Treatment Of Personality Disorder Research Articles

Patient-related factors associated with patient retention and non-completion in psychosocial treatment of borderline personality disorder: A systematic review.

The potential efficacy of psychosocial interventions in the treatment of borderline personality disorder (BPD) is impacted by significant treatment non-completion (TNC), with meta-analytic studies reporting rates of attrition of between 25% and 28%. Increasing patient retention could facilitate outcomes and improve resource utilization, given limited healthcare services. A systematic search of PsycINFO, CINAHL, EMBASE, CENTRAL, and Web of Science Core Collection identified 33 articles that met the criteria for inclusion. Although substantial heterogeneity in terms of methodology and quality of analysis limited conclusions that could be drawn in the narrative review, a few consistent patterns of findings were elucidated, such as Cluster B personality disorder comorbidities and lower therapeutic alliance were associated with TNC. Interestingly, the severity of BPD symptoms was not a predictor of TNC. These findings are discussed in terms of their potential theoretical contribution to TNC. Clinically, there may be value in applying mindfulness and motivational interviewing strategies early on in treatment for individuals who present uncertainty about engaging in treatment. Further research to develop this empirical landscape includes focusing on high-powered replications, examining burgeoning lines of research, and investigating dynamic predictors of TNC.

Mentalisation-based treatment for borderline personality disorder: a narrative review of recent process and outcome findings

This article presents a narrative review of recent process and outcome studies of mentalisation-based treatment (MBT) for borderline personality disorder (BPD). The author introduces the theoretical origins of mentalisation, its role in BPD, and the therapeutic approach of MBT. Quantitative and qualitative findings are then reviewed and critically appraised for their methodological strengths and limitations. The review finds that BPD patients benefit from the multicomponent structure and active ingredients of MBT. Finally, practical implications are discussed and directions for future research are proposed.

Mental flexibility and epistemic trust through implicit social learning – A meta-model of change processes in psychotherapy with personality disorders

This position paper follows the call for transtheoretical meta-models of general clinical change by concentrating on severe mental illness such as Personality Disorders (PDs). We have identified a core process of change related to mental flexibility through implicit learning and propose recommendations for stance and technique that are informed by research on Mentalization-Based-Treatment (MBT) and the learning components as represented in the Mediational Intervention for Sensitizing Caregivers (MISC). While the idea of corrective emotional experience as a general change mechanism involves discriminating between an old and new relationship to update relationship knowledge, the capacity to understand and process corrective emotional experiences may be limited and even iatrogenic in patients with PDs. By integrating MBT and MISC, a meta-model of change is created that allows training in and observation of the granular-level, behaviorally anchored, actions taken by the therapist to open up social learning. Here, social learning is conceptualized as epistemic trust, increasing the client’s reflective functioning during sessions to ultimately enhance cognitive flexibility outside the therapy room. This opens the possibility to implement and observe micro changes in what should be termed now implicit cognitive and emotional corrective experiences. Thus, we propose to shift towards implicit learning within professional relationships; that is, internalizing a new way of thinking about any life-event that requires adaption thereby creating adaptive capacities via mental flexibility as the general change mechanism of Personality Disorder (PD) treatment.

Arts and psychomotor therapies in the treatment of personality disorders.

Arts and psychomotor therapies in the treatment of personality disorders.

Effects of Dialectical Behavior Therapy (DBT) Skills Training on Depression and Anxiety Disorders - A Pilot Study under Routine Care Conditions

Skills training as an integral part of dialectical behavioral therapy (DBT) is highly effective in the treatment of borderline personality disorder. Research interest is increasingly focused on the transdiagnostic effects of the skills training on depression and anxiety disorders. The present study examined the extent to which the findings of high-quality randomized controlled studies can be transferred to everyday treatment under routine care conditions. N=26 patients without personality disorders were treated in a day clinic over a period of eight weeks. In the control group, 11 patients received routine care treatment and in the experimental group 15 patients additionally received weekly skills training. Symptom distress, as well as emotion regulation and mindfulness were assessed longitudinally at three time points. Multilevel analyzes were used to examine whether there was an additive effect of the skills training. The experimental group was superior to the control group in all endpoints. The effect sizes were comparable to those from experimental research. Improvements in mindfulness were significantly correlated with reductions in symptom distress. The findings fit into previous research efforts and complement them with a naturalistic research perspective. The advantages and disadvantages of an experimental and naturalistic research perspective are discussed, and relevant limitations of the present study are highlighted. Skills training is an established, flexible, modular therapy program that is ideal for improving the adaptability of patients with different psychological diagnoses.

