Introduction to the Special Feature on Recent Progress in the Treatment of Personality Disorder

Abstract

Few areas in the study of personality disorder are as active as work on treatment, making this an opportune time to publish a special feature in the Journal reviewing some recent conceptual and empirical developments. New conceptions of personality pathology are leading to treatments specifically designed to treat the characteristic problems of personality pathology. New formulations of older treatments are emerging to explain mechanisms of change. Although empirical studies are still sparse, more are being published and major trials are underway. The results of these endeavors are extending our ideas about effective treatment options and creating the possibility of a more evidence–based approach. The issue begins with an article by Anthony Ryle describing a cognitive analytic approach to the treatment of borderline personality disorder, an innovative integration of cognitive and psychodynamic therapies that addresses the core self and interpersonal problems of borderline pathology. The theoretical and conceptual theme continues with Anthony Bateman and Peter Fonagy’s discussion of the ideas and principles behind the psychodynamic model used in their important studies of the efficacy of day treatment programs. John Clarkin and colleagues present an overview of their random-controlled trial of transference–focused therapy. Clive Robins and Alex Chapman review some recent developments in dialectical behavior therapy and explore possible directions for research. Subsequently, Peter Tyrer and colleagues describe an evaluation of their interesting and remarkably cost-effective approach to deliberate self–harming behavior. Work of the pharmacology of personality disorder has also increased in recent years and the results of randomized clinical trials are beginning to form the basis of a rationale use of medication. Paul Markovitz provides a valuable update and critique of recent studies. Finally, Elizabeth Hembree, Shawn Cahill, and Edna Foa present an empirical study on the important issue of the impact of personality disorder on the outcome of treating the sequelae of trauma. This array of presentations illustrates the activity of the field. They also reveal a little of how the field is changing and how theory–based approaches, often developed to treat other disorders, are giving way to evidence–based interventions and treatments that are more tailored to the problems and pathology of personality-disordered patients. The field is beginning to move away from global questions of treatment efficacy to address such critical questions as: What is the most effective way to treat a particular problem or component of psychopathology? What mechanisms mediate change? And, Journal of Personality Disorders, 18(1), 1-2, 2004 © 2004 The Guilford Press