Integrated treatment for personality disorders: A commentary.

Abstract

Despite the articulation and growing evidence for shared properties in effective psychotherapies (Castonguay, 2000; Wampold, 2001) and the value of integrated protocols (Krueger & Glass, 2013), the training and the provision of psychotherapy are becoming increasingly monothetic (Govrin, 2014; Heatherington et al., 2012; Levy & Anderson, 2013; Wachtel, 2014). This movement toward monocultures is in contrast to the development of a comprehensive and integrative theory of psychotherapy that operates across different biological, psychological, and social levels (Dimaggio & Lysaker, 2014; Levy & Anderson, 2013). The Society for the Exploration of Psychotherapy Integration (SEPI) and the Journal of Psychotherapy Integration can potentially serve an important role in the field by providing a context in which thoughtful scholars capable of generating comprehensive and integrative theories of psychotherapy, and researchers capable of translating and operationalizing complex concepts, can work toward this shared goal. This special issue edited by Dimaggio (2015b) and including leading integrative thinkers in the field represents such an effort. The editor and contributors are to be congratulated for their thoughtful and stimulating papers. Personality disorders (PDs) are important to psychotherapists because these difficulties derive through developmental processes (Levy, 2005) and are thus more amenable to psychological interventions rather than to psychopharmacological ones. Research shows that personality disorders are highly prevalent. Recent epidemiological studies suggest that PDs have a prevalence rate between 9 and 15% in the general population (Grant et al., 2004; Trull, Jahng, Tomko, Wood, & Sher, 2010), whereas clinical studies have found that 40% of outpatients have a diagnosable PD (Zimmerman, Rothschild, & Chelminski, 2005). With these prevalence rates PDs are more common than schizophrenia, bipolar disorder, and autism combined. Personality disorders are also commonly comorbid with a range of other disorders such as bipolar disorder, depression, anxiety disorders, eating disorders, posttraumatic stress disorder, and substance abuse disorders. This comorbidity is especially meaningful given that the presence of PDs negatively affects the course and treatment efficacy for these disorders (see NewtonHowes, Tyrer, & Johnson, 2006). With such high prevalence rates and comorbidity almost half the patients a clinician will treat on an outpatient basis, regardless of other diagnoses or presenting problems, will have a diagnosable personality disorder that will affect the course and outcome for the patient. In addition, many more patients are subthreshold for a personality disorder, which also poses a significant challenge for clinicians. For instance, Zimmerman and colleagues found that the presence of only a single borderline personality disorder (BPD) symptom increases the likelihood of suicide attempts, suicidal ideation, worse social and occupational functioning, and greater utilization of health care services (Ellison, Rosenstein, Chelminski, Dalrymple, & Zimmerman, in press; Zimmerman, Chelminski, Young, Dalrymple, & Martinez, 2012). Thus, it is incumbent on the treating clinician to not only assess for PDs when treating patients who suffer from problems that are frequently comorbid with PDs but to also privilege the treatment of PDs. Despite the presence of a number of empirically supported, efficacious treatments for perKenneth N. Levy and J. Wesley Scala, Department of Psychology, Pennsylvania State University. Correspondence concerning this commentary should be addressed to Kenneth N. Levy, Department of Psychology, Pennsylvania State University, 362 Bruce V. Moore Building, University Park, PA 16802. E-mail: klevy@psu.edu T hi s do cu m en t is co py ri gh te d by th e A m er ic an Ps yc ho lo gi ca l A ss oc ia tio n or on e of its al lie d pu bl is he rs .