Treatment Of Personality Disorder Research Articles

“The People Who Leave Here Are Not the People Who Arrived.”: A Qualitative Analysis of the Therapeutic Process and Identity Transition in the Offender Personality Disorder Pathway

Individuals with personality disorder are often construed as difficult to treat, and sometimes even “untreatable.” In this study, 24 men who had completed treatment on the offender personality disorder treatment pathway participated in focus groups at a high-security prison in the United Kingdom. The results of the data analysis revealed three superordinate themes that captured the impact and experience of the therapeutic process. The three themes were “A self-reconstructed,” which focused on the reconstruing and reconstructions of participants’ identity and how intervention assisted with a coherent narrative of self. The second superordinate theme, “Relational resilience and dealing with abandonment,” relates to the attachment to therapists and the negotiation of relational boundaries and resilience. The third theme, “Reimagining and re-experiencing trauma,” focuses on participants’ exploration and reliving of trauma, and how group processes allowed for shared understanding and a reconstruing of their trauma. Implications for policy and practice are discussed.

Early Maladaptive Schemas and Schema Modes in clinical disorders: A systematic review.

Although schema therapy has been predominantly applied to treat personality disorders, interest into its application in other clinical disorders is growing. Central to schema therapy are Early Maladaptive Schemas (EMS) and Schema Modes. Since existing EMS and Schema Modes were primarily developed in the context of personality disorders, their relevance for clinical disorders is unclear. We conducted a systematic review of the presence of EMS and Schema Modes in clinical disorders according to DSM criteria. Per disorder, we evaluated which EMS and Schema Modes were more pronounced in comparison with clinical as well as non-clinical control groups and which EMS and Schema Modes were most highly endorsed within the disorder. Although evidence concerning EMS was scarce for several disorders, and only few studies on Schema Modes survived inclusion criteria, we identified meaningful relationships and patterns for EMS and Schema Modes in various clinical disorders. The present review highlights the relevance of EMS and Schema Modes for clinical disorders beyond personality disorders. Depending on the theme of the representation, EMS act as vulnerabilities both across diagnoses and for specific disorders. Thus, EMS and resulting Schema Modes are potential, valuable targets for the prevention and treatment of clinical disorders.

The specifics of cognitive and behavioral responses to therapy of the patients with borderline personality disorder: overview of foreign studies

The study of diagnostic methods and the development of methods for the treatment of personality disorders is a significant scientific task. Personality disorders, including borderline personality disorder, characterized by hypertrophied emotions and a violation of self-identification, are painful for both patients and their loved ones. The article analyzes the results of a number of studies and observations in the field of experience of the treatment of borderline personality disorder. Cognitive and behavioral responses to therapy of the patients with borderline personality disorder are considered, as well as the features of building a therapeutic alliance, the formation of epistemological trust of the patient to the therapist, resistance to therapy and early dropout. Based on the analysis of a number of studies, it was found that patients with borderline personality disorder are in dire need of psychotherapy, believe that the therapist is the person who can solve all their problems, often transfer responsibility for their condition on him, forming a kind of child–parent relationship. Because of this, patients with borderline personality disorder often violate the therapist's personal boundaries, demanding his availability at any time. Such patients may perceive therapy as the only safe environment. At the same time, due to the fear of rejection, the formation of a therapeutic alliance takes a long time.

Why using “consciousness” in psychotherapy? Insight, metacognition and self-consciousness

