Original Article Longitudinal outcome in patients with bipolar disorder assessed by life-charting is influenced by DSM-IV personality disorder symptoms Axis II features and outcome in bipolar disorder The relationship between mood disorders and pathological personality features or disorders is an important clinical issue and an understudied area. Mood disorders are frequently recurrent and refractory to treatment and the presence of maladaptive personality features is often seen as a poor prognostic indicator. A number of conceptual models have been advanced to explain the rela- tionship between mood disorders and personality, all with implications for the etiology and course of mood disorders (1, 2). One of the most vexing questions has been the implications of personality features and disorders for treatment outcome in mood disorders (3). This question has been studied frequently in major depressive disorder (MDD) but remains almost unstudied in bipolar disorder (BD). For MDD, a considerable body of evidence has emerged that examines personality issues both from a conceptual and practical perspective, inclu- ding numerous studies examining the impact of personality factors on treatment outcome. These studies tend to proceed from two distinct theoret- ical perspectives. One perspective is based on research that examines personality traits, and essentially aims to describe universal individual differences or ÔnormalÕ personality. The most Bieling PJ, MacQueen GM, Marriot MJ, Robb JC, Begin H, Joffe RT, Young LT. Longitudinal outcome in patients with bipolar disorder assessed by life-charting is influenced by DSM-IV personality disorder symptoms. Bipolar Disord 2003: 5: 14–21. ª Blackwell Munksgaard, 2003 Objectives: Few studies have examined the question of how personality features impact outcome in bipolar disorder (BD), though results from extant work and studies in major depressive disorder suggest that personality features are important in predicting outcome. The primary purpose of this paper was to examine the impact of DSM-IV personality disorder symptoms on long-term clinical outcome in BD. Methods: The study used a Ôlife-chartingÕ approach in which 87 BD patients were followed regularly and treated according to published guidelines. Outcome was determined by examining symptoms over the most recent year of follow-up and personality symptoms were assessed with the Structured Clinical Interview for DSM-IV (SCID-II) instrument at entry into the life-charting study. Results: Patients with better outcomes had fewer personality disorder symptoms in seven out of 10 disorder categories and Cluster A personality disorder symptoms best distinguished euthymic and symptomatic patients. Conclusions: These results raise important questions about the mechanisms linking personality pathology and outcome in BD, and argue that conceptual models concerning personality pathology and BD need to be further developed. Treatment implications of our results, such as need for psychosocial interventions and treatment algorithms, are also described. Peter J Bieling, Glenda M MacQueen, Michael J Marriot, Janine C Robb, Helen Begin, Russell T Joffe and L Trevor Young Mood Disorders Program, Department of Psychiatry and Behavioral Neurosciences, McMaster University and St Joseph’s Healthcare, Hamilton, Ontorio, Canada Key words: bipolar disorder – longitudinal outcome – personality disorder – personality disorder symptoms Received 3 June 2002, revised and accepted for publication 28 August 2002 Corresponding author: Peter J. Bieling PhD, Department of Psychology, St Joseph’s Hospital, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada. Fax: 905 521 6120; e-mail: pbieling@stjosham.on.ca Bipolar Disorders 2003: 5: 14–21 Copyright ª Blackwell Munksgaard 2003 BIPOLAR DISORDERS ISSN 1398-5647 14