Sonja Vaglum

Personality disorders 2–5 years after treatment: a prospective follow‐up study

Ninety‐seven patients consecutively admitted to a day unit specializing in the treatment of personality disorders were included in a prospective follow‐up study. At follow‐up an average of 3 years after index admission, patients with borderline personality disorder (BPD) displayed a moderate symptom reduction and a fair global outcome. Patients with schizotypal personality disorder (STP) showed a similar reduction in symptoms but retained relatively poor global functioning. Individuals with cluster C personality disorders, in contrast, showed both a good global outcome and a marked symptom reduction. STP individuals were the least socially adjusted, employed and self‐supporting of all diagnostic subgroups. STP and BPD individuals had far more inpatient treatment in the follow‐up period than other groups. The overall suicide rate was low compared with most similar studies.

Day hospital therapeutic community treatment for patients with personality disorders. An empirical evaluation of the containment function.

Does a day hospital format represent an adequate level of treatment for decompensated patients with personality disorders? The study concerns 97 consecutive patients, 50 of whom belonged to cluster A and B personality disorders. The patients were referred partly from an acute admission ward and partly from outpatient departments. The mean treatment time was approximately 6 months. The dropout rate for schizotypal and borderline patients was 38%. No patient committed suicide. Two patients made suicidal attempts during treatment. The level of medication was moderate, and 58% of the patients were drug-free at discharge. Treatment results at discharge, measured by SCL-90 and Health Sickness Rating Scale, were very good for patients with axis I disorders only, good for cluster C personality disorders, modest for borderline patients, and very modest for schizotypal patients. In general, the results indicate that the containing capacity of a day hospital therapeutic community is substantial and that it may reduce the need for long-term inpatient treatment.

Borderline and Other Mental Disorders in Alcoholic Female Psychiatric Patients: A Case Control Study

A random sample of female, nonalcoholic psychiatric outpatients, day and inpatients from one catchment area (n = 65; C group), was compared with female psychiatric patients with a DSM-III alcohol disorder (n = 64; A group). On DSM-III, axis, I, the frequency of additional symptom diagnoses, including depressions, was nearly equal. On axis II, the A group had an additional personality disorder significantly more often (81 vs. 46%), borderline personality disorder being the most frequent (66 vs. 11%). Among patients with depressive disorders, the differences between the A and the C group on axis II were the same. But alcoholic patients suffering from a major depressive disorder more frequently had a borderline personality disorder than other subgroups. The alcohol problems seem to be more related to ongoing personality problems than to episodic, symptomatic disorders. Female psychiatric patients with alcohol problems are diagnostically a heterogeneous group and should not be offered a uniform therapy.

Depression and alcohol consumption in non alcoholic and alcoholic women: a clinical study

ABSTRACT— The relationship between level of depression and alcohol consumption was studied in 64 alcoholic women, 80 non alcoholic female psychiatric patients and 72 healthy women, using a clinical, semistructured interview, SADS, SSP and HSCL‐58. Among DSM‐III depressive women, the alcohol consumption was bimodally distributed. Among healthy women, there was an inverse relationship between depressive symptoms and alcohol consumption. Among non alcoholic women dysthymic patients consumed significantly more than major depressive, subclinically depressed and psychotic non depressive patients, and significantly less than healthy, non depressive women. Among alcoholic women, there was no difference in consumption between major depressives, dysthymics and the other diagnostic groups. The results show that there was no general dose‐response relationship between level of depression and alcohol consumption. Anxiety level and personality disorder may be more influential on the alcohol consumption than the level of depression among depressive women.

Comparison between Personality Disorder Diagnoses in DSM-III and DSM-III-R: Reliability, Diagnostic Overlap, Predictive Validity

97 nonpsychotic consecutive day patients were diagnosed by the axis 1 and 2 in the DSM-III and DSM-III-R system, and their treatment response during their stay was measured by the Health Sickness Rating Scale. The interrater reliability was equally good for both diagnostic systems. On axis 1, there were only minor differences between DSM-III and DSM-III-R. On axis 2, the frequency of schizotypal disorder was reduced by 40% and the frequency of histrionic disorder by two-thirds. The number of schizoid disorders increased from zero to five. Of the DSM-III schizotypals who lost this diagnosis in DSM-III-R (n = 8), 4 got a new diagnosis of schizoid personality and 4 maintained their borderline diagnoses. In DSM-III-R there was a sharper demarcation between patients with severe and nonsevere personality disorder with regard to treatment outcome, indicating an increased validity of these categories. There was also a sharper demarcation between borderline versus histrionic and schizotypal, and between schizotypal and schizoid diagnoses.