Since its early development, clinical psychology has questioned the impact of “consciousness” on the determination of human responsibility across psychiatric disorders. In recent years, specific clinical approaches have focused on “consciousness” work that could play a key role in psychotherapy. We focused our research on clinical psychology's consciousness-related concepts of insight, self-consciousness, and metacognition. Insight and metacognition, for example, have prompted increased interest in schizophrenia (SZ), bipolar disorder (BD), and, more recently, borderline personality disorder (BPD) treatments as representative of the latest advances in the cognitive and behavioral therapy field. Here we review cognitive, social, and clinical psychology research measuring “consciousness” in BPD, SZ, and BD, exploring the implications of different conceptualizations of consciousness-like concepts for treatment adherence, symptom evolution, and related aspects of psychotherapy. Our results show the overall relevance of using measures of clinical and cognitive insight, emphasizing the more central role of cognitive insight and metacognition in psychotherapy, as it appears that consciousness can remain useful if understood as a cognitive skill. The inclusion of a conceptualization of self-consciousness is important in order to address the social component of psychotherapy, as it does in biopsychosocial approaches. We discuss the implications of such results for global efficacy, for the relevance of the “consciousness” concept to clinical psychology, and for the potential need to keep operationalizing different conceptualizations of it in psychotherapy. We open the debate on the definition of consciousness to motivational aspects of change and to general considerations of both legal and ethical aspects.

The Neuropsychological Mechanisms of Treatment of Bipolar Disorder and Borderline Personality Disorder: Activation Likelihood Estimation Meta-Analysis of Brain Imaging Research.

Objective: To explore the alteration of brain regions after treatments for bipolar disorder (BD) and borderline personality disorder (BPD) in order to discover the underlying neural mechanisms of therapies.Data Sources: An electronic search of the PubMed, Embase, Cochrane Library, and Web of Science databases from inception until June 2021 was conducted.Study Selection: Articles reporting the results of changes in brain activation after treatment, to assess the effects of therapy relative to a before-treatment condition, were included. A total of 1,592 records were retrieved, with 34 studies ultimately included.Data Extraction: Activation coordinates were extracted from each study. We used activation likelihood estimation meta-analysis to evaluate the similarities and differences in the activation of different brain regions in patients with BD and BPD after treatment with psychotherapy and drug therapy.Results: Most brain regions with abnormal activation were improved after treatments for BD and BPD. The brain activity changes produced by psychotherapy were mostly in the frontal areas, while drug therapy primarily impacted the limbic areas. In BD, treatments were associated with activation alterations in the inferior frontal gyrus, superior temporal gyrus, and cingulate gyrus, while in BPD, treatments were associated with activation alterations in the supramarginal gyrus, middle frontal gyrus, and parahippocampal gyrus.Conclusions: These results suggest that drug therapy might have a bottom-up effect, while psychotherapy might have a top-down effect. This study may contribute to the clinical prediction of treatment efficacy in BD and BPD and to the identification of more accurate neuroimaging biomarkers for treatment of the two disorders.

Life stories of patients with personality disorders before and after treatment: Change and stability in agency and communion.

Studying written life stories of patients with personality disorders (PDs) may enhance knowledge of how they understand themselves, others and the world around them. Comparing the construction of their life stories before psychotherapy to their reconstruction after psychotherapy may provide insight in therapeutic changes in the understandings of their lives. As few studies addressed this topic, the current study explored changes in agency (i.e., perceived ability to affect change in life), and communion (i.e,, perceived connectedness to other persons) in written life stories of 34 patients with various PDs, before and after intensive psychotherapy treatment. Life stories showed a positive increase in agency from pre- to posttreatment, in particular regarding internal agency, societal success, and occupational success. No significant changes were observed for communion as a whole. However, the perceived number and quality of close relationships revealed a significant positive increase. The increased agency in the reconstruction of patients' life story after psychotherapy suggests that patients improved their perceived ability to affect change in their own lives. This can be seen as an important step in the treatment of PDs towards further recovery.

The development of narrative identity in the psychodynamic treatment of avoidant personality disorder: A case study.

