Treatment Of Personality Disorder Research Articles

Diagnosis and Treatment of Antisocial Personality Disorder: A Case Report

Abstract
 Introduction. Antisocial personality disorder (ASPD) defines patterns of behavior that are irresponsible for social, exploitative, and unproblematic issues that begin in early childhood or adolescence and are manifested by changes in the life phase. This case report was aimed to describe antisocial personality disorder experienced by a girl in Aceh, Indonesia.
 Case Presentation. A woman, 19 years old, a college student, living in a suburban area, came to consult to hospital with complaints of anxiety and difficulty sleeping. The patient claimed that she often wanted to hurt and persecute others. She often try to hurt other people, but do not get caught because she said the act was carried out accidentally. When she was a child, she liked to torture animals and she did it without guilty and pity. Lately patient felt the desire to hurt others is getting bigger.
 Conclusion. Management of antisocial personality disorder can be adjusted to the circumstances and background or risk factors of the disorder, and treatment is used to reduce symptoms.

Analysis of the Clinical Case of Long-term Monitoring of a Patient with Comorbid Depression: Special Considerations of Psychopharmacotherapy

Depression associated with somatic diseases ranks high among other depressive disorders and has a number of specifi c clinical features as compared to classic depression.The aim of the study was to analyse specifi c features of comorbid depression clinical course, its diagnosis, and methodology for the selection of psychopharmacotherapy—using a clinical case as an example.Results: the authors carried out a detailed retrospective clinical analysis of medical records of long-term (over three years) dynamic monitoring of a patient with comorbid vascular depression. They explored the tactics of selecting pharmacotherapy for anxiety-depressive disorder given the underlying chronic cerebral ischemia, atherosclerosis of brachiocephalic arteries, аrterial hypertension, and atherosclerotic cardiosclerosis. The primary focus was on specifi c aspects of vascular depression pharmacotherapy that were governed by a diverse clinical picture of comorbid personality disorders, dynamic transformation of somatic, neurological, and psychic symptoms and syndromes in a patient. The paper highlights the need for alignment of scientifi c and methodological approaches to assessment of potential risks associated with the use of psychotropic medicines.Conclusions: the choice of rational psychopharmacotherapy for vascular depression should be governed by the data on the drug effi cacy for the prevailing clinical symptoms, by the age and gender characteristics of the patient, by compensation status of organs and systems, as well as by genetic, personal, and social characteristics that aff ect the disease progression. The use of a comprehensive multidisciplinary approach to the diagnosis and treatment of comorbid personality disorders, as well as implementation of personalised medicine methodology in clinical practice in order to assess the patient’s condition as infl uenced by changes in his/her somatic, neurological, psychic status and the results of psychological testing, will increase the effi cacy and safety of treatment.

Am I bipolar or what? Exploring the phenomenological, treatment and prognosis overlap of borderline personality disorder and bipolar disorder

PurposeThe term borderline applied to personality dynamics was first introduced by Adolph Stern in 1938. This new term included a particular group of patients who, in an organizational blurring, remained in the limbo between neurosis and psychosis. To find a more assertive and holistic characterization of borderline personality disorder (BPD), the purpose of this paper is to explore borderline phenomenology, setting boundaries and discussing points of approach and divergence of this personality disorder comparing them specifically to bipolar affective disorder (BAD) and also explore the differences in their treatment and prognosis.Design/methodology/approachThis paper is a review and synthesis of the extant literature, mapping out the similar and unique aspects of each pathology.FindingsAlthough there are approximation parameters between BPD and BAD, the phenomenology and the course of both diseases appear to be different. Indeed, this paper seems to have some uncertainty about the sphere of each entity and the domain of comorbidity. Despite the overlapping rates found, it is the understanding that the consequences and strategies for managing comorbidity are underexplored.Originality/valueAs the association of both disorders can be difficult not only in terms of management and understanding of their consequences and implications but also in long-term negative perpetuation, this review has direct implications for clinicians so that they can understand the similarities and particularities of each entity, leading to a more correct psychopathological approach in these individuals.

A randomised trial of dialectical behaviour therapy and the conversational model for the treatment of borderline personality disorder with recent suicidal and/or non-suicidal self-injury: An effectiveness study in an Australian public mental health service.

Borderline personality disorder is a complex mental disorder that is associated with a high degree of suffering for the individual. Dialectical behaviour therapy has been studied in the largest number of controlled trials for treatment of individuals with borderline personality disorder. The conversational model is a psychodynamic treatment also developed specifically for treatment of borderline personality disorder. We report on the outcomes of a randomised trial comparing dialectical behaviour therapy and conversational model for treatment of borderline personality disorder in a routine clinical setting. Participants had a diagnosis of borderline personality disorder and a minimum of three suicidal and/or non-suicidal self-injurious episodes in the previous 12 months. Consenting individuals were randomised to either dialectical behaviour therapy or conversational model and contracted for 14 months of treatment (n = 162 commenced therapy). Dialectical behaviour therapy involved participants attending weekly individual therapy, weekly group skills training and having access to after-hours phone coaching. Conversational model involved twice weekly individual therapy. Assessments occurred at baseline, mid-treatment (7 months) and post-treatment (14 months). Assessments were conducted by a research assistant blind to treatment condition. Primary outcomes were change in suicidal and non-suicidal self-injurious episodes and severity of depression. We hypothesised that dialectical behaviour therapy would be more effective in reducing suicidal and non-suicidal self-injurious behaviour and that conversational model would be more effective in reducing depression. Both treatments showed significant improvement over time across the 14 months duration of therapy in suicidal and non-suicidal self-injury and depression scores. There were no significant differences between treatment models in reduction of suicidal and non-suicidal self-injury. However, dialectical behaviour therapy was associated with significantly greater reductions in depression scores compared to conversational model. This research adds to the accumulating body of knowledge of psychotherapeutic treatment of borderline personality disorder and supports the use of both dialectical behaviour therapy and conversational model as effective treatments in routine clinical settings, with some additional benefits for dialectical behaviour therapy for persons with co-morbid depression.

