Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-25T11:07:27.008Z Has data issue: false hasContentIssue false
  • English
  • Français

Borderline Personality Disorder and Traits in Veterans: Psychiatric Comorbidity, Healthcare Utilization, and Quality of Life Along a Continuum of Severity

Published online by Cambridge University Press:  07 November 2014

Donald W. Black ,
Nancee Blum ,
Elena Letuchy ,
Caroline Carney Doebbeling ,
Valerie L. Forman-Hoffman  and
Bradley N. Doebbeling
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To examine the presence of borderline personality disorder (BPD) traits in Gulf War veterans, and to assess psychiatric comorbidity, health status, healthcare utilization, and quality of life (QOL) along a continuum of BPD trait severity.

Method:

BPD and traits were evaluated using the Schedule for Non-Adaptive and Adaptive Personality in 576 veterans who were either deployed to the Persian Gulf (1990–1991) or were on active duty though not deployed to the Gulf. Demographic and military characteristics, personal and family history, psychiatric comorbidity, and QOL were also assessed.

Results:

One or more BPD traits were present in 247 subjects (43%), and BPD (≥5 traits) was identified in 15 subjects (3%).The number of traits was significantly associated with age and level of education. Lifetime psychiatric comorbidity was significantly associated with the number of BPD traits present, and level of functioning, health status, healthcare utilization, social functioning, self-injurious tendencies, and military/behavioral problems.

Conclusion:

BPD and traits identified in Gulf War veterans were associated with significant psychiatric morbidity, poorer QOL, and increased utilization of healthcare resources. Early recognition and treatment of veterans with BPD symptoms may be warranted to minimize the burden on the healthcare system.

