Treatment Of Personality Disorder Research Articles

Le « Good Psychiatric Management-Adolescents » (GPM-A) : un modèle généraliste et accessible de traitement du trouble de la personnalité borderline chez l’adolescent

The Good Psychiatric Management for Adolescents (GPM-A) is a generalist model of structured care for adolescents with borderline personality disorder. It is based on principles derived from several psychotherapies validated in the treatment of borderline personality disorder and on current good practice data. Borderline personality disorder is conceptualised as the result of a particular sensitivity to relationships (defined with the term interpersonal hypersensitivity). The GPM-A offers clinicians a pragmatic approach based on good practice in the care of adolescents with borderline personality disorder. Developed in the United States, it is currently being disseminated in the French-speaking world. This article provides a summary of the main components of the model and a discussion of the benefits expected from its implementation among French-speaking clinicians.

Arts and psychomotor therapies in personality disorder treatment: An appropriate therapeutic entrance to personal development: A commentary.

Personality disorders (PD) are based not just on maladaptive ideas about self and others, they also are grounded on embodied patterns of behaviors and reactions to interpersonal stressors. There is growing interest in working with the body and through the body so to address automatisms that lead to suffering and dysfunctional social action. In this issue of the Journal of Clinical Psychology: In-Session the use of art and psychomotor therapies for these patients was explored by seven different clinical perspectives. Patients described presented with different PD and associated symptoms. The arts and psychomotor therapies deployed in personality disorder treatment are: (visual) art therapy, music therapy, drama therapy, dance (movement) therapy, and psychomotor therapy making psychotherapeutic use of the different modalities: art, music, play, role-play, performance, improvisation, dance, body awareness and movement. Interventions provide kinesthetic, sensory, perceptual, and symbolic opportunities to invite alternative modes of meaning-making, accessing own needs and wishes, and communicating them to others. In this commentary we summarize some of the different topics covered by the clinical-based papers, including working mechanisms of arts and psychomotor therapies, the importance of bottom-up emotion regulation processes, how to treat trauma in the presence of a PD, how to integrate art and psychomotor therapies in a fine-grained formulation and how to understand the process of change. Although there is a need for more empirical research, we hope this issue makes a solid case that clinicians can effectively include art and psychomotor therapies when treating the full range of PD.

THE KEY CHARACTERISTICS OF THE COGNITIVE-BEHAVIORAL THERAPY AS A PERFORMANCE FACTOR IN THE PSYCHOLOGICAL PRACTICE

Cognitive Behavioral Therapy (CBT) is a modern, pragmatic, evidence-based psychotherapeutic approach. Numerous studies have proven the effectiveness of CBT in the treatment of depression, anxiety disorders, eating disorders and personality disorders. CBT is used along with the pharmacological treatment of schizophrenia, bipolar disorder, and other mental disorders. The research focuses on the main characteristics of cognitive-behavioral therapy, such as therapeutic relationship, conceptualization, psychoeducation, and relapse prevention, which are essential for therapeutic performance. The ways of reflection development are outlined, the difficulties encountered by a CBT therapist are identified. An evaluation form of the implementation of key components of CBT in practice is proposed, which includes a list of questions for sessions planning and the therapeutic plan development. Keywords: fundamentals of cognitive-behavior therapy (CBT), principles, conceptualization, therapeutic relationships, psychoeducation, reflection, relapse prevention

Physical Activity in young female outpatients with BORderline personality Disorder (PABORD): a study protocol for a randomized controlled trial (RCT)