Avoidant personality disorder (AvPD) is characterized by feelings of shyness, inadequacy, and restraint in intimate relationships and has been associated with a disturbance in narrative identity, which is the internalized and evolving story of past, present, and future experiences. Study findings have indicated that an improvement in overall mental health through psychotherapy may increase narrative identity. However, there is a lack of studies incorporating not only the examination of narrative identity development before and after psychotherapy but also within psychotherapy sessions. This case study examined the development of narrative identity in short-term psychodynamic psychotherapy treatment of a patient with AvPD, using therapy transcripts and life narrative interviews before, after, and 6 months following treatment termination. Narrative identity development was assessed in terms of agency, communion fulfillment, and coherence. Results showed that the patient's agency and coherence increased over the course of therapy, whereas communion fulfillment decreased. At the six-month follow-up, agency and communion fulfillment increased, whereas coherence remained stable. The results of this case study suggest that the patient's sense of narrative agency and ability to narrate coherently improved after undergoing short-term psychodynamic therapy. The decrease of communion fulfillment during psychotherapy and later increase after termination suggests that the patient became more aware of conflictual patterns in their relationships, therefore realizing that their wishes and desires were not being fulfilled in their current relationships. This case study displays the possible impact short-term psychodynamic therapy may have by helping patients with AvPD develop a narrative identity.

Societal costs of personality disorders: A cross-sectional multicenter study of treatment-seeking patients in mental health services in Norway.

There is a relatively small body of research on the cost-of-illness of personality disorders (PDs). Most studies only include borderline PD. The aim of this study was to investigate mean societal costs, including its components, (direct) health service costs and (indirect) productivity loss, among treatment-seeking patients with the broad range of all PDs according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Cross-sectional data from 911 patients diagnosed with at least 1 PD were retrieved from the quality register of the Norwegian Network for Personality Disorders-a collaboration of PD treatment units within specialist mental health services. The patients were referred in the time period 2017-2020. Estimation of costs was based on a bottom-up approach, using information from a structured interview covering the 6-month period before assessment, whereas unit costs were retrieved from public reports, public records, or public agencies. The human capital approach was used to calculate productivity loss. Diagnoses were determined by semi-structured diagnostic interviews (Structured Clinical Interview for DSM-5-PD [SCID-5-PD]). The mean societal costs were €20.260 during the 6-month period before specialized treatment. The largest cost component was productivity loss (65%), whereas health service costs constituted 35%. The main contributors to societal costs from the underlying health service cost components were inpatient treatment (20.5%) and individual outpatient treatment (10.5%). Societal costs were substantial among treatment-seeking patients with the broad range of DSM-5 PDs, comparable to the societal costs of schizophrenia, and significantly higher than the societal costs of both depression and anxiety disorders. The cost estimates converged with recent, register-based cost-of-illness studies of different PDs but exceeded previous findings from other bottom-up studies. Furthermore, the results underscore the importance of implementing effective and specialized treatment for patients with a broad range of PDs, not only to alleviate individual suffering but also to reduce the level of societal costs. The emphasis on productivity loss as a main contributor to the overall societal costs is substantiated, hence underlining the relevance of interventions focusing on improving occupational functioning.

Treatment of depression and borderline personality disorder with 1 Hz repetitive transcranial magnetic stimulation of the orbitofrontal cortex – A pilot study

Borderline personality disorder (BPD) is characterised by impairments in emotional regulation, impulse control and interpersonal interaction. Comorbid depression is common. The orbitofrontal cortex (OFC) plays a crucial role in the biological substrate of BPD. We investigated the effects of 1 Hz repetitive transcranial magnetic stimulation (rTMS) targeting the OFC on depressive symptoms and symptoms of BPD in 15 patients suffering from both conditions to assess feasibility and effectiveness. Target treatment intensity was 120% of resting motor threshold (RMT) and intended duration four weeks. Treatment improved both symptoms of depression as measured by the Hamilton Depression Rating Scale and of BPD as measured by Borderline Symptom List-23 and Barratt Impulsivity Scale. Drop-out rates were high with 7/15 patients not completing the full course of rTMS, but only two drop-outs were related to treatment. Only a minority of patients tolerated target treatment intensity. Despite the limitations, the results suggest efficacy of treatment and welcome further research.

Bringing personality disorder in from the cold: Why personality disorder is a fundamental concern for youth mental health.

