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Longitudinal outcome in patients with bipolar disorder assessed by life-charting is influenced by DSM-IV personality disorder symptoms

Authors

  • Peter J Bieling,

    1. Mood Disorders Program, Department of Psychiatry and Behavioral Neurosciences, McMaster University and St Joseph's Healthcare, Hamilton, Ontorio, Canada
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  • Glenda M MacQueen,

    1. Mood Disorders Program, Department of Psychiatry and Behavioral Neurosciences, McMaster University and St Joseph's Healthcare, Hamilton, Ontorio, Canada
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  • Michael J Marriot,

    1. Mood Disorders Program, Department of Psychiatry and Behavioral Neurosciences, McMaster University and St Joseph's Healthcare, Hamilton, Ontorio, Canada
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  • Janine C Robb,

    1. Mood Disorders Program, Department of Psychiatry and Behavioral Neurosciences, McMaster University and St Joseph's Healthcare, Hamilton, Ontorio, Canada
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  • Helen Begin,

    1. Mood Disorders Program, Department of Psychiatry and Behavioral Neurosciences, McMaster University and St Joseph's Healthcare, Hamilton, Ontorio, Canada
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  • Russell T Joffe,

    1. Mood Disorders Program, Department of Psychiatry and Behavioral Neurosciences, McMaster University and St Joseph's Healthcare, Hamilton, Ontorio, Canada
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  • L Trevor Young

    1. Mood Disorders Program, Department of Psychiatry and Behavioral Neurosciences, McMaster University and St Joseph's Healthcare, Hamilton, Ontorio, Canada
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  • 1

    A follow-up analysis suggested that, when entered separately, all three personality disorder clusters had significant predictive ability with Wald criterion scores ranging from 18.00 for Cluster A, to 9.14 for Cluster B, to 8.99 for Cluster C.

Corresponding author: Peter J. Bieling PhD, Department of Psychology, St Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada. Fax: 905 521 6120; e-mail: pbieling@stjosham.on.ca

Abstract

Objectives:  Few studies have examined the question of how personality features impact outcome in bipolar disorder (BD), though results from extant work and studies in major depressive disorder suggest that personality features are important in predicting outcome. The primary purpose of this paper was to examine the impact of DSM-IV personality disorder symptoms on long-term clinical outcome in BD.

Methods:  The study used a ‘life-charting’ approach in which 87 BD patients were followed regularly and treated according to published guidelines. Outcome was determined by examining symptoms over the most recent year of follow-up and personality symptoms were assessed with the Structured Clinical Interview for DSM-IV (SCID-II) instrument at entry into the life-charting study.

Results:  Patients with better outcomes had fewer personality disorder symptoms in seven out of 10 disorder categories and Cluster A personality disorder symptoms best distinguished euthymic and symptomatic patients.

Conclusions:  These results raise important questions about the mechanisms linking personality pathology and outcome in BD, and argue that conceptual models concerning personality pathology and BD need to be further developed. Treatment implications of our results, such as need for psychosocial interventions and treatment algorithms, are also described.

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