BackgroundCurrent treatments for mental disorders, like pharmacotherapy or psychological approaches, do not lead to full remission in all individuals. Physical activity (PA) is effective at improving psycho-physical health in major depressive and anxiety disorders. However, the efficacy of PA as an adjunctive treatment for borderline personality disorder (BPD) has not been studied. To date, there are no approved pharmacological treatments for this severe condition and limited accessibility to effective psychotherapeutic interventions. This study tests the efficacy of a structured PA programme as an additional treatment for BPD outpatients.MethodsThe PABORD is a randomised controlled trial for female outpatients (18–40 years) with a BPD diagnosis. The intervention group (n = 32) will participate in a 12-week structured PA programme supervised by a sport medicine physician and preceded by three psychoeducation sessions on healthy eating habits. The control group (n = 32) will receive a 12-week psychoeducation programme on PA, diet, and health risks of a sedentary lifestyle for a total of 8 sessions. The study aims to determine if the PA intervention is superior to the control in reducing BPD symptoms. Secondary aims include improving PA levels and physical and psychological health. Assessments will be conducted at baseline, post-intervention, and 3 months post-intervention.DiscussionThe structured PA programme is expected to outperform the control group in terms of health and PA outcomes at the end of the intervention. Repeated assessments will also help to identify psychosocial factors that influence PA maintenance. Findings will support the potential widespread implementation of PA programmes for BPD treatment.Trial registrationClinicalTrials.gov NCT06461104. Registered on 6 June 2024 {2a}.

Change in emotion-based narrative as a potential mechanism of change in a brief treatment for borderline personality disorder

Background: The move from inconsistent and problematic autobiographical narrative to a more coherent and reality-based narrative construction of the Self has been discussed as potential mechanism of change in psychotherapies for personality disorders. So far, little empirical evidence exists that demonstrates in a time-dependent design the role of narrative construction in the treatment of borderline personality disorder, in particular when it comes to understanding the integration of body-related information from the affective system with the autobiographical narrative. The present study aims at demonstrating change in emotion-based narrative markers over brief psychiatric treatment and to assess the impact of these changes on subsequent symptom change. Methods: A total of N = 57 clients with borderline personality disorder were assessed at three timepoint over the course of four months of brief psychiatric treatment, within the context of a secondary process-outcome analysis of a randomized controlled trial. Symptom change was assessed using the OQ-45.2 and emotion-narrative change was assessed using the Narrative-Emotion Process Coding System to code client’s in-session speech in terms of problem, transition and change markers. Results: All three emotion-based marker categories evidenced significant changes in the assumed direction. The reduction in problem emotion-based narrative markers (e.g., empty story telling) between session 1 and 5 into the treatment predicted the symptom reduction assessed between session 5 and 10. Conclusions: Emotion-based narrative construction may be a suitable method to study the pathway of change toward a more coherent and reality-based narrative construction of the Self-in-interaction-with-the-Other. Reduction of emotion-based problem-marker may be a promising candidate for a mechanism of change in treatments for personality disorders which should be tested in a time-dependent controlled design.

Pain prevalence rates and the mediating role of negative affect in adults referred to personality disorder treatment: A cross-sectional study

Personality disorders (PDs) are prevalent among individuals with chronic pain, but less is known about the prevalence of pain in the PD population. This study therefore sought to explore the prevalence of current or everyday pain among individuals referred to outpatient PD treatment, and further explore the mediating role of negative affect in the relationship between PD severity and current pain. Data was retrieved from the Norwegian Network for PDs’ quality register which included 4361 participants. Pain was operationalized using the EQ-5D-3L “pain or discomfort” item and four SCL-90-R pain-related items (“pain bothersomeness”). Rates of self-reported pain were explored both pre and post treatment to determine the persistency of the pain-related symptoms. The role of negative affect in the relationship between PD severity and pain was investigated by linear regression analysis. A substantial burden of pain-related symptoms was demonstrated, as 71% and 80% reported moderate to extreme pain or discomfort and pain bothersomeness, respectively. Muscle soreness was the most common pain (59%) followed by headache (48%), low back pain (46%), and heart or chest pain (34%). Moderate to extreme pain or discomfort was persistent for 77% of the participants who provided end of treatment data (mean treatment duration was 82 weeks). Negative affect mediated the relationship between PD severity and pain. To our knowledge, this is the first large-scale study on everyday pain in patients with PDs. The findings reveal that moderate to extreme pain is prevalent among persons with PDs and that this co-occurrence is driven by negative affect. PerspectivePain is a prevalent and potentially underrecognized symptom in personality disorders and persists until treatment termination for a large group of patients. This co-occurrence may be driven by a susceptibility to negative affect that is enhanced by personality disorder features.