Personality disorder (PD) has its peak incidence between puberty and young adulthood. By any measure, it is among the most severe mental health problems occurring in young people, uniquely predicting debilitating current problems and acting as a 'gateway' to diverse and serious future problems. Yet, PD still struggles for legitimacy and parity of access to services, including early intervention. Addressing PD is fundamental to youth mental health, and early intervention for PD has reached 'proof of concept'. Yet, reform is hindered by bigotry and sectarianism. Successful early intervention calls for a shift in the culture of services, countering damaging myths, addressing bigotry, and fostering hope. Such reforms are well within the reach of youth mental health.

Is personalized treatment selection a promising avenue in bpd research? A meta-regression estimating treatment effect heterogeneity in RCTs of BPD.

Psychotherapy is the first-line treatment for borderline personality disorder (BPD) in evidence-based care. The effects are, on average, medium; however, nonresponse rates point to differential treatment effects. Personalized treatment selection has the potential to improve outcomes, but they depend on the heterogeneity of treatment effects (HTEs), which this article seeks to establish. Using an extensive database of randomized controlled trials on psychotherapy for BPD, we determined a reliable estimate of this heterogeneity in treatment effects by (a) applying Bayesian variance ratio meta-analysis and (b) estimating the HTE. In total, 45 studies were included in our study. HTE was found for all psychological treatments, although with low degrees of certainty. Across all psychological treatment and control group types, the estimate for the intercept was 0.10, indicating a 10% higher variance of endpoint values in the intervention groups after controlling for differences in posttreatment means. The results suggest that, while there might be sufficient heterogeneity in treatment effects, the estimates are uncertain, and future research is needed to gain more accurate boundaries for HTE. Personalizing psychological treatments for BPD by using treatment selection approaches could have positive effects, but the current evidence does not allow for a precise estimate of potential outcome improvement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Object Relations–Informed Psychotherapy: Introduction to Festschrift Honoring Otto F. Kernberg, M.D.

Object Relations–Informed Psychotherapy: Introduction to Festschrift Honoring Otto F. Kernberg, M.D.

The first German evidence-based clinical guidelines on borderline personality disorder

IntroductionThough the evidence regarding the psychotherapeutic and drug treatment of borderline personality disorder (BPD) is rapidly accumulating, with more then 120 randomised controlled trial on the clinical treatment being availabe currently, no evidence-based guidelines existed as yet in Germany. This talk will present the first German evidence-based clinical guidelines for BPD.ObjectivesIn this talk the German evidence-based clinical guidelines for borderline personality disorder will be presented, and focuses and important recommendations highlighted.MethodsA diverse, multidisciplinary panel, including members with research and clinical expertise in the treatment and care of individuals with BPD as well as representatives of persons with lived experience and their relatives, has developed the first evidence-based German treatment guidelines for BPD. The Australian NHMRC and the British NICE guidelines were used as source guidelines and adapted, based on the findings of updated literature searches. All recommendations were consented in an independently moderated, formalised consensus process. Special attention was paid to the management of financial and non-financial conflicts of interest.ResultsThe guidelines support the early detection and treatment of BPD and recommend that the diagnosis be made in adolescents from the age of twelve years on. Disorder-specific psychotherapies, i.e. structured psychological therapies that are specifically designed for people with BPD, are recommended as the first-line treatment for BPD. If the primary focus is the treatment of self-harm, Dialectical Behaviour Therapy or Mentalisation-Based Treatment are recommended. Drug treatment should only be considered if in crisis psychological interventions do not suffice and should be withdrawn as early as possible. Besides, drug treatment may only have a role if required for the treatment of comorbid psychic disorders. The guidelines also recommend educating significant others of the person concerned about the disorder and including them in the development of crisis plans. It is also recommended to offer support to relatives, especially if they are children or adolescents. Also, the role of individuals with BPD who are parents is considered, and early support to foster parenting skills and attachment relationships is recommended.ConclusionsThe first evidence-based German guidelines on BPD are now available and will help to ameliorate the health care of persons with a diagnosis of BPD. The publication of an English version is impending.Disclosure of InterestNone Declared

Social Elite in Imperial China: Their Destinies as Documented by the Historical Literature and Their Personality as Defined by the Contemporary Five-Factor Model

