Zanarini Mary C, Temes Christina M, Glass Isabel V, Frankenburg Frances R, Fitzmaurice Garrett M, Unruh Brandon T, Weiss Roger D
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Am J Addict. 2025 Feb 25. doi: 10.1111/ajad.70012.
The purpose of this study is to detail the long-term course of substance use disorders (SUDs) among patients with borderline personality disorder (BPD) and subjects with other personality disorders (OPD).
Two hundred and ninety patients with BPD and 72 subjects with OPD were assessed at baseline and 12 contiguous waves of follow-up as part of the McLean Study of Adult Development (MSAD). The SCID-I for DSM-III-R Axis I disorders was administered 13 times (at baseline admission and at 12 follow-up periods). Kaplan-Meier analyses were used to assess time-to-remission (2-12 years in length), time-to-recurrence (2-12 years after first remission), and cumulative time-to-new onsets of alcohol and drug use disorders.
Both study groups achieved high rates of remission (ranging from 12-year long to 2-year long) from alcohol use disorder (AUD) (BPD: 64%-91%; OPD: 80%-100%) and drug use disorder (DUD) (BPD: 71%-100%; OPD: 75%-100%). Recurrences (following 12-year long and 2-year long remissions) of AUD (BPD: 24%-63%; OPD: 46%-70%) and DUD (BPD: 28%-67%; OPD: 0%-38%) were not uncommon. Cumulative rates of new onsets during the 24 years of prospective follow-up of AUD (BPD: 5%-27%; OPD: 2%-10%) and DUD (BPD: 5%-21%; OPD: 7%-18%) were less common.
Remissions of alcohol and drug use disorders among borderline patients are very common but recurrences are not uncommon. Results also suggest that new onsets of these disorders are relatively rare.
The course of SUDs in those with BPD is more complex than found in prior shorter-term studies.
本研究旨在详细阐述边缘型人格障碍（BPD）患者及其他人格障碍（OPD）患者物质使用障碍（SUD）的长期病程。
作为麦克莱恩成人发展研究（MSAD）的一部分，对290例BPD患者和72例OPD患者在基线及连续12次随访时进行评估。针对DSM-III-R轴I障碍的SCID-I进行了13次评估（在基线入院时及12个随访期）。采用Kaplan-Meier分析评估缓解时间（时长为2至12年）、复发时间（首次缓解后2至12年）以及酒精和药物使用障碍新发病例的累积时间。
两个研究组酒精使用障碍（AUD）（BPD：64% - 91%；OPD：80% - 100%）和药物使用障碍（DUD）（BPD：71% - 100%；OPD：75% - 100%）均实现了较高的缓解率（时长从12年到2年不等）。AUD（BPD：24% - 63%；OPD：46% - 70%）和DUD（BPD：28% - 67%；OPD：0% - 38%）在（12年和2年缓解后）复发的情况并不罕见。在24年的前瞻性随访中，AUD（BPD：5% - 27%；OPD：2% - 10%）和DUD（BPD：5% - 21%；OPD：7% - 18%）新发病例的累积发生率相对较低。
边缘型患者酒精和药物使用障碍的缓解非常常见，但复发也并不罕见。结果还表明这些障碍的新发病例相对较少。
BPD患者中SUD的病程比先前短期研究中发现的更为复杂。
