Narcissistic, Antisocial, and Noncomorbid Subgroups of Borderline Disorder: Are They Distinct Entities by Long-Term Clinical Profile?
Abstract
This study evaluates the influence of narcissistic and antisocial features on the long-term functioning of individuals with borderline personality disorder. Borderline patients discharged from Chestnut Lodge Hospital, an inpatient residential treatment facility, were followed up an average of 15 years later to assess longitudinal clinical profile. Despite differences in baseline psychopathology, members of Narcissistic, Antisocial, and Noncomorbid Borderline subgroups turned out to be roughly equivalent on almost all long-term course and outcome dimensions. The implications of these results for the nosology and treatment of personality disorders are discussed.
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Studies have documented the persistence of narcissistic pathology, even among patients who improve symptomatically.
“Overall, studies (Table 2) (76–83) have documented the persistence of narcissistic pathology, even among patients who improve symptomatically.”
From Narcissistic Personality Disorder: Progress in Understanding and Treatment (2022) · cites this paper as [77]
Cites
Establishment of Diagnostic Validity in Psychiatric Illness: Its Application to Schizophrenia
ROBINS, E., & GUZE, S. B. (1970) · American Journal of Psychiatry · doi:10.1176/ajp.126.7.983 · Cited by 2,243 · see citing works
Severe Personality Disorders: Psychotherapeutic Strategies
Kernberg, O. F. (1984) · Medical Entomology and Zoology · Cited by 1,311 · see citing works
Object Relations Theory and Clinical Psychoanalysis
Murray, M. E. (1977) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1977.31.3.468 · Cited by 911 · see citing works
The Validity of DSM-III Borderline Personality Disorder
Pope, H. G. (1983) · Archives of General Psychiatry · doi:10.1001/archpsyc.1983.01790010025003 · Cited by 458 · see citing works
The Chestnut Lodge Follow-up Study
McGlashan, T. H. (1984) · Archives of General Psychiatry · doi:10.1001/archpsyc.1984.01790170047006 · Cited by 447 · see citing works
Self-citationDiscriminating features of borderline patients
Gunderson, J. G., & Kolb, J. E. (1978) · American Journal of Psychiatry · doi:10.1176/ajp.135.7.792 · Cited by 333 · see citing works
The Chestnut Lodge Follow-up Study: III. Long-term Outcome of Borderline Personalities
McGlashan, T. H. (1986) · Archives of General Psychiatry · doi:10.1001/archpsyc.1986.01800010022003 · Cited by 304 · see citing works
Self-citationA Checklist for the Diagnosis of Schizophrenia
Astrachan, B. M., Harrow, M., Adler, D. G., Brauer, L. D., Schwartz, A., Schwartz, C., & TUCKER, G. J. (1972) · The British Journal of Psychiatry · doi:10.1192/bjp.121.5.529 · Cited by 300 · see citing works
Games, P. A. (1971) · American Educational Research Journal · doi:10.3102/00028312008003531 · Cited by 249 · see citing works
Social competence and outcome in psychiatric disorder.