Background: The association between personality and life outcome has been widely studied in Western countries, and one might question whether the association exists in China. The official documentation from the Twenty-Six Histories of Imperial China, which presents life-long data on the social elite, may offer a convenient way to realize this effort. Meanwhile, a possible association might help identify competent personalities and offer treatment hints for personality disorders or other psychiatric deviations worldwide. Methods: Based on these historical records (about 618–1911 AD) on 18 social elite groups with long longevity (Macrobian group) and 30 with normal lifespans (Control group), we assessed personality traits/facets using the revised NEO Personality Inventory (NEO-PI-R) and destiny using the Destiny Evaluation Questionnaire (DEQ). Results: Compared to the Controls, the Macrobian group scored higher on the DEQ’s Health and Destiny in General and lower on the NEO-PI-R traits Openness to Experience and Extraversion and facets such as Openness to Fantasy, Openness to Aesthetics, Openness to Feelings, Excitement-Seeking, and Self-Consciousness. In the Macrobian group, the Trust and Compliance facets predicted the DEQ’s Family and Marriage and Social Relationships aspects, respectively; Conscientiousness and its facets Dutifulness, Self-Discipline, and Competence predicted Family and Marriage, Career Achievement, and Destiny in General, respectively; and the Self-Consciousness facet predicted worse performance in Career Achievement, Family and Marriage, and Social Relationships and the Depression facet of Destiny in General. In the Control group, Openness to Feelings positively and Anxiety negatively predicted Health. Conclusions: Less self-focused attention and more interdependence between individuals were beneficial to several aspects of individual destiny in Imperial China, which might be profound for the individual career development and clinical treatment of personality disorders in contemporary society.

An Integrated Developmental Approach to Personality Disorders in Adolescence: Expanding Kernberg's Object Relations Theory.

This article is a tribute to Dr. Otto F. Kernberg and his contribution to the theoretical understanding of personality pathology in adolescence. In his object relations theory of the structure of personality, an integrated identity is considered central to healthy personality functioning and is contrasted with identity diffusion, which is posited to underlie the maladaptive interpersonal functioning of patients with severe personality disorders. His work provided an early theoretical foundation for the understanding and treatment of personality disorders in adults, but a need remained for a deeper understanding of the development and treatment of personality disorders during adolescence. During the past 10 years, Kernberg has led a group of clinicians and developmental researchers focusing on childhood and adolescence to elaborate an understanding of the development, assessment, and treatment of personality disorders among adolescents. He proposed that in the context of typical development, adolescence is important to the expansion of identity, because it represents the period when sexual and aggressive impulses are integrated and earlier representations of the self and others are revised and become more realistic and nuanced. Furthermore, adolescence entails a reorganization of the moral system and enrichment of the ego ideal. This article presents two methods for assessing personality disorders in adolescence that are based on Kernberg's theory and demonstrates the use of transference-focused psychotherapy for adolescents with personality disorders.

Personality disorders as a predictor of counterproductive knowledge behavior: the application of the Millon Clinical Multiaxial Inventory-IV

PurposeThis study investigates the role of personality disorders in the context of counterproductive knowledge behavior.Design/methodology/approachData were collected through a survey administered to 120 full-time employees recruited from Amazon’s Mechanical Turk. Personality disorders were measured by means of the Millon Clinical Multiaxial Inventory-IV.FindingsPersonality disorders play an important role in the context of counterproductive knowledge behavior: employees suffering from various personality disorders are likely to hide knowledge from their fellow coworkers and engage in knowledge sabotage. Of particular importance are dependent, narcissistic and sadistic personality disorders as well as schizophrenic and delusional severe clinical syndromes. There is a need for a paradigm shift in terms of how the research community should portray those who engage in counterproductive knowledge behavior, reconsidering the underlying assumption that all of them act deliberately, consciously and rationally. Unexpectedly, most personality disorders do not facilitate knowledge hoarding.Practical implicationsOrganizations should provide insurance coverage for the treatment of personality disorders, assist those seeking treatment, inform employees about the existence of personality disorders in the workplace and their impact on interemployee relationships, facilitate a stress-free work environment, remove social stigma that may be associated with personality disorders and, as a last resort, reassign workers suffering from extreme forms of personality disorders to tasks that require less interemployee interaction (instead of terminating them).Originality/valueTo the best of the authors’ knowledge, this work represents one of the first attempts to empirically investigate the notion of personality disorders in the context of knowledge management.