Healing wounded trees: clinicians' perspectives on treatment of complex posttraumatic stress disorder.

While treatment guidelines agree on the first-line interventions for the treatment of posttraumatic stress disorder (PTSD), there is an ongoing debate between experts regarding the treatment of complex posttraumatic stress disorder (C-PTSD). As scientific research is slowly emerging, different treatment approaches are used in clinical practice This article aims to provide a set of treatment options for C-PTSD in adult survivors of repeated exposure to severe violence and abuse, both in childhood and later on in life. The developmental-contextual perspective on mental health forms the basis of this approach. This perspective is elaborated using the tree metaphor. Then, several treatment strategies are suggested. The presented strategies are a combination of the existing evidence-based approaches for the treatment of PTSD and personality disorders. They target psychological damage in survivors while taking their developmental trajectories and ecological environments into consideration. The treatment model presented is based on longstanding clinical practice and it may be a promising framework for treating C-PTSD. However, it still needs to be scientifically examined for acceptability and effectiveness.

Making meaning of one's own life story in words and images: A narrative case report of personal recovery from personality disorder through the interventions "An Empowering Story" and art therapy.

Understanding and processing life experiences are essential in the treatment of personality disorders to promote personal recovery and psychological wellbeing. In this qualitative case report, drafted in co-creation between the client, clinical psychologist, and art therapist, individual treatment consisted of two psychotherapeutic interventions, "An Empowering Story" and life-story-focused art therapy, in 12 parallel sessions for 24 weeks. Hilda, 68 years of age, had been diagnosed with an unspecified personality disorder and various traits of borderline personality disorder. She experienced emotional exhaustion following long-term mental health problems rooted in a traumatic early childhood. This affected her ability to manage her emotions and social relations, resulting in the sense that her life had no meaning. Hilda was invited to reconstruct her life experiences, divided into the past, turning point, and present/future, in a written and a painted life story. This allowed for the integration of traumatic as well as positive memories, enhanced self-compassion, and meaning making. She developed self-reflection and integration of internal conflicts leading to a better emotional balance and self-understanding. Art therapy emphasizes bottom-up regulatory processes, while narrative psychology supports top-down regulatory processes. The combined approach effectively integrated bottom-up, experiential, sensory experiences with top-down, cognitive emotion-regulation processes. The results suggest that psychotherapeutic interventions involving a multi-pronged, complementary, and thus more holistic approach can support personal recovery in personality disorders.

Schema Therapy for the Treatment of Personality Disorder in Later Life

About 1 in 10 older persons suffer from a personality disorder, which lowers their quality of life and wellbeing and increases their medical consumption of both somatic and mental health care. Meta-analyses show that several types of psychotherapy targeting personality (cost-)effectively reduce psychological distress and improve maladaptive personality functioning in younger and middle-aged people with personality disorders compared to usual care. The paucity of randomized controlled trials on the effectiveness of psychotherapy for personality disorders in later life is an example of ageism in modern health care, denying the ever-increasing life expectancy and ageing society worldwide. This may partly be due to the historical claim of Sigmund Freud that psychotherapy is not suitable for people aged 50+ as they would no longer be educable (‘erziehbar’) anymore.Schema therapy is an integrative psychotherapy that was originally developed for the treatment of chronic psychiatric disorders but has primarily been applied to borderline personality disorder. In younger and middle-aged adults, evidence for the effectiveness of schema therapy is growing considerably. Nonetheless, none of the randomized controlled clinical trials have included older persons thus far. Case-series, however, have shown that schema therapy is feasible for older persons with personality disorders and is highly appreciated. Therefore, in this symposium we will first present an overview of the evidence for the effectiveness of schema therapy, highlighting the case-series conducted in older age groups, secondly the results of the first randomized controlled trial on the effectiveness of schema therapy in later life, and finally, the potential of taking positive schemas into account, including a feasibility study in an older population.

Implementing a whole-of-service stepped care approach to personality disorder treatment: Impact of training and service redesign on clinician attitudes and skills.