The complexity of interpersonal physiology during rupture and repair episodes in the treatment of borderline personality disorder: a proof-of-concept multimethod single case study of verbal and non-verbal interactional dynamics.

The aim of this proof-of-concept multimethod exploratory single case study is to increase knowledge of the underlying mechanisms of alliance ruptures and repairs in Borderline Personality Disorder treatment across and within the psychotherapeutic treatment process. The multimethod includes outcome assessment of patient self-reporting questionnaires (the Affect Integration Inventory, the Hopkins Symptom Checklist), observation-based ratings of sessions with the Rupture Resolution Rating System, quantitative analysis of heart rate variability using recurrence quantification analysis, and a qualitative multimodal interaction analysis of within-session dynamics. Results reveal how patterns of heart rate synchrony between patient and therapist reflect periodical patterns of emotional interaction corresponding to key therapeutic alliance processes throughout the treatment process. Particularly, heart rate synchronization and desynchronization correspond with increasing rupture resolution ratings and positive outcome measures in the last part of the therapy process, indicating increased productivity, affectivity, and positive change. The qualitative microanalysis highlights context sensitivity to alliance management within sessions. Physiological arousal is found to underlie important alliance processes, including emotion regulation, relatedness, security, empathic responding, sense-making, and validation in correspondence with different therapist verbal and non-verbal markerbs. Clinical implications and study limitations are discussed. Recommendations are made for future directions in relation to applying multimethod approaches when studying rupture and repair processes in psychotherapy.

Dysfunctional Personality Disorder Beliefs, Treatment Adherence and Lifetime Suicide Attempts of Bipolar Disorder Patients Type-1

Dysfunctional Personality Disorder Beliefs, Treatment Adherence and Lifetime Suicide Attempts of Bipolar Disorder Patients Type-1

The family alliance as a facilitator of therapeutic change in systemic relational psychotherapy for borderline personality disorder: A case study.

Managing the Therapeutic Alliance is often complex when it comes to the treatment of borderline personality disorder (BPD), but the alliance is crucial for the success of the therapy. Combined individual and family interventions have been shown to be very useful in treating of these cases. This study has two objectives. First, to describe how the family therapeutic alliance facilitates therapeutic change through family psychotherapy for families with a member diagnosed with BPD. Second, to analyze how the therapeutic change achieved through combined individual and family systemic relational psychotherapy affects the individual functioning of the patient with BPD. This single case study used the System of Observation of Family Therapy Alliances (SOFTA-o) to analyze the therapeutic alliance, along with two semi-structured clinical interviews, one at the beginning and one at the end of therapy. Results show a dynamic and positive evolution of the therapeutic alliance throughout the therapeutic process and how this alliance facilitated therapeutic change, both reducing the symptomatology of the patient with BPD and improving family communication and functioning. Results contribute to highlighting the importance of including family therapy as an intervention unit in protocols for patients with BPD.

Therapeutic alliance rupture and resolution in a brief psychiatric treatment for borderline personality disorder

AbstractBackgroundThe focus of this case study was to explore the development of the therapeutic alliance in relation to alliance rupture and resolution and the effect of motive‐focussed psychotherapeutic techniques on this process in the treatment of borderline personality disorder (BPD).MethodsTherapeutic alliance rupture and resolution processes were analysed in relation to outcomes over the course of a 10 week, short‐term generalist psychiatric treatment for BPD in two patients, hereby referred to as Clara and Rebecca. Clara received treatment in the form of good psychiatric management (GPM) with the addition of motive‐oriented therapeutic relationship (MOTR) techniques. Rebecca received treatment in the form of GPM.ResultsBoth patients experienced a clinically significant reduction in symptoms. Ruptures and resolution processes occurred at low frequencies in Clara's treatment, while ruptures and resolution processes were numerous in Rebecca's treatment. The focus in Clara's treatment was on rupture prevention because of the added presence of MOTR techniques, while the focus in Rebecca's treatment was on rupture identification and resolution.DiscussionResults support the hypothesis that symptom reduction was achieved through two distinct pathways of change as a function of the treatment condition, which suggests the potential presence of multiple effective psychotherapeutic techniques for alliance development. Limitations of this study and clinical implications for the treatment of BPD in psychotherapy, with a special focus on the therapeutic alliance, are discussed.

