenigsberg  HW:  A comparison of hospitalized and nonhospitalized borderline patients.  Am J Psychiatry 1982; 139:1292–1297
[PubMed]
 
Frances  A;  Clarkin  JF;  Gilmore  M;  Hurt  SW;  Brown  R:  Reliability of criteria for borderline personality disorder: a comparison of DSM-III and the Diagnostic Interview for Borderline Patients.  Am J Psychiatry 1984; 141:1080–1084
[PubMed]
 
Tarnopolsky  A;  Berelowitz  M:  “Borderline personality”: diagnostic attitudes at the Maudsley Hospital.  Br J Psychiatry 1984; 144:364–369
[CrossRef] | [PubMed]
 
Pope  HG  Jr;  Jonas  JM;  Hudson  JI;  Cohen  BM;  Tohen  M:  An empirical study of psychosis in borderline personality disorder.  Am J Psychiatry 1985; 142:1285–1290
[PubMed]
 
Chopra  HD;  Beatson  JA:  Psychotic symptoms in borderline personality disorder.  Am J Psychiatry 1986; 143:1605–1607
[PubMed]
 
George  A;  Soloff  PH:  Schizotypal symptoms in patients with borderline personality disorders.  Am J Psychiatry 1986; 143:212–215
[PubMed]
 
Jacobsberg  LB;  Hymowitz  P;  Barasch  A;  Frances  AJ:  Symptoms of schizotypal personality disorder.  Am J Psychiatry 1986; 143:1222–1227
[PubMed]
 
Snyder  S;  Pitts  WM:  Characterizing paranoia in the DSM-III borderline personality disorder.  Acta Psychiatr Scand 1986; 73:500–505
[CrossRef] | [PubMed]
 
McGlashan  TH:  Testing DSM-III symptom criteria for schizotypal and borderline personality disorders.  Arch Gen Psychiatry 1987; 44:143–148
[CrossRef] | [PubMed]
 
Widiger  TA;  Frances  A;  Warner  L;  Bluhm  C:  Diagnostic criteria for the borderline and schizotypal personality disorders.  J Abnorm Psychol 1986; 95:43–51
[CrossRef] | [PubMed]
 
Nurnberg  HG;  Hurt  SW;  Feldman  A;  Suh  R:  Evaluation of diagnostic criteria for borderline personality disorder.  Am J Psychiatry 1988; 145:1280–1284
[PubMed]
 
Links  PS;  Steiner  M;  Mitton  J:  Characteristics of psychosis in borderline personality disorder.  Psychopathology 1989; 22:188–193
[CrossRef] | [PubMed]
 
Silk  KR;  Westen  D;  Lohr  NE;  Benjamin  J;  Gold  L:  DSM-III and DSM-III-R schizotypal symptoms in borderline personality disorder.  Compr Psychiatry 1990; 31:103–110
[CrossRef] | [PubMed]
 
Zanarini  MC;  Gunderson  JG;  Frankenburg  FR:  Cognitive features of borderline personality disorder.  Am J Psychiatry 1990; 147:57–63
[PubMed]
 
Zanarini  MC;  Frankenburg  FR;  DeLuca  CJ;  Hennen  J;  Khera  GS;  Gunderson  JG:  The pain of being borderline: dysphoric states specific to borderline personality disorder.  Harv Rev Psychiatry 1998; 6:201–207
[CrossRef] | [PubMed]
 
Zanarini  MC;  Frankenburg  FR;  Hennen  J;  Silk  KR:  The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder.  Am J Psychiatry 2003; 160:274–283
[CrossRef] | [PubMed]
 
Spitzer  RL;  Williams  JB;  Gibbon  M;  First  MB:  The Structured Clinical Interview for DSM-III-R (SCID), I: history, rationale, and description.  Arch Gen Psychiatry 1992; 49:624–629
[CrossRef] | [PubMed]
 
Zanarini  MC;  Gunderson  JG;  Frankenburg  FR;  Chauncey  DL:  The Revised Diagnostic Interview for Borderlines: discriminating BPD from other axis II disorders.  J Pers Disord 1989; 3:10–18
[CrossRef]
 
Zanarini  MC;  Frankenburg  FR;  Chauncey  DL;  Gunderson  JG:  The Diagnostic Interview for Personality Disorders: interrater and test-retest reliability.  Compr Psychiatry 1987; 28:467–480
[CrossRef] | [PubMed]
 
Zanarini  MC;  Frankenburg  FR:  Attainment and maintenance of reliability of axis I and II disorders over the course of a longitudinal study.  Compr Psychiatry 2001; 42:369–374
[CrossRef] | [PubMed]
 
