Major Depressive Disorder and Borderline Personality Disorder Revisited: Longitudinal Interactions

John G. Gunderson, M.D.; Leslie C. Morey, Ph.D.; Robert L. Stout, Ph.D.; Andrew E. Skodol, M.D.; M. Tracie Shea, Ph.D.; Thomas H. McGlashan, M.D.; Mary C. Zanarini, Ed.D.; Carlos M. Grilo, Ph.D.; Charles A. Sanislow, Ph.D.; Shirley Yen, Ph.D.; Maria T. Daversa, M.D.; and Donna S. Bender, Ph.D.

Background: This report investigates the longitudinal association of changes in major depressive disorder (MDD) and borderline personality disorder.

Method: A DSM-IV-diagnosed sample of 161 patients with borderline personality disorder who have been followed with repeated measures at 6, 12, 24, and 36 months are investigated to see whether those with co-occurring MDD differ at baseline and in their course. Proportional hazard regression and cross-lagged panel analyses are used to demonstrate whether changes in the course of either disorder have predictable effects on the course of the other.

Results: The rate of remissions of borderline personality disorder was not affected by whether patients had co-occurring MDD. The rate of MDD remissions was significantly reduced by co-occurring borderline personality disorder. Both regression analyses and panel analyses indicated that improvements in borderline personality disorder were often followed by improvements in MDD but that improvements in MDD were not followed by improvements in borderline personality disorder. Five of the 9 borderline criteria, including those that most relate to affects, were particularly apt to remit prior to MDD remissions.

Conclusions: When borderline personality disorder and MDD co-occur, they can sometimes have independent courses, but more often improvements in MDD are predicted by prior improvements in borderline personality disorder. Clinicians should not ignore borderline personality disorder in hopes that treatment of MDD will be followed by improvement of borderline personality disorder.

(J Clin Psychiatry 2004;65:1049-1056)

Received Jan. 21, 2004; accepted April 28, 2004. From the Harvard Medical School and McLean Hospital, Boston, Mass. (Drs. Gunderson, Zanarini, and Daversa); Texas A&M University, College Station (Dr. Morey); Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Drs. Stout, Shea, and Yen); Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York (Drs. Skodol and Bender); Yale University School of Medicine, New Haven, Conn. (Drs. McGlashan, Grilo, and Sanislow).

In the spirit of full disclosure and in compliance with all ACCME Essential Areas and Policies, the faculty for this CME activity were asked to complete a full disclosure statement. The information received is as follows: This work was funded by the National Institute of Mental Health (NIMH). Award sites include Brown University Department of Psychiatry and Human Behavior (MH50837, Drs. Stout, Shea, and Yen), Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute (MH50839, Drs. Skodol and Bender), Harvard Medical School and McLean Hospital (MH50840, Drs. Gunderson, Zanarini, and Daversa), Texas A&M University (MH50838, Dr. Morey), Yale University School of Medicine (MH50850, Drs. McGlashan, Grilo, and Sanislow) and MH01654 (Dr. McGlashan).

Principal Investigators are John G. Gunderson, Thomas H. McGlashan, Leslie C. Morey, M. Tracie Shea, and Andrew E. Skodol. This manuscript has been reviewed and approved by the Publications Committee of the Collaborative Longitudinal Personality Disorders Study.

Corresponding author and reprints: John G. Gunderson, M.D., McLean Hospital, 115 Mill Street, Belmont, MA 02478 (e-mail: psychosocial@mcleanpo.mclean.org).