Updating art therapy guidelines for people with personality disorders: a consensus review

ABSTRACT Background The British Association of Art Therapists has specialist interest groups that focus on specific areas of practice, and the need for a review was identified. The author consulted experts in the field of personality disorder and conducted a review of existing guidelines. Art therapy benefits from professional guidelines to ensure safe and effective practices, provide clarity for therapists and maintain consistency in treatment approaches. These guidelines help uphold ethical standards, protect patients’ wellbeing, inform research and promote accountability within the field of art therapy. Aims This paper aims to review and update the professional consensus guidelines for art therapists working with personality disorder, originally published in 2012. Methods A literature search identified new themes relevant to current professional practice. The authors employed semi-structured questionnaires and interviews in the adapted Delphi method process. Experts in the field submitted their responses in three rounds of review. Results Experts in the field indicated that changes were needed to the existing guidelines. The updated guidelines now offer improved clarity regarding practice and more accurately reflect current knowledge in this specific area. Experts reached a consensus on these updated guidelines in the final round of the review process. Conclusions The experts in the field identified significant changes to the guidelines and agreed on the guidelines’ usefulness in enhancing the professional profile and training of student art therapists. Implications for research The updated guidelines will require periodic review in the future to reflect evolving practices and the understanding of effective and safe treatment of personality disorder.

Evidence-based group therapy for severe mental illness (SMI): Treatment for schizophrenia and borderline personality disorder.

Evidence-based group therapy for severe mental illness (SMI): Treatment for schizophrenia and borderline personality disorder.

Exploring Margaret Mahler's Theory: Applications in Borderline Personality Disorder Treatment within Psychiatric Wards.

This article delves into fundamental themes within Margaret Mahler's separation-individuation theory, placing particular emphasis on the rapprochement phase. It illustrates how these themes are crucial for comprehending and effectively managing inpatients grappling with borderline personality disorder. Mahler's conceptual framework offers valuable insights for caregivers and staff, equipping them to navigate the clinical and emotional complexities inherent in the treatment of this distinct patient population during their stay in psychiatric wards.

Early Change as a Predictor of Treatment Outcome in Patients with a Personality Disorder

A significant proportion of patients with a personality disorder do not benefit from treatment. Monitoring treatment progress can help adjust ineffective treatments. This study examined whether early changes in symptoms and personality dysfunction during the first phase of therapy could predict treatment outcomes. Data from 841 patients who received specialized treatment for personality disorders were analyzed. The study focused on whether changes in the Outcome Questionnaire-45.2 (OQ-45.2) symptom distress scale (SD), the General Assessment of Personality Disorder (GAPD), and Severity Indices of Personality Problems (SIPP) in the early phase of therapy predicted post-treatment personality dysfunction, as measured by the SIPP and GAPD. Early changes within a specific SIPP domain were the strongest predictors of post-treatment outcomes in that same domain. Early changes in symptoms significantly predicted outcomes in Self-Control, Relational Functioning, and Identity Integration, while the GAPD predicted outcomes in Self-Control and Social Attunement on the SIPP. For the GAPD, early changes on the GAPD itself, followed by early changes on the OQ-45 SD and the SIPP domain Social Attunement, were significant predictors. Thus, when it comes to personality dysfunction, early changes in a specific domain or measure are the best predictors of outcomes in that same domain. While the OQ-45 predicted some aspects of personality dysfunction, it should not replace disorder-specific measures. Additionally, the SIPP domains and the GAPD should not be used interchangeably to predict each other. In sum, considering these factors, monitoring early change can be useful in assessing progress in the treatment of patients with personality disorders.

Designing a Measurement Feedback System for Personality Disorders: Should Outcome Monitoring be Based on Symptom Severity or Personality Functioning?

