Quality of life in borderline patients comorbid with anxiety spectrum disorders - a cross-sectional study
Status PubMed-not-MEDLINE Language English Country New Zealand Media electronic-ecollection
Document type Journal Article
PubMed
27536074
PubMed Central
PMC4975144
DOI
10.2147/ppa.s108777
PII: ppa-10-1421
Knihovny.cz E-resources
- Keywords
- adjustment disorders, anxiety disorders, borderline personality disorder, dissociation, quality of life,
- Publication type
- Journal Article MeSH
INTRODUCTION: Borderline personality disorder (BPD) significantly reduces the quality of life (QoL) in mental, social, and work domains. Patients with BPD often suffer from depressive anxiety symptoms. The purpose of this cross-sectional study was to compare the QoL and demographic and clinical factors of inpatients diagnosed with BPD and comorbid anxiety spectrum disorders, and healthy controls. METHODS: Ninety-two hospitalized patients treated in the psychotherapeutic department and 40 healthy controls were included. Subjects were assessed by the Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), Dissociative Experiences Scale, Beck Depression Inventory (BDI)-II, Beck Anxiety Inventory, Clinical Global Impression, demographic questionnaire, Sheehan Disability Scale (SDS), and Sheehan Anxiety Scale. RESULTS: BPD patients suffered from comorbid anxiety disorders, panic disorder (18.5%), social phobia (20.7%), generalized anxiety disorder/mixed anxiety depression disorder (17.4%), adjustment disorder (22.8%), and posttraumatic stress disorder (8.7%); 19.6% patients had two or more anxiety disorder comorbidities. Patients score in Q-LES-Q (general) was 36.24±9.21, which was significantly lower in comparison to controls (57.83±10.21) and similar in all domains (physical health, feelings, work, household, school/study, leisure, social activities). The subjective level of depression measured by BDI and SDS (social life and family subscales) negatively correlated with all Q-LES-Q domains. CONCLUSION: Patients suffering from BPD and comorbid anxiety disorders have a lower level of QoL compared to healthy controls in all measured domains. Negative correlations of the Q-LES-Q domains with clinical scales (Dissociative Experiences Scale, BDI, Beck Anxiety Inventory, Sheehan Anxiety Scale, Clinical Global Impression, and SDS) are noticeable.
See more in PubMed
World Health Organisation . ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation; 1992.
Brüne M. Borderline personality disorder: why ‘fast and furious’? Evol Med Public Health. 2016;2016(1):52–66. PubMed PMC
American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC: American Psychiatric Association; 1994.
Arntz A, van Genderen H. Schema Therapy for Borderline Personality Disorder. Chichester: Wiley-Blackwell; 2009.
Coid J, Yang M, Tyrer P, Roberts A, Ullrich S. Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry. 2006;188(5):423–431. PubMed
Samuels J. Personality disorders: epidemiology and public health issues. Int Rev Psychiatry. 2011;23(3):223–233. PubMed
Hayward M, Slade M, Moran PA. Personality disorders and unmet needs among psychiatric inpatients. Psychiatr Serv. 2006;57(4):538–543. PubMed
Vyskocilova J, Prasko J, Sedlackova Z, Ociskova M, Grambal A. Schema therapy for CBT therapists who treat borderline patients. Act Nerv Super Rediviva. 2014;56(1–2):24–31.
Latalova K, Prasko J. Aggression in borderline personality disorder. Psychiatr Q. 2010;81:239–251. PubMed
Fornaro M, Orsolini L, Marini S, et al. The prevalence and predictors of bipolar and borderline personality disorders comorbidity: systematic review and meta-analysis. J Affect Disord. 2016;195:105–118. PubMed
Vyskocilova J, Prasko J, Novak T, Pohlova L. Is there any influence of personality disorder on the short term intensive group cognitive behavioral therapy of social phobia? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011;155(1):85–94. PubMed
American Psychiatric Association Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatry. 2001;158(10 Suppl):1–52. PubMed
Davidson KM, Tyrer P, Norrie J, Palmer SJ, Tyrer H. Cognitive therapy v. usual treatment for borderline personality disorder: prospective 6-year follow-up. Br J Psychiatry. 2010;197(6):456–462. PubMed
Prasko J, Diveky T, Grambal A, et al. Transference and countertransference in cognitive behavioral therapy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010;154(3):189–198. PubMed
Linehan MM, Kehrer CA. Borderline personality disorder. In: Barlow DH, editor. Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual. 2nd ed. New York, NY: Guilford; 1993. pp. 396–441.
