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A Life Course Approach to Mental Disorders$
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Karestan C. Koenen, Sasha Rudenstine, Ezra Susser, and Sandro Galea

Print publication date: 2013

Print ISBN-13: 9780199657018

Published to Oxford Scholarship Online: January 2014

DOI: 10.1093/acprof:oso/9780199657018.001.0001

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Borderline, schizotypal, avoidant, obsessive–compulsive, and other personality disorders

Borderline, schizotypal, avoidant, obsessive–compulsive, and other personality disorders

(p.174) Chapter 16 Borderline, schizotypal, avoidant, obsessive–compulsive, and other personality disorders
A Life Course Approach to Mental Disorders

Andrew E. Skodol

Oxford University Press

Personality disorders (PDs) have traditionally been conceptualized as enduring and stable, despite many early follow-up studies that showed that 〈50% of patients with PDs retained these diagnoses over time. Because of the methodological limitations of these studies, a new generation of rigorous follow-along studies was spawned. The results of three such studies, the Collaborative Longitudinal Personality Disorders Study, The McLean Study of Adult Development, and The Children in the Community Study are reviewed here. By contrast with the traditional view of PDs as stable forms of psychopathology, these methodologically rigorous longitudinal studies, in both clinical and epidemiological populations, indicate that patients with PDs improve over time and have a clinical course that is likely more waxing and waning than chronic. Results on the course of functional impairment in PDs suggest that impairment is more stable than personality psychopathology itself, but that when PD improves, improvement in functioning follows.

Keywords:   borderline personality disorder, schizotypal personality disorder, avoidant personality disorder, obsessive–compulsive personality disorder, other personality disorder, longitudinal studies, clinical course, outcome, remission, functional impairment

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