Methods:
A total of 290 inpatients with BPD [Borderline Personality Disorder] were interviewed at baseline and 12 consecutive follow-up waves, each separated by two years, after index hospitalization. Included were also 72 inpatients with other personality disorders. Surviving patients were reinterviewed. A series of interviews and self-report measures were used to assess psychosocial functioning and treatment history, axis I and II disorders, and childhood/adult adversity.
Results:
Results show that rates of SSDI [Social Security Disability Insurance] utilization were relatively stable over 24 years of follow-up (on average, 47.2% of the patients with BPD were on SSDI). Patients with BPD were three times more likely to be on SSDI than patients with other PDs. Patients with BPD displayed flexibility in their usage of SSDI. By 24 years, 46% of patients remitted, out of which 85% experienced recurrence and 50% of the patients had a new onset over time. In multivariate analyses, four variables were found to predict SSDI status in patients with BPD over time. These variables were: age 26 or older, lower IQ, severity of non-sexual childhood abuse, and presence of PTSD. ...
There is one thing about this study that make me wonder. Hospitalization is uncommon for Borderline Disorder itself yet this study tracked patients who had been hospitalized. That would suggest that these patients either had unusually bad cases of Borderline Disorder or had other psychiatric diagnoses in addition to Borderline Disorder. I will say that sometimes those with Borderline Disorder are hospitalized by mistake because the behaviors of the patients involved suggested some other disorder such as Bipolar Disorder. There's certainly the intensity of symptoms with Borderline Disorder, just not that much risk of suicide or homicide, which, in general, is what gets you hospitalized for a psychiatric disorder these days.
The fact that patients with Borderline Disorder were much more likely to be on Social Security disability benefits than those with other personality disorders is not surprising. To begin with, Social Security approves almost no one based upon a personality disorder alone. However, Borderline is one of the worst personality disorders you can have. If anyone is going to be approved on a personality disorder, it's likely to be someone with Borderline Disorder. Also, those with other really severe personality, disorders such as Antisocial Personality Disorder, are likely to spend a lot of time in prison. That's not the case with Borderline Disorder.
Clients with Borderline Disorder are difficult for me to deal with but it's not just their relationships with lawyers. People with Borderline Disorder can't maintain relationships with anyone, including employers. That's the problem. The fact that less than 50% of those with Borderline Disorder are on Social Security disability benefits is proof of how hard it is to be approved for Social Security disability benefits. Very few of those with a Borderline Disorder diagnosis work more than intermittently. That's just a fact. If you have a disorder that prevents you from working on a regular basis, shouldn't you be approved for Social Security disability benefits?
