Predictors of treatment completion and outcomes for individuals with borderline personality disorder
Bibliographic record
Abstract
Background: Borderline personality disorder (BPD) is a pervasive mental disorder characterized by emotional instability, unstable interpersonal relationships, and impulsive behaviours. The disorder is associated with decreased pain sensitivity related to self-harming behaviours, heightened sensitivity to chronic pain, a high prevalence of co-occurring mood, anxiety and substance use disorders, and severe functional impairment in several domains. Specialized treatments have demonstrated superiority to treatment as usual but there is still a proportion of individuals who dropout of treatment early. Objectives: The objective of this study was to examine factors predictive of treatment completion and outcomes among individuals entering specialized treatment for BPD. Baseline measures were also compared at intake between individuals with and without a drug or alcohol problem to determine if substance abuse was associated with greater psychiatric symptom severity. Outcome variables examined at 3- and 6-month follow-up included treatment completion, severity of psychological symptoms, substance use, and depressive symptoms. Methods: This study was conducted at the Personality Disorders Clinic at the Allan Memorial Institute of the McGill University Health Centre in Montreal. Information was collected from 65 patients that met DSM-IV criteria for BPD and were enrolled in a 3-month outpatient treatment program. Patients' baseline psychological distress, lifetime Axis I comorbidity, subjective experiences of pain, objective measures of physiological sensitivity, employment, medical, and family/social functioning, and severity of substance problems were examined. Results: At baseline, substance abuse was associated with greater psychiatric symptom severity, mood disturbance, impulsivity, and number of lifetime Axis I comorbidities. However, problem substance use did not predict treatment dropout or outcomes of psychopathology or functional improvement at follow-ups. Treatment completers were less likely to have had substance abuse, recent suicide attempt, or severe depressive symptoms at 3 months compared to non-completers. Psychiatric severity and depressive symptoms decreased over time, but impairment in medical, employment, and family/social functioning did not improve by 6-month follow-up. Regression analysis indicated the most significant predictor of moderate to severe depressive symptoms at 3 months was a lifetime history of sexual abuse.Conclusions: Together these findings suggest that physiological sensitivity, comorbid psychiatric disorders, and severity of substance use do not predict treatment dropout or improvements in psychopathology and psychosocial functioning. Nonetheless, the association of substance abuse with psychiatric severity, impulsivity, mood disturbance, and lifetime comorbidities provide insight into the effects of drug and alcohol problems on the presentation of BPD. The relationship between treatment dropout and greater psychological distress highlight the importance of treatment retention on psychopathology outcomes. Sexual abuse history and functional impairment should be targeted in future interventions to improve outcomes for individuals with BPD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".