Drs. Zanarini and Frankenburg Reply

To the Editor: We read Dr. Waugaman’s comments about our article with interest. We agree with his observation that Stone, in his landmark study of the course of borderline personality disorder, found that substance abuse accounted for more of the variance in outcome for women with borderline personality disorder than any of the other significant factors studied. However, this was not true for men with borderline personality disorder or of the sample taken as a whole. In these two analyses, parental brutality (physical aggression and violence) was the factor most strongly associated with overall outcome.

In any case, both of these studies point out the importance of substance abuse in the course and outcome of borderline personality disorder. We hope that this information leads to clinicians paying close attention to this often overlooked set of co-occurring disorders.