Partner relations and the development of alcoholism in female psychiatric patients

ABSTRACT— Sixty four consecutive female alcoholic psychiatric patients were interviewed about the causes to which they attributed the start of the abuse and the interaction between lifetime drinking career and partnerships. Thirty‐three (51%) attributed the start to problems with partners (P‐group): 21 drank to keep their partners, 12 drank when they were abandoned. Among the others (non P‐group) four subgroups were identified: the social stigmatized group (n= 4), the parent abandoned group (n= 6), the teenage acting out group (n= 13), and the psychotic group (n= 7). Those who attributed the causes to a certain partnership (n= 33) were significantly older when the abuse started, more often divorced/separated, had more often had more than one alcoholic partner, less often a schizophrenic psychosis and more often a pure borderline personality disorder.

Comorbidity for borderline and schizotypal personality disorders. A study of alcoholic women.

Twenty-six women alcoholics who fulfilled the criteria for a pure borderline personality disorder (BPD) were compared with 16 women alcoholics who also fulfilled the criteria of a schizotypal personality disorder (called mixed borderline disorder, MBD) based on personal interviews including SADS, SIB, Childhood Environment Scale (CES), and the Premorbid Adjustment Scale (PAC). The MBD women had fewer alcoholic relatives, poorer relationships with parents and siblings, a more deviant score on CES and PAC, a higher incidence of nervous children, and a poorer social network. They also reported more losses and a greater frequency of depressive symptoms during childhood and adolescence, earlier contact with psychiatry, and more frequent hospitalizations. They had a higher frequency of a nonalcoholic axis I disorder (mainly depressive and anxiety disorders), as well as a greater frequency of a paranoid personality disorder. The results show that the MBD women were more psyehopathologically disturbed and support a possible link between MBD and affective disorders. The findings also indicate that MBD may be a clinical entity that should be differentiated from the pure BPD group both in clinical work and forthcoming research.

Phases on the way to alcoholism in female psychiatric patients

ABSTRACT: Sixty‐four female alcoholic psychiatric patients were interviewed with a semistructured clinical interview and the standardized interviews: SADS and SSP. The drinking histories were classified into two pre‐alcoholic phases: the sporadic and the regular drinking phases: and two alcoholic phases: the escalating and the established phases. Age of abuse, the presence of major depression, schizophrenic psychosis, borderline and schizotypal personality disorder, primary or secondary abuse, number of alcoholic partners, attribution of causes of abuse, and marital state were related to one or several phases. Age of first drink, social class, alcoholism in parents and drug abuse were not. The study demonstrates the diversity of pathways to alcoholism in women, and shows the importance of studying different phases separately. A subgroup with “rapid changes” to a high, stable abuse was characterized by a high frequency of major depression and relationship problems.

Differences between alcoholic and non alcoholic female psychiatric patients

ABSTRACT: Sixty‐four consecutive DSM‐III alcoholic female psychiatric patients (A‐group) were compared with 65 non alcoholic women from the same psychiatric units. The A‐women more often had nervous sisters. They were younger at the first intercourse, had had more frequent intercourses during the last year, more often had a poor relationship with their children. They had had more heterosexual partners, living‐together relationships and divorces, and had more often a dependent adult relationship. The mean age of the first nervous symptoms and of coming to psychiatry was significantly lower in the A‐group, and they had more suicidal attempts and criminality. During childhood, adolescence and adult age, they reacted more often to losses with acting out and alcohol abuse. Nervous problems and close contact difficulties seem to have manifested themselves mostly before the alcohol abuse was established.

Family Risk Factors of Alcoholism and Drinking Patterns among Non Alcoholic Women: An Inverse Relationship? An Exploratory Study of Female Employees

95 non alcoholic female employees were personally interviewed and divided into three drinking pattern groups with an increasing level of alcohol consumption: the traditional feminine drinking group (TF) (n=28), the new feminine drinking group (NF) (n=37), and the masculine drinking group (M) (n=30). The groups were compared on family variables which may be regarded as risk factors of alcoholism. The results show an inverse relationship between family risk factors and consumption level, the TF-group having significantly more risk factors than the other two groups. The TF-women more often came from families where the mother and her parents were abstainers, while the father and his parents were more often alcohol abusers or not abstainers. The TF-women were more often attached to their alcoholic fathers as children, while the M-women were more often attached to their mothers. The choice of drinking pattern may be inversely related to the frequency of family risk factors among non alcoholic women.