Personality disorders are a highly prevalent mental health condition. Historically, clinician attitudes have been negative, and only a small number have specialised training. This study evaluated clinician attitudes and confidence in working with people with personality disorder following the combination of training and implementation of a stepped care whole-of-service approach. A total of 102 multidisciplinary mental health clinicians were trained to implement the stepped care approach, and completed surveys prior to implementation and at 12 months follow up. Clinicians delivered manualised structured psychological therapy as part of the model. Measures assessed changes in attitudes and confidence, and impact of the service changes and therapy approach. Qualitative responses elucidated core themes. Evaluation at 12 months post training and service redesign showed improvements in clinician skills, confidence, theoretical knowledge and attitudes. Qualitative thematic analysis found core themes of improved understanding, clinical skills and improvements in the accessibility and timeliness of treatment. Implementing a whole-of-service model featuring stepped care therapies enhanced clinician attitudes, confidence, skills and knowledge in working with people with personality disorders. Clinicians identified that the whole-of-service model also improved accessibility to treatment, and quality of clinical care to the consumer and their carers.

Readiness and Personality Disorders: Considering Patients' Readiness for Change and Our System's Readiness for Patients.

The culture around personality disorder treatment has changed drastically in the past generation. While once perceived as effectively untreatable, there are now numerous evidence-based treatment approaches for personality disorders (especially borderline personality disorder). The questions, however, of who should be matched to which treatment approach, and when, remain largely unanswered. In other areas of psychiatry, particularly substance use disorders and eating disorders, assessing patient treatment readiness is viewed as indispensable for treatment planning. Despite this, relatively little research has been done with respect to readiness and personality disorder treatment. In this article, we propose multiple explanations for why this may be the case, relating to both the unique features of personality disorders and the current cultural landscape around their treatment. While patients with personality disorders often face cruel stigmatization, and much more work needs to be done to expand access to care (i.e., our system's readiness for patients), even gold-standard treatment options are unlikely to work if a patient is not ready for treatment. Further study of readiness in the context of personality disorders could help more effectively match patients to the right treatment, at the right time. Such research could also aid development of strategies to enhance patient readiness.

Addressing the challenges of reconstructing systematic reviews datasets: a case study and a noisy label filter procedure

Systematic reviews and meta-analyses typically require significant time and effort. Machine learning models have the potential to enhance screening efficiency in these processes. To effectively evaluate such models, fully labeled datasets—detailing all records screened by humans and their labeling decisions—are imperative. This paper presents the creation of a comprehensive dataset for a systematic review of treatments for Borderline Personality Disorder, as reported by Oud et al. (2018) for running a simulation study. The authors adhered to the PRISMA guidelines and published both the search query and the list of included records, but the complete dataset with all labels was not disclosed. We replicated their search and, facing the absence of initial screening data, introduced a Noisy Label Filter (NLF) procedure using active learning to validate noisy labels. Following the NLF application, no further relevant records were found. A simulation study employing the reconstructed dataset demonstrated that active learning could reduce screening time by 82.30% compared to random reading. The paper discusses potential causes for discrepancies, provides recommendations, and introduces a decision tree to assist in reconstructing datasets for the purpose of running simulation studies.

In the Poem My Last Duchess the Duke Suffers from Personality Disorders

Personality disorders are characterized by thoughts and feelings about oneself and other people that have a significant adverse effect on an individual’s ability to operate in many facets of life. The study aims to give an account of conditions of personality disorders such as narcissism and avoidance. The significance of the study is that people need to have education about people who suffer from personality disorders, their behaviors, and their actions. The main objective of the study is to describe the effects of personality disorders, including those that are connected, and how they might be linked to actions and thoughts of homicide. The study used an analytical and descriptive method to provide an account of the conditions of personality disorders based on the Duke of My Last Duchess poem. According to the study’s findings, individuals who suffer from personality disorders are unable to control their haughtiness, conceit, and arrogance which leads them to commit crimes. The researcher recommends preventing and treating personality disorder conduct, as well as understanding the primary causes of symptoms.

Adverse Childhood Experiences Are Associated With Personality Disorder: A Prospective, Longitudinal Study.

