Borderline Personality Disorder Features in Nonclinical Young Adults 2. Two-Year Outcome Timothy J Trull Department of Psychology University of Missouri–Columbia J. David Useda Department of Psychology University of Missouri–Columbia Kelly Conforti Department of Psychology University of Missouri–Columbia Bao-Tran Doan Department of Psychology University of Missouri–Columbia ABSTRACT Borderline personality disorder (BPD) is thought to develop by early adulthood, and it is characterized by lack of control of anger, intense and frequent mood changes, impulsive acts, disturbed interpersonal relationships, and life-threatening behaviors. We describe data from a 2-year follow-up study of nonclinical young adults who, at study entry, exhibited a significant number of BPD features. Individuals with borderline features were more likely to have academic difficulties over the succeeding 2 years, and these participants were more likely to meet lifetime criteria for a mood disorder and to experience interpersonal dysfunction than their peers at the 2-year follow-up assessment. These findings indicate that BPD features are associated with poorer outcome even within a nonclinical population. This research was supported by a University of Missouri Research Board Grant and, in part, by National Institute of Mental Health Grant 1R55 MH/OD52695-01A1. Correspondence may be addressed to Timothy J. Trull, Department of Psychology, University of Missouri, 210 McAlester Hall, Columbia, Missouri, 65211. Received: December 28, 1995 Revised: September 9, 1996 Accepted: September 9, 1996 Over the last 15 years, the interest in studying borderline personality disorder (BPD) has grown tremendously. The increase in the number of studies focusing on BPD can be traced back to the introduction of this diagnosis into the American diagnostic nomenclature in the third edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM—III; American Psychiatric Association, 1980 ). BPD is now the most frequently diagnosed personality disorder in clinical settings, and more research is conducted on BPD than on any other personality disorder ( Blashfield & McElroy, 1987 ; Widiger & Trull, 1993 ). By far, the majority of studies on BPD have involved clinical samples. These studies have provided useful information regarding the treatment outcome and course of BPD (e.g., Linehan, Armstrong, Suarez, Allmon, & Heard, 1991 ; Linehan, Heard, & Armstrong, 1993 ; Stone, 1990 ). A relatively neglected area of research, however, has been the assessment of the prevalence, nature, and outcome of Journal of Abnormal Psychology © 1997 by the American Psychological Association May 1997 Vol. 106, No. 2, 307-314 For personal use only--not for distribution. Page 1 of 1212/4/2000http://spider.apa.org/ftdocs/abn/1997/may/abn1062307.htmlBPD features in nonclinical (i.e., not currently seeking psychological services) young adults. It is important to conduct these studies of nonclinical young adults for several reasons. First, BPD appears to be relatively prevalent in nonclinical populations ( Gunderson & Zanarini, 1987 ; Zimmerman & Coryell, 1989 ). Second, clinical participants diagnosed with BPD may be unrepresentative because the most severe or dysfunctional cases (those that have the most frequent or lengthy treatments) are those that are most likely to be sampled in clinical studies ( Cohen & Cohen, 1984 ). Third, evidence suggests that nonclinical young adults with BPD features present a level of dysfunction across a number of spheres of functioning that is severe enough to warrant further study ( Trull, 1995 ). Trull (1995) reported two studies that involved the development of a psychometric strategy for identifying nonclinical young adults who exhibit significant BPD features. The implementation of this strategy results in the classification of young adults into B+ (borderline features positive) and B − (borderline features negative) groups. B+ individuals are either subsyndromal (i.e., they do not meet five or more DSM—IV [ Diagnostic and Statistical Manual of Mental Disorders, 4th ed.; American Psychiatric Association, 1994] BPD criteria) or they exhibit enough BPD features to warrant a diagnosis; the base rate of a BPD diagnosis among B+ individuals is estimated to be approximately 13% ( Trull, 1995 ). As reported by Trull (1995) , the Personality Assessment Inventory—Borderline Features Scale (PAI-BOR; Morey, 1991 ) was administered to large groups of college undergraduates, and random samples of above-threshold (PAI-BOR score of 38 or more and at least 2 SD s above the mean score of a community sample; Morey, 1991 ) and below-threshold participants were brought into the laboratory for more extensive assessment. First, to ensure that PAI-BOR scores were not primarily a function of state-like conditions, the PAI-BOR was readministered to all those participating in the laboratory phase of these studies. Participants were categorized into B+ and B − groups if their scores were above or below threshold, respectively, at both screening and at retest. Second, these laboratory participants completed a number of inventories and interviews that assessed a range of features believed to be related to BPD in clinical samples: depression, personality traits, coping, Axis I disorders, and interpersonal problems. A number of comparisons were made between B+ and B − participants, and, in general, results supported the concurrent validity of this classification. Specifically, B+ participants in Trull's (1995) Study 1 were shown to exhibit higher levels of negative affectivity, depression, maladaptive personality traits, general psychopathology symptoms, and BPD symptoms. B+ participants in Trull's Study 2 endorsed more interpersonal problems, and they received more anxiety and mood disorder diagnoses than their B − counterparts. Across both studies, the absolute level of dysfunction exhibited in most of these domains approached that of study participants from clinical settings. These initial studies ( Trull, 1995 ) mark an important first step in identifying young adults with significant levels of borderline features who may go on to experience significant dysfunction in later years. Similar psychometric strategies have been developed for identifying and prospectively following individuals who appear likely, at a later point in time, to reach syndromal levels for particular mental disorders (
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