Course and predictors of social security disability insurance in patients with borderline personality disorder over 24 years of prospective follow-up

Borderline Personality Disorder and Emotion Dysregulation · 5 authors, 5 centres

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However, on an individual level, there was substantial fluidity: 46% of BPD patients remitted from SSDI at some point, but 85% of those experienced a recurrence, and 50% of patients had a new onset over the study period.

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220 CHARS

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cohort

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psychiatry

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ORIGINAL PAPER

PMC10561411

Course and predictors of social security disability insurance in patients with borderline personality disorder over 24 years of prospective follow-up

Borderline Personality Disorder and Emotion Dysregulation

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ABSTRACT

Background The utilization of Social Security Disability Insurance (SSDI) is frequent in patients with borderline personality disorder (BPD) and may represent a meaningful marker of a patient’s symptom severity, poor psychosocial functioning, and/or inner suffering. Over 24 years of prospective follow-up, the present study aims to describe the course of SSDI and assess the role of clinically relevant predictors. Methods A total of 290 inpatients with BPD were interviewed at baseline and 12 consecutive follow-up waves, each separated by two years, after index hospitalization. Included were also 72 inpatients with other personality disorders. Surviving patients were reinterviewed. A series of interviews and self-report measures were used to assess psychosocial functioning and treatment history, axis I and II disorders, and childhood/adult adversity. Results Results show that rates of SSDI utilization were relatively stable over 24 years of follow-up (on average, 47.2% of the patients with BPD were on SSDI). Patients with BPD were three times more likely to be on SSDI than patients with other PDs. Patients with BPD displayed flexibility in their usage of SSDI. By 24 years, 46% of patients remitted, out of which 85% experienced recurrence and 50% of the patients had a new onset over time. In multivariate analyses, four variables were found to predict SSDI status in patients with BPD over time. These variables were: age 26 or older, lower IQ, severity of non-sexual childhood abuse, and presence of PTSD. Conclusions The results of this study suggest that a combination of a demographic factors, childhood adversity, natural endowment, and comorbidity are significant predictors of receiving SSDI over time. On a group level, there is a relative stability of SSDI usage over time, but on the individual level, the present study found a high fluctuation in receiving SSDI over 24 months of prospective follow-up.

CITATION EXPORT

Ueli Kramer, Christina M. Temes, Frances R. Frankenburg et al.. Course and predictors of social security disability insurance in patients with borderline personality disorder over 24 years of prospective follow-up. Borderline Personality Disorder and Emotion Dysregulation. (2023). https://doi.org/10.1186/s40479-023-00236-x

AUTHORS

5 · 5 CENTRES

Ueli Kramer, Christina M. Temes, Frances R. Frankenburg, Isabel V. Glass, Mary C. Zanarini

1https://ror.org/019whta54grid.9851.50000 0001 2165 4204Department of Psychiatry, Institute of Psychotherapy and General Psychiatry Service, University of Lausanne, Place Chauderon 18, CH-1003 Lausanne, Switzerland
2grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Harvard Medical School, Boston, USA
3grid.189504.10000 0004 1936 7558Edith Nourse Rogers VA Medical Center, Boston University School of Medicine, Boston, USA
4https://ror.org/01kta7d96grid.240206.20000 0000 8795 072XMcLean Hospital, Belmont, USA
5grid.38142.3c000000041936754XMcLean Hospital, Harvard Medical School, Boston, USA