Measurement feedback systems (MFS) providing insight in treatment progress can improve mental healthcare outcomes. However, there is no uniform measurement feedback system that could be used to measure treatment progress for personality disorders (PD). This study compared two types of measures: a generic measure for symptom severity (Brief Symptom Index, BSI) and a specific measure for personality functioning (Severity Indices of Personality Problems, SIPP) at different points in time in order to provide insight in the most suitable measuring moment for a MFS for PD. This study is conducted in a sample of 996 Dutch PD patients (mean age 33.51 (SD 10.42), 73.1% female). Symptom severity and personality functioning were assessed before and multiple times during treatment, using a timespan of 24months. Outcomes were examined over time using multilevel modeling. Symptom severity (generic measure) and personality functioning (specific measure) improved equally after 24months. However, during these 24months, different patterns of change were observed for symptom severity compared to severity of personality problems. In general, symptom severity decreased most during the 1st months of treatment, whereas personality functioning improved only after 6months of treatment. A generic instrument of symptom severity is able to measure early changes in symptom distress but may not be able to measure longer term changes in personality functioning. The authors discuss policy implications for benchmarking using specific measures in the treatment of personality disorders.

From Theory to Therapy: A Review of Anti-Social Personality Disorder

Treatment of anti-social personality disorder in clinical practice is difficult because of the condition's complex etiology, enduring nature, and significant societal impact. This review summarizes evidence-based therapy approaches, comorbidities, and biopsychosocial variables related to ASPD, by indicating the state of the field. Twin studies and neuroimaging research arguing for structural brain anomalies provide clear evidence that genetic predispositions and neurobiological abnormalities play a role in ASPD. Psycho-social variables also participate in the development and characteristics of the condition, such as maltreatment in childhood and disturbed family relationships. Emerging therapeutic approaches such as Mentalization-Based Treatment, Psychodynamic Art Psychotherapy, Transference-Focused Psychotherapy, Schema Therapy, and Mindfulness-Based Interventions show promise, though their efficacy varies and requires further investigation.

The Effectiveness of Dialectical Behavior Therapy Compared to Schema Therapy for Borderline Personality Disorder: A Randomized Clinical Trial

Introduction: In the treatment of borderline personality disorder (BPD), there is empirical support for both dialectical behavior therapy (DBT) and schema therapy (ST); these treatments have never been compared directly. This study examines whether either of them is more effective than the other in treating patients with BPD. Methods: In this randomized, parallel-group, rater-blind clinical trial, outpatients aged between 18 and 65 years with a primary diagnosis of BPD were recruited in a tertiary outpatient treatment center (Lübeck, Germany). Participants were randomized to DBT or ST with one individual and one group session per week over 1.5 years. The primary outcome was the BPD symptom severity assessed with the mean score of the Borderline Personality Disorder Severity Index at 1-year naturalistic follow-up. Results: Between November 26, 2014, and December 14, 2018, we enrolled 164 patients (mean age = 33.7 [SD = 10.61] years). Of these, 81 (49.4%) were treated with ST and 83 (50.6%) with DBT, overall, 130 (79.3%) were female. Intention-to-treat analysis with generalized linear mixed models did not show a significant difference at 1-year naturalistic follow-up between DBT and ST for the BPDSI total score (mean difference 3.32 [95% CI: –0.58–7.22], p = 0.094, d = −24 [–0.69; 0.20]) with lower scores for DBT. Pre-to-follow-up effect sizes were large in both groups (DBT: d = 2.45 [1.88–3.02], ST: d = 1.78 [1.26–2.29]). Conclusion: Patients in both treatment groups showed substantial improvements indicating that even severely affected patients with BPD and various comorbid disorders can be treated successfully with DBT and ST. An additional non-inferiority trial is needed to show if both treatments are equally effective. The trial was retrospectively registered on the German Clinical Trials Register, DRKS00011534 without protocol changes.