Type
Original Research
Information
CNS Spectrums , Volume 11 , Issue 9 , September 2006 , pp. 680 - 689
Copyright
Copyright © Cambridge University Press 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Gunderson, J. Borderline Personality Disorder: A Clinical Guide. 2nd ed. Washington, DC: American Psychiatric Publishing, Inc.; 2002 Google Scholar
2. Widiger, TA, Frances, AJ. Epidemiology, diagnosis, and comorbidity of borderline personality disorder. In: Tasman, A, Hales, RE, Frances, AJ, eds. American Psychiatric Press Review of Psychiatry, vol 8. Washington, DC: American Psychiatric Press; 1989:8–24.Google Scholar
3. Zimmerman, M, Coryell, W. DSM-III personality disorder diagnoses in a non-patient sample: demographic correlates and comorbidity. Arch Gen Psychiatry. 1989;46:682–689.Google Scholar
4. Bender, DS, Dolan, RT, Skodol, AE, et al. Treatment utilization by patients with personality disorders. Am J Psychiatry. 2001;158:295–302.Google Scholar
5. Skodol, AE, Gunderson, JG, McGlashan, TH, et al. Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. Am J Psychiatry. 2002;159:276–283.Google Scholar
6. Fyer, MR, Frances, AJ, Sullivan, T, Hurt, SW, Clarkin, J. Comorbidity of borderline personality disorder. Arch Gen Psychiatry. 1988;45:348–352.Google Scholar
7. Zanarini, MC, Frankenburg, FR, Dubo, ED, et al. Axis I comorbidity of borderline personality disorder. Am J Psychiatry. 1998;155:1733–1739.Google Scholar
8. Paris, J. Social Factors in Personality Disorders: A Biopsychosocial Approach to Etiology and Treatment. New York, NY: Cambridge University Press; 1996.Google Scholar
9. Fyer, MR, Frances, AJ, Sullivan, T, Hurt, SW, Clarkin, J. Suicide attempts in patients with borderline personality disorder. Am J Psychiatry. 1988;145:737–739.Google Scholar
10. Soloff, PH. Lynch, KG, Kelly, TM, Malone, KM, Mann, JJ. Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: a comparative study. Am J Psychiatry. 2000;157:601–608.Google Scholar
11. Clark, LA. Schedule for Non-Adaptive and Adaptive Personality (SNAP): Manual for Administration, Scoring, and Interpretation. Minneapolis, Minn: University of Minnesota Press; 1996.Google Scholar
12. Self-reported illness and health status among Gulf War veterans. A population-based study. The Iowa Persian Gulf Study Group. JAMA. 1997;277:238–245.Google Scholar
13. Black, DW, Carney, CP, Forman-Hoffman, VL, et al. Depression in veterans of the first Gulf War and comparable military controls. Ann Clin Psychiatry. 2004;16:53–61.Google Scholar
14. Ang, DC, Peloso, PM, Woolson, RF, Kroenke, K, Doebbeling, BN. Predictors of incident chronic widespread pain among veterans of the first Gulf War. Clin J Pain. 2006;22:554–563.Google Scholar
15. Forman-Hoffman, VL, Carney, CP, Sampson, TR, et al. Mental health comorbidity patterns and impact on quality of life among veterans serving during the first Gulf War. Qual Life Res. 2005;14:2303–2314.Google Scholar
16. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed rev. Washington, DC: American Psychiatric Association; 1987.Google Scholar
17. Spitzer, RL, Williams, JBW, Gibbon, M, First, MB. The Structured Clinical Interview for DSMIII-R (SCID), I: History, rationale, and description. Arch Gen Psychiatry. 1992;49:624–629.Google Scholar
18. Leckman, JF, Sholomskas, D, Thompson, WD, Belauger, A, Weismann, MM. Best estimate of lifetime psychiatric diagnosis: a methodological study. Arch Gen Psychiatry. 1982;39:879–883.Google Scholar
19. Carney, CP, Sampson, T, Voelker, M, et al. Women in the Gulf War: Combat experience, exposure and subsequent health care use. Milit Med. 2003;168:654–661.Google Scholar
20. Rosenheck, R. War Zone Stress Among Returning Persian Gulf Troops: A Preliminary Report. West Haven, Conn: VA New England Program Evaluation Center; 1991.Google Scholar
21. Gallops, M, Laufer, RS, Yager, T. Revised Combat Exposure Scale. In: Laufer, RS and Yager, T, eds. Legacies of Vietnam: Comparative Adjustments of Veterans and Their Peers, vol 3rd. Washington, DC: Government Printing Office; 1994;125.Google Scholar
22. Cutrona, CE. Social support and stress in the transition to parenthood. J Abnorm Psychol. 1984;93:378–390.Google Scholar
23. Cutrona, CE, Russell, D. The provisions of social relationships and adaptation to stress. Advances in Personal Relationships. 1987;1:37–67.Google Scholar
24. Ware, J. Appendix C: script for personal interview SF-36 administration. In: SF-36 Health Survey Manuals and Interpretation Guide. Boston, Mass: Nimrod Press; 1993.Google Scholar
25. Wells, KB, Stewart, A, Hays, RD, et al. The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. JAMA. 1989;262:914–919.Google Scholar
26. Voelker, MD, Saag, KG, Schwartz, DA, et al. Health-related quality of life in Gulf War era military personnel. Am J Epidemiol. 2002;155:899–907.Google Scholar
27. SAS software, ver 8.2. Carey, NIC: SAS Institute Inc.; 2003.Google Scholar
28. Syndecor, GW, Cochran, WG. Statistical Methods. 6th ed. Ames, IA: Iowa State University Press; 1967.Google Scholar
29. Jonckheere, AR. A distribution-free k-sample test against ordered alternatives. Biometrika. 1954;41:133–145.Google Scholar
30. Hoge, CW, Lesikar, SE, Guevara, R, et al. Mental disorders among U.S. military personnel in the 1990s: association with high levels of health care utilization and early military attrition. Am J Psychiatry. 2002;159:1576–1583.Google Scholar
31. Linehan, MM. Cognitive-Behavioral Treatment for Borderline Personality Disorder. New York, NY: Guilford Press; 1993.Google Scholar
32. Blum, N, Pfohl, B, John, DS, Monahan, P, Black, DW. STEPPS: a cognitive-behavioral systemsbased group treatment for outpatients with borderline personality disorder–a preliminary report. Compr Psychiatry. 2002;43:301–310.Google Scholar
33. Langbehn, DR, Pfohl, BM, Reynolds, S, et al. The Iowa Personality Disorder Screen: development and preliminary validation of a grief interview. J Personal Disord. 1999;13:75–89.Google Scholar