Giesen-Bloo J, van Dyck R, Spinhoven P, et al. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry. 2006;63(6):649–658. PubMed
Doering S, Hörz S, Rentrop M, et al. Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. Br J Psychiatry. 2010;196(5):389–395. PubMed
Fonagy P. The effectiveness of psychodynamic psychotherapies: an update. World Psychiatry. 2015;14(2):137–150. PubMed PMC
Clarkin JF. An integrated approach to psychotherapy techniques for patients with personality disorder. J Pers Disord. 2012;26(1):43–62. PubMed
Reneses B, Galián M, Serrano R, et al. A new time limited psychotherapy for BPD: preliminary results of a randomized and controlled trial. Actas Esp Psiquiatr. 2013;41(3):139–148. PubMed
IsHak WW, Elbau I, Ismail A, et al. Quality of life in borderline personality disorder. Harv Rev Psychiatry. 2013;21(3):138–150. PubMed
Black DW, Blum N, Letuchy E, Doebbeling C, Forman-Hoffman VL, Doebbeling BN. Borderline personality disorder and traits in veterans: psychiatric comorbidity, healthcare utilization, and quality of life along a continuum of severity. CNS Spectr. 2006;11(9):680–689. PubMed
Perseius KI, Andersson E, Asberg M, Samuelsson M. Health-related quality of life in women patients with borderline personality disorder. Scand J Caring Sci. 2006;20(3):302–307. PubMed
Feenstra DJ, Hutsebaut J, Laurenssen EM, Verheul R, Busschbach JJ, Soeteman DI. The burden of disease among adolescents with personality pathology: quality of life and costs. J Pers Disord. 2012;26(4):593–604. PubMed
Soeteman DI, Verheul R, Busschbach JJ. The burden of disease in personality disorders: diagnosis-specific quality of life. J Pers Disord. 2008;22(3):259–268. PubMed
Sidlova M, Prasko J, Jelenova D, et al. The quality of life of patients suffering from schizophrenia – a comparison with healthy controls. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011;155(2):173–180. PubMed
Holubova M, Prasko J, Hruby R, et al. Coping strategies and quality of life in schizophrenia: cross-sectional study. Neuropsychiatr Dis Treat. 2015;11:3041–3048. PubMed PMC
Holubova M, Prasko J, Latalova K, et al. Are self-stigma, quality of life, and clinical data interrelated in schizophrenia spectrum patients? A cross-sectional outpatient study. Patient Prefer Adherence. 2016;10:265–274. PubMed PMC
Latalova K, Prasko J, Diveky T, Kamaradova D, Velartova H. Cognitive dysfunction, dissociation and quality of life in bipolar affective disorders in remission. Psychiatr Danub. 2010;22(4):528–534. PubMed
Wilks CR, Korslund KE, Harned MS, Linehan MM. Dialectical behavior therapy and domains of functioning over two years. Behav Res Ther. 2016;77:162–169. PubMed PMC
Skodol AE, Geier T, Grant BF, Hasin DS. Personality disorders and the persistence of anxiety disorders in a nationally representative sample. Depress Anxiety. 2014;31(9):721–728. PubMed
Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline personality disorder. Lancet. 2004;364:453–461. PubMed
Lavner JA, Lamkin J, Miller JD. Borderline personality disorder symptoms and newlyweds’ observed communication, partner characteristics, and longitudinal marital outcomes. J Abnorm Psychol. 2015;124(4):975–981. PubMed PMC
Petfield L, Startup H, Droscher H, Cartwright-Hatton S. Parenting in mothers with borderline personality disorder and impact on child outcomes. Evid Based Ment Health. 2015;18(3):67–75. PubMed PMC
Prasko J, Houbova P, Novak T, et al. Influence of personality disorder on the treatment of panic disorder – comparison study. Neuro Endocrinol Lett. 2005;26(6):667–674. PubMed
Harned MS, Tkachuck MA, Youngberg KA. Treatment preference among suicidal and self-injuring women with borderline personality disorder and PTSD. J Clin Psychol. 2013;69(7):749–761. PubMed PMC
Williams GE, Daros AR, Graves B, McMain SF, Links PS, Ruocco AC. Executive functions and social cognition in highly lethal self-injuring patients with borderline personality disorder. Personal Disord. 2015;6(2):107–116. PubMed
