The impact of comorbid dysthymic disorder on outcome in personality disorders

Abstract

Objective The goal of our study was to investigate the impact of dysthymic disorder (DD), a form of chronic depression, on naturalistic outcome in individuals with personality disorders (PD). Method The Collaborative Longitudinal Personality Disorders Study is a cohort initially including 573 subjects with four targeted PDs (borderline, avoidant, schizotypal and obsessive-compulsive) and 95 subjects with major depression but no PD. At baseline, 115 subjects were diagnosed with coexisting dysthymic disorder (DD), of whom 109 (94.8%) were PD subjects. Regression analyses were performed to predict three classes of broad clinical outcome after two years of prospective follow-up. We hypothesized that DD diagnosis at baseline would be associated with worse outcome on 1) persistence of a PD diagnosis, 2) impairment in psychosocial functioning (as measured by the Longitudinal Interval Follow-up Evaluation [LIFE]), and 3) crisis-related treatment utilization. Results Baseline DD diagnosis was associated with persistence of PD diagnosis at 2 years, particularly for borderline and avoidant PDs. It was associated with worse outcome on global social adjustment, life satisfaction, recreation, and friendships, but not employment or relationship with spouse. Contrary to expectation, DD did not increase suicide attempts, emergency room visits, or psychiatric hospitalizations. Conclusions Comorbidity of DD is associated with persistence of PD diagnosis, and with worse outcome on many, but not all, measures of psychosocial functioning.

The impact of comorbid depression on recovery from personality disorders and improvements in psychosocial functioning: Results from a randomized controlled trial

“…Overall, these findings differ from those of a previous naturalistic cohort study showing that personality disorder patients with co-morbid dysthymic disorder had lower recovery rates at twoyears follow-up compared to patients without comorbid dysthymic disorder (Hellerstein et al, 2010). However, the Hellerstein et al study did not test whether severity was a stronger predictor, overruling the effects of depression.…”

“…Shea et al found that remission from depression was related to higher chances of remission from borderline personality disorder at two-year follow-up . Hellerstein et al (2010) found that personality disorder patients with comorbid dysthymic disorder had a higher chance to still meet criteria of a personality disorder and had worse psychosocial functioning at a two-year follow up assessment. Finally, Gunderson et al (2004) found no evidence that the presence of major depressive disorder was associated with remission of borderline personality disorder at three-year followup.…”

Chronische Depression und Persönlichkeitsstörung – zwei Seiten derselben Medaille?

“…Bei der Betrachtung dieser Komorbiditätsdaten muss berücksichtigt werden, dass der Begriff Komorbidität unterschiedlich aufgefasst werden kann (16,30,34 (4,19,44,50,51,57,58). Ein Kästchen entspricht einer Prävalenz von 0,5%.…”

The influence of depressive symptoms on the efficacy of a short-term group form of Schema Cognitive Behavioural Therapy for personality disorders: A naturalistic study

“…We have found two naturalistic studies of effectiveness for personality disorders after a short form of group psychotherapy (20 sessions) in an outpatient setting: van Vreeswijk et al (11) and Renner et al (7) found a moderate (SCL-90-GSI; ES=0.66) and large effect size (SCL-90-GSI; ES=0.81) respectively.However, most effect studies of the treatment of personality disorders have failed to look at how comorbidity affects outcome, even though, in daily practice, many patients suffer from comorbid conditions, generally depressive disorders (12). Nevertheless, we have found only two studies (13,14) that examine the impact of depressive symptoms on the treatment of personality disorders. Hellerstein et al, (13) found that comorbid dysthymic disorders impaired remission from personality disorders in long-term individual treatment.…”