Zigler, E., & Phillips, L. (1961) · Journal of Abnormal & Social Psychology · doi:10.1037/h0046232 · Cited by 234 · see citing works
Familial Transmission of DSM-III Borderline Personality Disorder
Loranger, A. W. (1982) · Archives of General Psychiatry · doi:10.1001/archpsyc.1982.04290070031007 · Cited by 189 · see citing works
So, L., Valkenburg, C. V., Larntz, K., & Hs, A. (1986) · American Journal of Psychiatry · doi:10.1176/ajp.143.6.718 · Cited by 146 · see citing works
McGlashan, T. H. (1983) · Archives of General Psychiatry · doi:10.1001/archpsyc.1983.01790110061011 · Cited by 108 · see citing works
Self-citationSchizotypal Personality Disorder
McGlashan, T. H. (1986) · Archives of General Psychiatry · doi:10.1001/archpsyc.1986.01800040039006 · Cited by 76 · see citing works
Self-citationA Developmental View of Old and New Perspectives of Personality Disorders
Vaillant, G. E. (1987) · Journal of Personality Disorders · doi:10.1521/pedi.1987.1.2.146 · Cited by 28 · see citing works
MMPI Critical Item Characteristics of the DSM-III Borderline Personality Disorder
Pitts, W. M., Gustin, Q. L., Mitchell, C. E., & Snyder, S. (1985) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-198510000-00009 · Cited by 3 · see citing works
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Narcissistic Personality Disorder: Facing DSM-V
Ronningstam, E. (2009) · Psychiatric Annals · doi:10.3928/00485713-20090301-09 · Cited by 226 · see citing works
Axis II comorbidity of borderline personality disorder
Zanarini, M. C., Frankenburg, F. R., Dubo, E., Sickel, A. E., Trikha, A., Levin, A., & Reynolds, V. (1998) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(98)90038-4 · Cited by 224 · see citing works
Long-Term Outcome in Personality Disorders
Stone, M. H. (1993) · The British Journal of Psychiatry · doi:10.1192/bjp.162.3.299 · Cited by 218 · see citing works
Ellison, W. D., Levy, K. N., Cain, N. M., Ansell, E. B., & Pincus, A. L. (2013) · Journal of Personality Assessment · doi:10.1080/00223891.2012.742904 · Cited by 137 · see citing works
Changes in pathological narcissism
(1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.2.253 · Cited by 121 · see citing works
The hypothalamic–pituitary–gonadal axis in mood disorders
Young, E. A., & Korszun, A. (2002) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/s0889-8529(01)00002-0 · Cited by 114 · see citing works
Gacono, C. B., Meloy, J. R., & Berg, J. L. (1992) · Journal of Personality Assessment · doi:10.1207/s15327752jpa5901_4 · Cited by 96 · see citing works
Hilsenroth, M. J., Holdwick, D. J., Castlebury, F. D., & Blais, M. A. (1998) · Psychotherapy: Theory, Research, Practice, Training · doi:10.1037/h0087845 · Cited by 70 · see citing works
Narcissistic Personality Disorder: Progress in Understanding and Treatment
Weinberg, I., & Ronningstam, E. (2022) · Focus · doi:10.1176/appi.focus.20220052 · Cited by 59 · see citing works
PSYCHONEUROENDOCRINOLOGY OF DEPRESSION
Young, E. A., & Korszun, A. (1998) · Psychiatric Clinics of North America · doi:10.1016/s0193-953x(05)70007-1 · Cited by 59 · see citing works
Dos and Don'ts in Treatments of Patients With Narcissistic Personality Disorder
Weinberg, I., & Ronningstam, E. (2020) · Journal of Personality Disorders · doi:10.1521/pedi.2020.34.supp.122 · Cited by 51 · see citing works
Conflicts, Defenses and the Stability of Narcissistic Personality Features
Perry, J., & Perry, J. C. (2004) · Psychiatry · doi:10.1521/psyc.67.4.310.56570 · Cited by 46 · see citing works
Prediction of Outcome in Borderline Personality Disorder
Plakun, E. M. (1991) · Journal of Personality Disorders · doi:10.1521/pedi.1991.5.2.93 · Cited by 41 · see citing works
Narcissistic Pathology: Empirical Approaches
Levy, K. N., Chauhan, P., Clarkin, J. F., Wasserman, R. H., & Reynoso, J. S. (2009) · Psychiatric Annals · doi:10.3928/00485713-20090401-03 · Cited by 39 · see citing works