Köhling J, Moessner M, Ehrenthal JC, et al. Affective instability and reactivity in depressed patients with and without borderline pathology. J Pers Disord. 2015 Dec 1; Epub. PubMed
Alnaes R, Torgersen S. The relationship between DSM-III symptom disorders (Axis I) and personality disorders (Axis II) in an outpatient population. Acta Psychiatr Scand. 1988;78(4):485–492. PubMed
Oldham JM, Skodol AE, Kellman HD, et al. Comorbidity of axis I and axis II disorders. Am J Psychiatry. 1995;152(4):571–578. PubMed
Zanarini MC, Frankenburg FR, Dubo ED, et al. Axis I comorbidity of borderline personality disorder. Am J Psychiatry. 1998;155(12):1733–1739. PubMed
Keuroghlian AS, Gunderson JG, Pagano ME, et al. Interactions of borderline personality disorder and anxiety disorders over 10 years. J Clin Psychiatry. 2015;76(11):1529–1534. PubMed
Baryshnikov I, Suvisaari J, Aaltonen K, et al. Self-reported symptoms of schizotypal and borderline personality disorder in patients with mood disorders. Eur Psychiatry. 2016;33:37–44. PubMed
Ansell EB, Pinto A, Edelen MO, et al. The association of personality disorders with the prospective 7-year course of anxiety disorders. Psychol Med. 2011;41(5):1019–1028. PubMed PMC
Janosiková EH, Daviesová JL. Psychiatrická ošetrovatel’ská starostlivost’ (Preklad z amerického originálu) [Psychiatric Nursing (Translation from the American Original)] Martin: Vydavatel’stvo Osveta; Slovak: 1999.
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(2):274–283. PubMed
Bagge C, Nickell A, Stepp S, Durrett C, Jackson K, Trull TJ. Borderline personality disorder features predict negative outcomes 2 years later. J Abnorm Psychol. 2004;113(2):279–288. PubMed
Larivière N, Couture É, Blackburn C, et al. Recovery, as experienced by women with borderline personality disorder. Psychiatr Q. 2015;86(4):555–568. PubMed
Zanarini MC, Ruser T, Frankenburg FR, Hennen J. The dissociative experiences of borderline patients. Compr Psychiatry. 2000;41(3):223–227. PubMed
Pastucha P, Prasko J, Diveky T, et al. Borderline personality disorder and dissociation – comparison with healthy controls. Act Nerv Super Rediviva. 2009;51(3–4):146–149.
Paris J, Zweig-Frank H. Dissociation in patients with borderline personality disorder. Am J Psychiatry. 1997;154(1):137–138. PubMed
Spitzer C, Barnow S, Armbruster J, Kusserow S, Freyberger HJ, Grabe HJ. Borderline personality organization and dissociation. Bull Menninger Clin. 2006;70(3):210–221. PubMed
Ross CA. Borderline personality disorder and dissociation. J Trauma Dissociation. 2007;8(1):71–80. PubMed
Navarro-Haro MV, Wessman I, Botella C, García-Palacios A. The role of emotion regulation strategies and dissociation in non-suicidal self-injury for women with borderline personality disorder and comorbid eating disorder. Compr Psychiatry. 2015;63:123–130. PubMed
Niedtfeld I, Defiebre N, Regenbogen C, et al. Facing the problem: impaired emotion recognition during multimodal social information processing in borderline personality disorder. J Pers Disord. 2016 Apr 11; Epub. PubMed
Simeon D, Guralnik O, Schmeidler J, Sirof B, Knutelska M. The role of childhood interpersonal trauma in depersonalization disorder. Am J Psychiatry. 2001;158(7):1027–1033. PubMed
Watson S, Chilton R, Fairchild H, Whewell P. Association between childhood trauma and dissociation among patients with borderline personality disorder. Aust N Z J Psychiatry. 2006;40(5):478–481. PubMed
Savitz JB, van der Merwe L, Newman TK, Solms M, Stein DJ, Ramesar RS. The relationship between childhood abuse and dissociation. Is it influenced by catechol-O-methyltransferase (COMT) activity? Int J Neuropsychopharmacol. 2008;11(2):149–161. PubMed
Prasko J, Raszka M, Diveky T, et al. Obsessive-compulsive disorder and dissociation – comparison with healthy controls. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010;154(2):179–183. PubMed
Prasko J, Latalova K, Diveky T, et al. Panic disorder, autonomic nervous system and dissociation – changes during therapy. Neuro Endocrinol Lett. 2011;32(5):641–651. PubMed