There is a lack of studies that have prospectively examined adverse childhood experiences (ACEs) in association with a personality disorder (PD). Data from a sample of 8,199 adolescents first assessed for ACEs were linked with subsequent data from the Norwegian Patient Register in order to obtain diagnoses of a PD in adulthood (after a 14-year follow-up). We used logistic regression analysis. Any type of ACE gave a 3.8-fold higher risk of developing a PD. Abuse, more specifically emotional abuse, came out as one of the strongest predictors. Of the adolescents who developed a PD, approximately 90% had a history of ACE. The results of this study support the importance of assessing ACEs, such as abuse, neglect, and household dysfunction, in the diagnostic procedure and treatment for PD.

Evolutionary systems therapy for paranoid personality disorder: A seven cases series.

Little is known about effective psychosocial treatments for paranoid personality disorder. This study explores the feasibility of a novel treatment, namely Evolutionary Systems Therapy, in supporting individuals diagnosed with paranoid personality disorder. Seven patients attended 10 months of individual therapy without receiving any psychopharmacological treatment. The primary outcome was the feasibility of the intervention, while the secondary outcomes were remission from the diagnosis and reliable changes in personality pathology and paranoid ideation. All recruited patients completed the intervention and did not report any adverse events. Six out of seven patients experienced remission from the diagnosis of paranoid personality disorder. All participants showed reliable changes in personality pathology and paranoid ideation, which were maintained at the 1-month follow-up. Further research is needed to confirm these encouraging results.

Impact of clinical severity on treatment response in a randomized controlled trial comparing day hospital and intensive outpatient mentalization-based treatment for borderline personality disorder.

This study examined the impact of clinical severity on treatment outcome in two programs that differ markedly in treatment intensity: day hospital mentalization-based treatment (MBT-DH) and intensive outpatient mentalization-based treatment (MBT-IOP) for borderline personality disorder (BPD). A multicenter randomized controlled trial was conducted. Participants include the full intention-to-treat sample of the original trial of N= 114 randomized BPD patients (MBT-DH n= 70, MBT-IOP n= 44), who were assessed at baseline and subsequently every 6 up to 36 months after start of treatment. Outcomes were general symptom severity, borderline features, and interpersonal functioning. Clinical severity was examined in terms of severity of BPD, general symptom severity, comorbid symptom disorders, comorbid personality disorders, and cluster C personality features. None of the severity measures was related to treatment outcome or differentially predicted treatment outcome in MBT-DH and MBT-IOP, with the exception of a single moderating effect of co morbid symptom disorders on outcome in terms of BPD features, indicating less improvement in MBT-DH for patients with more symptom disorders. Overall, patients with varying levels of clinical severity benefited equally from MBT-DH and MBT-IOP, indicating that clinical severity may not be a useful criterion to differentiate in treatment intensity.

The AIP model as a theoretical framework for the treatment of personality disorders with EMDR therapy.

Research has shown that the impact of traumatic events and circumstances on individuals is cumulative and potentially has a wide range of harmful consequences, including negative consequences on mental health. One such consequence is the development of a personality disorder, a persistent mental condition characterized by a pronounced pattern of difficulties in impulse control, emotional regulation, cognitive functions, self-esteem, and interpersonal relationships. A wide array of studies indicates that the personal history of individuals with a personality disorder is often marked by exposure to traumatic events or other types of adverse childhood experiences (ACEs). Because existing treatments for personality disorders are usually long and costly, it is essential to continue exploring alternative and complementary interventions. Nowadays, knowledge and clinical experience in regard to personality disorders have been gained in addressing ACEs by processing memories of these events through eye movement desensitization and reprocessing (EMDR) therapy. In this paper, we present a theoretical framework for this treatment approach, based on Shapiro's Adaptive Information Processing (AIP) model, describe its current empirical basis, and provide guidance on how to formulate a useful case conceptualization that can serve as a basis for the treatment of personality disorders with EMDR therapy. This approach is illustrated with a case example.

Therapeutic aphorisms for paranoid personality disorder and paranoid ideation treatment: psychological opposites and complementaries in brief therapy.