Holdwick, D. J., Hilsenroth, M. J., Castlebury, F. D., & Blais, M. A. (1998) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(98)90036-0 · Cited by 39 · see citing works
Assessment of narcissistic personality disorder: A multi-method review
Hilsenroth, M. J., Handler, L., & Blais, M. A. (1996) · Clinical Psychology Review · doi:10.1016/s0272-7358(96)00038-4 · Cited by 39 · see citing works
Clinical significance of outcome in long‐term follow‐up of borderline patients at a day hospital
Sandell, R., Alfredsson, E., Berg, M., Crafoord, K., Lagerlöf, A., Arkel, I., Cohn, T., RASCH, B., & Rugolska, A. (1993) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1993.tb03396.x · Cited by 33 · see citing works
Tramantano, G. (2003) · The American Journal of Psychoanalysis · doi:10.1023/a:1024079115405 · Cited by 24 · see citing works
Dowson, J. H. (1992) · Comprehensive Psychiatry · doi:10.1016/0010-440x(92)90062-u · Cited by 16 · see citing works
Castlebury, F. D., Hilsenroth, M. J., Handler, L., & Durham, T. W. (1997) · Assessment · doi:10.1177/107319119700400205 · Cited by 15 · see citing works
Identifying Narcissistic Personality Disorders in Preadolescents
Guilé, J.-M. (1996) · The Canadian Journal of Psychiatry · doi:10.1177/070674379604100604 · Cited by 15 · see citing works
Early maladaptive schemas and cognitive distortions in psychopathy and narcissism
Torres, C. (2002) · ANU Open Research (Australian National University) · doi:10.25911/5d7a2be7c763b · Cited by 15 · see citing works
Suárez, I. R., Guerrero‐Jiménez, M., Cervilla, J. A., & Gutiérrez, B. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120482 · Cited by 12 · see citing works
Borderline personality organization and prognosis in eating disorders.
Norring, C. E. A. (1993) · Psychoanalytic Psychology · doi:10.1037/h0079502 · Cited by 9 · see citing works
Developmental, structural, and clinical approach to narcissistic and antisocial personalities
Švrakić, D. M., McCallum, K., & Milan, P. (1991) · The American Journal of Psychoanalysis · doi:10.1007/bf01251036 · Cited by 7 · see citing works
Narcissistic Personality Disorder
Cain, N. M., & Boussi, A. (2020) · Springer eBooks · doi:10.1007/978-3-319-24612-3_604 · Cited by 3 · see citing works
Comparative Treatments for Borderline Personality Disorder
Tutek, D. A., & Linehan, M. M. (1993) · Springer eBooks · doi:10.1007/978-1-4615-2914-9_15 · Cited by 3 · see citing works
Book Review: New Essays on Narcissism.
Grünberger, B., & Plakun, E. M. (1993) · Journal of the American Psychoanalytic Association · doi:10.1177/000306519304100311 · Cited by 1 · see citing works
Narcissistic Personality Disorder
Cain, N. M., & Boussi, A. (2017) · Springer eBooks · doi:10.1007/978-3-319-28099-8_604-1
Psychopathy and Personality Disorders
Wallenborn, J. K., & Meloy, J. R. (2025) · Cambridge University Press eBooks · doi:10.1017/9781009280099.012
- Authors
- McGlashan, T. H., & Heinssen, R. K.
- Corresponding author
- McGlashan, Thomas H.
- ORCID
- McGlashan, Thomas H.
- Venue
- Psychiatric Clinics of North America
- Publisher
- Elsevier BV
- Published
- 1989-09
- Volume
- 12
- Issue
- 3
- Pages
- 653-670
- ISSN
- 0193-953X (ISSN-L)
- OpenAlex
- W2470751784
- Cited by
- 30
- References
- 16
- Citations by year
- 2025: 2 · 2022: 1 · 2020: 2 · 2017: 1 · 2012: 1
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Clinics of North America (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Keywords
- borderline personality disorder, long-term clinical outcomes, longitudinal course, personality disorder treatment, comorbidities, residential treatment
- MeSH terms
- Antisocial Personality Disorder, Borderline Personality Disorder, Depressive Disorder, Follow-Up Studies, Humans, Narcissism, Personality Disorders, Psychiatric Status Rating Scales, Retrospective Studies, Schizophrenic Psychology, Cohort Studies
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