Latalova K, Prasko J, Pastucha P, et al. Bipolar affective disorder and dissociation – comparison with healthy controls. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011;155(2):181–186. PubMed
Draijer N, Langeland W. Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients. Am J Psychiatry. 1999;156:379–385. PubMed
Roy A. Childhood trauma and neuroticism as an adult: possible implication for the development of the common psychiatric disorders and suicidal behavior. Psychol Med. 2002;32:1471–1474. PubMed
McFarlane A, Clark CR, Bryant RA, et al. The impact of early life stress on psychophysiological, personality and behavioral measures in 740 non-clinical subjects. J Integr Neurosci. 2005;4:27–40. PubMed
Stein MB, Schork NJ, Gelernter J. Gene-by-environment (serotonin transporter and childhood maltreatment) interaction for anxiety sensitivity, an intermediate phenotype for anxiety disorders. Neuropsychopharmacology. 2008;33(2):312–319. PubMed
Jones B, Reuber M, Norman P. Correlates of health-related quality of life in adults with psychogenic nonepileptic seizures: a systematic review. Epilepsia. 2016;57(2):171–181. PubMed
Mezinárodní klasifikace nemocí – 10. revize, MKN-10 (1. vydání) [International Classification of Diseases – 10th Revision, ICD-10 (1st Edition)] Praha: Maxdorf; 1996. Czech.
Ritsner M, Kurs R, Gibel A, Ratner Y, Endicott J. Validity of an abbreviated Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-18) for schizophrenia, schizoaffective, and mood disorder patients. Qual Life Res. 2005;14(7):1693–1703. PubMed
Müllerova H, Libigerova E, Prouzova M, et al. Mezikulturní přenos a validace dotazníku kvality života q-les-q (Quality of Life Enjoyment and Satisfaction Questionnaire) v populaci nemocných s depresivní poruchou [Cross-cultural transfer and validation of the Quality of Life Enjoyment and Satisfaction Questionnaire in the population of depressed patients] Psychiatrie. 2001;5:80–87. Czech.
Carlson EB, Putnam FW. An update on the Dissociative Experience Scale. Dissociation. 1993;6(1):16–27.
Carlson EB, Putnam FW, Ross CA, et al. In: Braun BG, Carlson EB, editors. Factor analysis of the Dissociative Experiences Scale: a multicenter study; Proceedings of the Eighth International Conference on Multiple Personality and Dissociative States; Chicago, IL: Rush; 1991.
Ptacek R, Bob P, Paclt I, et al. Psychobiology of dissociation and its clinical assessment. Neuro Endocrinol Lett. 2007;28(2):191–198. PubMed
Waller NG, Putnam FW, Carlson EB. Types of dissociation and dissociative types: a taxometric analysis of dissociative experiences. Psychol Methods. 1996;1(3):300–321.
Modestin J, Erni T. Testing the dissociative taxon. Psychiatry Res. 2004;126(1):77–82. PubMed
Waller NG, Ross CA. The prevalence and biometric structure of pathologic dissociation in the general population: taxometric and behavior genetic findings. J Abnorm Psychol. 1996;106(4):499–510. PubMed
Ptacek R, Bob P, Paclt I. Skala disociativnich zkusenosti – Ceska verze [Dissociative Experiences Scale – the Czech version] Cesk Psychol. 2006;50(3):262–272. Czech.
Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories-I and -II in psychiatric outpatients. J Pers Assess. 1996;67(3):588–597. PubMed
Storch EA, Roberti JW, Roth DA. Factor structure, concurrent validity, and internal consistency of the Beck Depression Inventory – Second Edition in a sample of college students. Depress Anxiety. 2004;19(3):187–189. PubMed
Preiss M, Vacir K. Beckova sebeposuzovaci skala depresivity pro dospele – BDI-II [Beck Self-Report Depression Scale for Adults – BDI-II] Brno: Psychodiagnostika; 1999. Slovak.
Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–897. PubMed
Kamaradova D, Prasko J, Latalova K, et al. Psychometric properties of the Czech version of the Beck Anxiety Inventory – comparison between diagnostic groups. Neuro Endocrinol Lett. 2016;36(7):706–712. PubMed
Guy W, editor. ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: DHEW; 1976.