Qualifications, Self-esteem, and Attitude of Health Practitioners toward Personality Disorders in Saudi Arabia

Background The attitudes of society and mental health practitioners towards mental illness are subject to multiple dimensions. This may affect the quality of health services and the client’s ability to seek treatment. It was hypothesized that there is a relationship between qualification, self-esteem, and attitudes toward personality disorders among mental health practitioners in Saudi Arabia. Objective This study aimed to assess how attitudes toward clients’ personality disorders relate to work qualifications and self-esteem among health practitioners in Saudi Arabia. Methods A correlational, within-subject, cross-sectional study was conducted, including psychologists and psychiatrists (N=171) across the five regions of Saudi Arabia, using a survey research design. The online survey contained a demographic information sheet and two standardized scales of attitudes toward personality disorders and self-esteem. Results Descriptive analysis, Pearson’s correlation coefficient, and ANOVA were conducted using SPSS. Significant positive correlations were found between the total Attitude to Personality Disorder Questionnaire and self-esteem, APDQ, and qualification scores (r = .319 and .283, both p < .001). There was also a significant positive correlation between self-esteem and qualification scores (r = .378, p <.001). Conclusion The findings of the study may help mental health practitioners understand attitudes toward personality disorders and the role of qualification and self-esteem in prompting a positive attitude. Mental health practitioner training interventions can enhance and support service quality. On-job professional training, additional training on how to treat personality disorders, and proper supervision for clinicians are highly recommended.

Predictors of treatment attendance in patients with posttraumatic stress disorder and comorbid personality disorders

IntroductionHigh dropout and low treatment attendance rates among patients with posttraumatic stress disorder (PTSD) and personality disorders (PDs) continue to pose a significant challenge. Despite numerous studies focusing on enhancing treatment attendance, the identification of consistent and reliable predictors in patients with PTSD and comorbid PDs remains limited. ObjectivesThis study aims to investigate a wide range of potential predictors of treatment attendance, encompassing demographic, patient-severity, treatment, and therapist-related variables in patients with PTSD and comorbid borderline and/or cluster C PDs. MethodsUtilizing data from 255 patients participating in two randomized controlled trials comparing trauma-focused treatment with or without concurrent PD treatment, candidate predictors were individually analyzed in univariate regression models. Significant predictors were then combined in a multiple ordinal regression model. ResultsIn total, 40% of patients attended fewer trauma-focused treatment sessions than the minimum recommended in treatment guidelines. Out of the 38 candidate predictors examined, five significant, independent predictors of treatment attendance emerged in a multiple ordinal regression model. Higher baseline PTSD severity (OR = 1.04, p = .036), higher education level (OR = 1.22, p = .009) and a stronger patient-rated working alliance (OR = 1.72, p = .047) with the therapist predicted higher treatment attendance. Conversely, inadequate social support from friends (OR = 0.90, p = .042) and concurrent PD treatment and trauma-focused treatment (OR = 0.52, p = .022) were associated with lower treatment attendance. ConclusionsIn conclusion, this constitutes the first study investigating predictors of treatment attendance in patients with PTSD and comorbid PDs. The results highlight the complexity of pinpointing reliable predictors. Nevertheless, the identification of five predictors provides valuable insights, aiding clinicians in customizing treatment strategies for individual patients and enhancing overall treatment attendance.

The Relationships between Metacognitive Beliefs and Personality Dysfunction: A Test Controlling for Personality Traits, Emotional Distress Symptoms and General Functioning

Personality dysfunction operationalized as impairment in self- and interpersonal functioning is a characteristic of personality disorders. The metacognitive model suggests that dysfunctional metacognitive beliefs are a common cause of psychological disorders, but the relevance and importance of metacognitions for personality dysfunction is less explored and was the objective for the current study. In a sample of 1278 individuals, we conducted a multiple hierarchical regression analysis to test the predictive role of metacognitive beliefs for personality dysfunction. We found a unique and independent contribution from negative beliefs about the uncontrollability and danger of worry and lower cognitive confidence to personality dysfunction whilst controlling age, gender, maladaptive personality traits, big-5 personality traits, emotional distress symptoms, and general psychosocial functioning. The results bring further support for the metacognitive model of psychological disorders which may be relevant for formulation and treatment of personality dysfunction and disorder.