The McLean Study of Adult Development (MSAD): Overview and Implications of the First Six Years of Prospective Follow-Up

Abstract

The McLean Study of Adult Development (MSAD) began 12 years ago. It is the first NIMH-funded prospective study of the course and outcome of borderline personality disorder (BPD). After careful analysis of the first six years of follow-up, 5 main findings concerning the symptomatic and psychosocial course of BPD have emerged from this study. The first finding is that remissions are far more common than previously recognized (about 74%). The second is that these remissions are quite stable and thus, recurrences are quite rare (about 6%). The third finding is that completed suicides are far more rare than anticipated (about 4% vs. 10%). The fourth finding is that a "complex" model of borderline psychopathology best describes BPD. In this model, some symptoms resolve relatively quickly, are the best markers for the disorder, and are often the immediate reason for needing costly forms of treatment, such as psychiatric hospitalizations. We termed these symptoms (e.g., self-mutilation, help-seeking suicide threats or attempts) acute symptoms. Other symptoms resolve more slowly, are not specific to BPD, and are closely associated with ongoing psychosocial impairment. We termed such symptoms (e.g., chronic feelings of intense anger, profound abandonment concerns) temperamental symptoms. Fifth, it was also found that borderline patients were improving psychosocially over time, particularly remitted borderline patients; psychosocial functioning of remitted patients continued to improve as time progressed, suggesting that they were somewhat belatedly achieving the milestones of young adulthood and not simply returning to a prodromal level of functioning. Taken together, these results suggest that the prognosis for BPD is better than previously recognized.

Personality Disorders and the 3-Year Course of Alcohol, Drug, and Nicotine Use Disorders

“…The symptom items, worded in non-technical language to avoid the need for insight or judgment, were adapted to be fully structured from items in the Structured Clinical Interview for DSM-IV Personality Disorders 65 , International Personality Disorder Examination 66 , and Diagnostic Interview for DSM-IV Personality Disorders 62 . AUDADIS-IV reliability, assessed in test-retest studies of NESARC participants 37, 38 , ranged from fair (paranoid, histrionic, avoidant κ=0.40-0.45) to very good (schizotypal, antisocial, narcissistic, borderline κ=0.67-0.71) 37, 38 , comparing favorably with semi-structured interviews in clinical samples 67 .…”

Exploring the complexity of the childhood trait–psychopathology association: Continuity, pathoplasty, and complication effects

“…More specifically, there has been a historical belief that personality disorders, in contrast to clinical disorders, reflect enduring patterns that are relatively stable over time. Recent longitudinal studies, however, have demonstrated a natural plasticity of personality symptoms both in adulthood (Cohen, Crawford, Johnson, & Kasen, 2005;Lenzenweger, 1999;Livesley, 2005;Skodol et al, 2005;Zanarini, Frankenburg, Hennen, Reich, & Silk, 2005) & Verhulst, 2003). In addition, a mass of literature reports on the substantial overlap between personality and psychopathology in adults (Widiger, 2003) and children (Tackett, 2006), including shared genetic etiological factors (Bienvenu, Hettema, Neale, Prescott, & Kendler, 2007;Krueger, Markon, Patrick, & Iacono, 2005).…”

Correlates of impulsive and hostile behavior in patients with borderline personality disorder and bipolar II disorder

“…22 Also, it seems that an impulsive act is a relatively stable aspect of BPD, but it is considered as a hypomanicdependent measure of BMD II. 23 According to the findings, the patients with BPD suffer from a higher degree of impulsive behavior and hostility, compared with the non-BPD patients. 24 Also, in another study it was concluded that the impulsive behavior in patients with BPD is distinct from that in the BMD II patients.…”