Zanarini  MC;  Frankenburg  FR;  Vujanovic  AA:  Inter-rater and test-retest reliability of the Revised Diagnostic Interview for Borderlines.  J Pers Disord 2002; 16:270–276
[CrossRef] | [PubMed]
 
Hollingshead  AB:  Two-Factor Index of Social Position .  New Haven, Conn,  Yale University, Department of Sociology, 1965
 
Hörz  S;  Zanarini  MC;  Frankenburg  FR;  Reich  DB;  Fitzmaurice  G:  Ten-year use of mental health services by patients with borderline personality disorder and with other axis II disorders.  Psychiatr Serv 2010; 61:612–616
[CrossRef] | [PubMed]
 
Zanarini  MC;  Frankenburg  FR;  Reich  DB;  Silk  KR;  Hudson  JI;  McSweeney  LB:  The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study.  Am J Psychiatry 2007; 164:929–935
[CrossRef] | [PubMed]
 
Brown  MZ;  Comtois  KA;  Linehan  MM:  Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder.  J Abnorm Psychol 2002; 111:198–202
[CrossRef] | [PubMed]
 
Gunderson  JG:  Revising the borderline diagnosis for DSM-V: an alternative proposal.  J Pers Disord 2010; 24:694–708
[CrossRef] | [PubMed]
 
Zanarini  MC;  Frankenburg  FR;  Dubo  ED;  Sickel  AE;  Trikha  A;  Levin  A;  Reynolds  V:  Axis II comorbidity of borderline personality disorder.  Compr Psychiatry 1998; 39:296–302
[CrossRef] | [PubMed]
 
Zanarini  MC;  Frankenburg  FR;  Vujanovic  AA;  Hennen  J;  Reich  DB;  Silk  KR:  Axis II comorbidity of borderline personality disorder: description of 6-year course and prediction to time-to-remission.  Acta Psychiatr Scand 2004; 110:416–420
[CrossRef] | [PubMed]
 
Linehan  MM;  Armstrong  HE;  Suarez  A;  Allmon  D;  Heard  HL:  Cognitive-behavioral treatment of chronically parasuicidal borderline patients.  Arch Gen Psychiatry 1991; 48:1060–1064
[CrossRef] | [PubMed]
 
Bateman  A;  Fonagy  P:  Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial.  Am J Psychiatry 1999; 156:1563–1569
[PubMed]
 
Giesen-Bloo  J;  van Dyck  R;  Spinhoven  P;  van Tilburg  W;  Dirksen  C;  van Asselt  T;  Kremers  I;  Nadort  M;  Arntz  A:  Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy.  Arch Gen Psychiatry 2006; 63:649–658
[CrossRef] | [PubMed]
 
Clarkin  JF;  Levy  KN;  Lenzenweger  MF;  Kernberg  OF:  Evaluating three treatments for borderline personality disorder: a multiwave study.  Am J Psychiatry 2007; 164:922–928
[CrossRef] | [PubMed]
 
Blum  N;  St John  D;  Pfohl  B;  Stuart  S;  McCormick  B;  Allen  J;  Arndt  S;  Black  DW:  Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up.  Am J Psychiatry 2008; 165:468–478
[CrossRef] | [PubMed]
 
McMain  SF;  Links  PS;  Gnam  WH;  Guimond  T;  Cardish  RJ;  Korman  L;  Streiner  DL:  A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder.  Am J Psychiatry 2009; 166:1365–1374
[CrossRef] | [PubMed]
 
Linehan  MM:  Cognitive-Behavioral Treatment of Borderline Personality Disorder .  New York,  Guilford, 1993
 
Zanarini  MC;  Frankenburg  FR;  Reich  DB;  Fitzmaurice  G:  Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study.  Am J Psychiatry 2012; 169:476–483
[PubMed]
 
References Container
+
+

Self-Assessment Quiz

Did you know? You can add a subscription now to earn CME Credits!

1.
What type of cognitive experience is most common among borderline patients?
2.
A significantly higher percentage of borderline patients than axis II comparison subjects reported any type of odd thinking over 16 years of prospective follow-up. Which of the following specific types of odd thinking were reported more often by borderline patients?
3.
What feature best differentiates quasi-psychotic thought from true psychotic thought?
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Web of Science® Times Cited: 1

Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 61.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 61.  >
APA Practice Guidelines > Chapter 0.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 61.  >
Topic Collections
Psychiatric News
APA Guidelines