Adding EMDR for PTSD at the onset of treatment of borderline personality disorder: A pilot study

Background and objectivesEye movement desensitization and reprocessing (EMDR) is an effective treatment for individuals suffering from posttraumatic stress disorder (PTSD). However, EMDR is not typically offered to people with PTSD who also meet the criteria for borderline personality disorder (BPD). This study examines the feasibility and clinical benefits of EMDR for PTSD delivered in addition to the onset of treatment as usual (TAU) for BPD. MethodsIn a non-concurrent, multiple baseline design, 12 patients with BPD and PTSD received fifteen weekly 45-min sessions of TAU. During this period, eight weekly 90-min EMDR sessions were added. Outcome measures were obtained weekly for self-reported PTSD symptoms (PTSD checklist for DSM-5), levels of psychopathology (Brief Symptom Checklist), and the effect of psychopathology on different areas of life (Sheehan Disability Scale). Results9 participants completed the treatment protocol. In the EMDR phase, PTSD severity scores decreased significantly between sessions, while no between-session drop in scores occurred during the TAU only phase. Similar results were obtained for general symptoms and disability. No adverse events were reported. LimitationsResults on the efficacy and safety of EMDR in patients with BPD and PTSD need to be replicated in larger samples and in RCTs before they can be generalized to the entire population. ConclusionsThe results of our study suggest that EMDR may be feasible and effective in reducing PTSD symptoms in patients concurrently receiving BPD treatment. EMDR appears to be a promising intervention for patients with BPD and comorbid PTSD.

Influence of Cultural and Contextual Factors on the Presentation, Risk Factors, and Treatment of Narcissistic Personality Disorder

Background: In spite of personality disorder is a common topic in the field of psychology and psychiatry, there are still very few studies few studies focusing on cultural and contextual factors of Narcissistic personality disorder (NPD).Method: By reviewing the literature about three countries UK, US and China, the precent study sort out the sociocultural and contextual differences of prevalence, presentation, risk factors and treatment of Narcissistic Personality Disorder (NPD).Result: Contextual and cultural factors have great impact on wide range of NPD’s different aspects. For the prevalence rate of three countries, comparing the highest percentage of three data, UK’s NPD prevalence rate is greater than US, and China has the less NPD prevalence rate. Concerning the presentation of NPD, female and male patients present variously. There is no data responding three countries’ patients’ NPD presentation. With regard of different risk factors, biology, psychotherapy and sociocultural are three of the most essential ones. Eventually, the NPD treatments of three different countries shows significant variety, including Chinese treatments related to traditional medicine, British mentalisation-based treatment and most widely used treatment in America--dialectical behavior therapy.

Effect of personality dysfunction severity, maladaptive schemas, resilience, and coping strategies on quality of life during treatment of personality disorders

Effect of personality dysfunction severity, maladaptive schemas, resilience, and coping strategies on quality of life during treatment of personality disorders

Biofeedback and Treatment for Borderline Personality Disorder.

Empirically validated treatments for borderline personality disorder rely on fostering self-awareness of one's internal experience for treatment success, yet these treatments do not include objective tools to assess self-awareness. Integrating biofeedback into empirically supported treatments provides a way to objectively measure physiological correlates of emotional states, thereby enhancing accurate self-assessment. By using biofeedback, individuals with borderline personality disorder may gain skills to increase self-awareness, improve emotion regulation, and enhance behavioral control. The authors propose that biofeedback can be used to objectively measure fluctuating emotional intensity, thereby facilitating structured self-assessment of emotions and enabling more effective use of interventions for emotion regulation; can be delivered by trained mental health professionals; and may even be considered as a stand-alone intervention replacing alternative, more costly, treatments.