Kadouri A, Corruble E, Falissard B. The improved Clinical Global Impression Scale (ICGI): development and validation in depression. BMC Psychiatry. 2007;7:7. PubMed PMC
Sheehan DV, Harnett-Sheehan K, Raj BA. The measurement of disability. Int Clin Psychopharmacol. 1996;11(Suppl 3):89–95. PubMed
Sheehan DV. The Anxiety Disease. New York: Scribner’s; 1983.
Sheehan DV. The Sheehan Disability Scales. In: Sheehan DV, editor. The Anxiety Disease and How to Overcome It. New York: Charles Scribner and Sons; 1983. p. 151.
Sheehan KH, Sheehan DV. Assessing treatment effects in clinical trials with the discan metric of the Sheehan Disability Scale. Int Clin Psychopharmacol. 2008;23(2):70–83. PubMed
McGlynn TJ, Metcalf HL, editors. Diagnosis and Treatment of Anxiety Disorders: A Physician’s Handbook. Washington, DC: American Psychiatric Press, Inc; 1989. pp. 98–99.
Albus M, Maier W, Shera D, Bech P. Consistencies and discrepancies in self- and observer-rated anxiety scales. A comparison between the self- and observer-rated Marks-Sheehan scales. Eur Arch Psychiatry Clin Neurosci. 1990;240(2):96–102. PubMed
European Medicines Agency Guideline for good clinical practice. 2002. [Accessed May 19, 2016]. Available from: http://www.edctp.org/fileadmin/documents/EMEA_ICH-GCP_Guidelines_July_2002.pdf.
Zimmerman M, Coryell W. DSM-III personality disorder diagnoses in a nonpatient sample. Demographic correlates and comorbidity. Arch Gen Psychiatry. 1989;46(8):682–689. PubMed
Arens EA, Stopsack M, Spitzer C, et al. Borderline personality disorder in four different age groups: a cross-sectional study of community residents in Germany. J Pers Disord. 2013;27(2):196–207. PubMed
Perugi G, Angst J, Azorin JM, et al. BRIDGE-II-Mix Study Group Relationships between mixed features and borderline personality disorder in 2,811 patients with major depressive episode. Acta Psychiatr Scand. 2015 Jun 12; Epub. PubMed
Ociskova M, Sedlackova Z, Prasko J, Latalova K, Kamaradova D. Pokud mě cejchujete, běžte s tou terapií někam! Hraniční porucha osobnosti a stigma [If you label me, go with your therapy to hell! Borderline personality disorder and stigma] Psychiatrie pro praxi. 2014;15(2):62–66. Czech.
Cramer V, Torgersen S, Kringlen E. Socio-demographic conditions, subjective somatic health, Axis I disorders and personality disorders in the common population: the relationship to quality of life. J Pers Disord. 2007;21(5):552–567. PubMed
Mendlowicz MV, Stein MB. Quality of life in individuals with anxiety disorders. Am J Psychiatry. 2000;157(5):669–682. PubMed
Latalova K, Prasko J, Diveky T, Kamaradova D, Velartova H. Quality of life in patients with bipolar disorder – a comparison with schizophrenic patients and healthy controls. Psychiatr Danub. 2011;23(1):21–26. PubMed
Brenes GA. Anxiety, depression, and quality of life in primary care patients. Prim Care Companion J Clin Psychiatry. 2007;9(6):437–443. PubMed PMC
Baranyi A, Leithgöb O, Kreiner B, et al. Relationship between post-traumatic stress disorder, quality of life, social support, and affective and dissociative status in severely injured accident victims 12 months after trauma. Psychosomatics. 2010;51(3):237–247. PubMed
Warshaw MG, Fierman E, Pratt L, et al. Quality of life and dissociation in anxiety disorder patients with histories of trauma or PTSD. Am J Psychiatry. 1993;150(10):1512–1516. PubMed
Dickinson LM, deGruy FV, 3rd, Dickinson WP, Candib LM. Health-related quality of life and symptom profiles of female survivors of sexual abuse. Arch Fam Med. 1999;8(1):35–43. PubMed
Price J, Cole V, Goodwin GM. Emotional side-effects of selective serotonin reuptake inhibitors: qualitative study. Br J Psychiatry. 2009;195(3):211–217. PubMed
Self-stigma and schizophrenia: a cross-sectional study