Treatment response in subtypes of borderline personality disorder

Abstract

AbstractBackground and Aims Based on the frequently noted heterogeneity in symptom representation and treatment resistance amongst clients with borderline personality disorder (BPD), this study sought to investigate whether a sample of 77 people with severe personality disorder, primarily BPD (n = 74), could be grouped into clinically meaningful subtypes. A follow‐up question was whether the subtypes would respond differently to a specialist intervention.Method Participants were public mental health clients referred to a specialist residential treatment programme in Victoria, Australia. Using an existing data set, cluster analysis was applied in order to identify subtypes based on various demographic, clinical and psychological variables. Post‐treatment analyses were carried out to investigate change in self‐harm, suicide attempts, depression and dissociation.Results Three subtypes were identified, namely: withdrawn–internalizing, severely disturbed–internalizing and anxious–externalizing. Furthermore, the subtypes responded differently to the treatment, with the withdrawn–internalizing subtype showing reduced levels of dissociation and the anxious–externalizing subtype responding by large reductions in levels of depression. The severely disturbed–internalizing subtype did not improve significantly on any of the outcome measures in this study.Discussion These findings suggest that subtypes can be identified amongst clients with BPD, and that the subtypes may be related to treatment outcomes. Copyright © 2009 John Wiley & Sons, Ltd.