Large variation of severity and longitudinal change of symptom distress among patients with personality disorders

Main objectives were to investigate (1) the longitudinal course of symptom distress among patients with personality disorders (PD) and (2) how different Axis-I and Axis-II pathology and treatment factors predict or moderate long-term outcome. All patients (n = 751) were admitted to short-term day hospital treatment, and 47% continued in group psychotherapy (mean duration 2.3 years). Symptom distress was assessed repeatedly over 5 years (Symptom Check List 90-R). Mixed models were chosen for statistical analyses. A main finding was the large variation in severity and longitudinal course of symptom distress. Five-year trends ranged from full symptom remission (31%) to pervasive, severe distress (36%). Co-occurring Axis-I disorders did not explain longitudinal variability of symptom distress. However, the presence and increasing severity of Axis-II pathology was strongly associated with more severe baseline symptom distress. Poor long-term outcomes were associated with the combination of avoidant PD and long treatment durations (>2.5 years), and borderline PD and short treatment durations (<0.4 years). Contrastingly, considerable symptom relief was associated with borderline PD and long treatment duration. In conclusion, the severity and longitudinal course of symptom distress among PD patients is closely associated with their personality structures and not sufficiently explained by Axis-I comorbidity.