BackgroundIn brief therapy (BT), aphorisms (As) have been considered a privileged element in therapeutic language. With a handful of words, they arouse emotions and different perspectives.Theoretical proposalIn As, a specific structure—the implicit and explicit symmetry of opposites (SoO)—allows a surprise effect, which in turn allows a therapeutic effect. Therefore, a carefully selected SoO (based on psychological complementaries) underlies the desired therapeutic reframing, which can be identified as a core goal of the psychotherapeutic intervention.Research questionIs it possible to identify As with therapeutic value in treating paranoid personality disorder (PPD) and high paranoid ideation (hPI) cases?MethodStarting from an initial collection of 369 original As created on the spot in 2,335 BT sessions, As used during on-line psychotherapy on 55 patients with PPD and/or an hPI measured with the SCL-90-R were identified.ResultsThirty-three As were selected and organised according to effective and ineffective strategies, the target of the BT intervention for PPD and hPI cases.

The Investigation on the Public Awareness and Treatment of Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a mental disorder that is often accompanied by symptoms of dysfunction, which is common among young people. This study started with a survey to collect the public awareness of BPD. After survey, the authors found that the public awareness was not sufficient enough. Therefore, the study decided to carry out a review of treatment methods for BPD. The authors conducted a interview with a therapist who had a cas about BPD to dicuss the procedure and effective of psychotherapies. After reviewing previous studies and interview, the main finding of the review is that DBT (Dialectical Behvaioral Therapy) and MBT (Mentalisation-Based Therapy) were found to have the best efficacy as they both focus on control of emotions and behaviors, while medical treatment may have led to worse outcomes. Therefore, this study contributes to helping therapists select appropriate treatments and remind relevant institutions to pay attention to BPD. Moreover, it tends to give the therapist certain selection guidance and list some methods to increase the popularity of BPD in public.

Borderline Kişilik Bozukluğunda İlk Nesne İlişkileri ve Duygu Düzenleme Güçlüğünün Objektif ve Projektif Yöntemlerle Belirlenmesi

Evaluation of the disorders in the personality organization of the individual is only possible by examining the object relations functions, and it is known that the elimination of emotion regulation difficulties (ERD) has a central role in the treatment of borderline personality disorder (BPD). Therefore, this study, in which objective and projective methods were used together, was designed to determine the ERD of BPD patients and the relationship between the patients' object relations and emotion regulation difficulties. It is thought that the results of the study can be useful in the psychotherapy processes of BPD patients. For this purpose, the Sociodemographic Data Form, Rorschach Test, and Emotion Regulation Difficulty Scale developed by the researchers were applied to 37 individuals diagnosed with Borderline Personality Disorder according to DSM-5 criteria and 37 individuals who did not have any psychiatric diagnosis as a result of their psychiatric examination by a psychiatrist. As a result of the study, it was determined that there was a significant relationship between BPD and ERD, and this relationship could be determined through the Rorschach test, and it was determined that BPD constituted 55% of the variance of ERD. ERD, which can have significant disruptive effects on the lives of borderline patients, was associated with the patients' lack of satisfaction and inclusion in their relations with their first object, which is usually their parents, and it was determined negative qualities of first objects accounted for 23% of the variance of difficulty in emotion regulation. It is thought that the results of the study may contribute to the acceleration of the solution of interpersonal problems, which have a close relationship with ERD, of the patients and the standardization of the Rorschach Test.

Group schema therapy: the temporal relationship between early maladaptive schemas and global psychological distress

Objective: Schema therapy is an effective treatment for personality disorders (PDs). The theory of schema therapy assumes that the decrease of global psychological distress is mediated by change in Early Maladaptive Schemas. The few studies that have investigated a temporal relationship have produced contradictory results. This study examined the temporal relationship between changes in Early Maladaptive Schemas and global psychological distress in Group Schema Therapy (GST) for patients with personality disorders. Method: Assessments were made of 115 patients at baseline, after 20, 40 and after 60 sessions of treatment. We used the Young Schema Questionnaire (YSQ) to measure the severity of Early Maladaptive Schemas and the Symptom Check List-90 Revisited (SCL-90R) to measure global psychological distress. Linear mixed model analyzes were used to examine the temporal relationship between the initial phase (0–20 and 0–40 sessions) and the later phase (40–60 sessions). Results: Change in Early Maladaptive Schemas does not precede change in global psychological distress. Conversely, global psychological distress does not precede change in Early Maladaptive Schemas; the improvement in both indicators is concurrent. Conclusion: In this study, we could not confirm that the decrease of Early Maladaptive Schemas precedes decrease of global psychological distress. We found a concurrent relationship.