Impulsiveness in Borderline Personality Disorder Predicts the Long-term Outcome of a Psychodynamic Treatment Program

Despite the preponderance of treatment outcome predictors in patients with borderline personality disorder (BPD), the predictive value of measures of impulsiveness is inconclusive. This naturalistic study consecutively included hospitalized patients with BPD (N = 99) who underwent a standardized and structured 12-week inpatient treatment program, which integrated cognitive-behavioral and psychodynamic elements. The Brief Symptom Checklist (BSCL) was applied as outcome measure over four time points: pre-treatment, post-treatment, first follow-up at six to eight weeks and second follow-up at one year after discharge. Impulsiveness was measured using the Barratt Impulsiveness Scale (BIS) at the pre-treatment time point. The BSCL significantly decreased between pre and post-treatment, followed by an increase after post-treatment without reaching pre-treatment extent. The temporal course of the BSCL significantly varied with pre-treatment BIS in that patients with higher impulsiveness revealed a stronger re-increase of symptom severity from post-treatment to end of follow-up than those with lower impulsiveness. The least impulsive patients thereby showed no rebound effect. The robustness of the results was examined by cross-validation. The results indicate that irrespective of the level of impulsiveness, patients with BPD profit from a structured inpatient treatment. However, long-term treatment success was impaired in patients with high level of impulsiveness at pre-treatment. Thus, self-ratings of impulsiveness in BPD patients can be utilized for treatment planning. After discontinuation of interventions, relapse prevention should be implemented early in high impulsive patients as symptoms recrudesce in the course after discharge.