New insights into diagnostics and therapy of personality disorders-Changes in ICD-11

Personality disorders (PD) occur frequently and show high remission rates in the long term, while psychosocial recovery remains unsuccessful in a substantial proportion of cases. In ICD-11 the traditional view that PDs have a high stability is abandoned. Instead, the minimum duration is 2 years. The diagnostic process differentiates between three degrees of severity (mild, moderate, severe) and five prominent personality trait domains. Optionally, aborderline qualifying factor can be additionally codified. There is sufficient empirical evidence only for the treatment of borderline PD (BPD). Disorder-specific psychotherapy, in particular dialectic behavioral therapy (DBT) and mentalization-based therapy (MBT) have proven to be effective. Therapy modules targeting functional impairments and prominent personality trait domains could close the existing gaps in the disorder-specific treatment of PD.

The process of recovery and change in a dialectical behaviour therapy programme for youth.

Dialectical behaviour therapy (DBT) is an effective treatment for borderline personality disorder and suicidal behaviour. However, it is a complex programme involving individual therapy, participation in skills training groups, and phone coaching aimed at improving emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. Little is known about what elements contribute to its effectiveness, or the characteristics of those who complete the programme and achieve recovery. In this study, six participants in a dialectical behaviour therapy programme for youth were interviewed at three time points over their recovery journey. The transcribed narratives were analysed using inductive methods, and the core processes related to recovery were elucidated and described: 'Becoming a cheerleader for DBT' and 'Learning the language of DBT and consolidation of skills'. Indicators of recovery included having a sound working alliance with the primary therapist and others involved in the programme and noticing meaningful improvements in problem areas which they attributed to particular skills and improved capacity to regulate emotions. The rich narrative description provided by participants might inspire some to remain engaged in a dialectical behavioural therapy programme or clinicians to consider promoting a positive view of the prognosis for borderline personality disorder.

How Personality Disorders Change in Psychotherapy: a Concise Review of Process.

The present review summarizes the current state of the art in psychotherapy processes during treatments for clients with personality disorders. We outline some methodological challenges in the discipline of process research, give a brief historical account on process research, and then focus on specific processes studied from an empirical perspective. The current review acknowledges the centrality of the therapeutic relationship, in particular the therapeutic alliance, therapist empathy, and responsiveness in explaining outcome across treatment modalities for personality disorders. The review describes evidence from three overall and overlapping lines of inquiry that have garnered scientific interest in the past years. For emotional change (regulation, awareness, and transformation), socio-cognitive change (mentalizing, meta-cognition, and interpersonal patterns), and increase in insight and change in defense mechanisms, evidence is moderate to strong for these processes to contribute to healthy change in treatments for personality disorders, in particular borderline personality disorder. Avenues of future studies are outlined.

Differential diagnosis personality disorder versus autism spectrum disorder in older adults

Scientific knowledge of autism spectrum disorders (ASD) in older adults is still scarce. Differential diagnosis of ASD and personality disorders is complicated, especially in later life. There is overlap between ASD and personality disorders, both conceptually and descriptively. The manifestation of both disorders is heterogeneous, influenced by age specific factors and characterised by similar behavioural symptoms and the lack of a sound developmental history. In both disorders, age specific changes can exceed adaptive abilities of patients, so ASD and personality disorders may become manifest for the first time in old age. More research is needed to fully understand the relationship between ASD and personality development across the life span. Also, there is a need for assessment instruments for both adults and older people with comorbid mental disorders and personality disorders in particular. As comorbidity of ASD and personality disorders appears to be common, more research should be done into treatment of comorbid personality disorders, also in later life.

Borderline Personality Disorder: To diagnose or not to diagnose? That is the question.

There is considerable controversy around psychiatric diagnosis generally and personality disorders specifically. Since its conception, borderline personality disorder has been controversial because of the stigma associated with the diagnosis and the therapeutic nihilism held by practitioners who encounter people with this high prevalence problem in acute settings. This paper reviews the history of the diagnosis of BPD and summarizes some of the controversy surrounding the categorical nature of diagnosis. Both the DSM 5 and ICD-11 will be discussed; however, for the purposes of this paper, the DSM 5 will take the primary focus due to greater cultural significance. Recent developments in the treatment of borderline personality disorder suggest that it is a highly treatable condition and that full clinical recovery is possible. This paper formulates an argument that despite problems with psychiatric diagnosis that are unlikely to be resolved soon, a diagnosis should be made with an accompanying formulation to enable people to receive timely and effective treatment to enable personal and clinical recovery.

Psychological treatment of personality disorders in older adults: a review

Despite a still reigning therapeutic nihilism, attention for the psychological treatment of personality disorders in older adults has been growing recently. The first empirical studies have been conducted, but their number is still limited, and varies from expert consensus to the first tests of effectiveness of schema therapy and dialectical behavior therapy. Therefore, there is an urgent need for further empirical studies into psychological treatments that have been optimized for older adults on all three treatment levels.

A pragmatic evaluation of a high-fidelity dialectical behaviour therapy programme for youth with borderline personality disorder

ABSTRACT Objective: This paper describes and evaluates a high-fidelity Dialectical Behaviour Therapy (DBT) programme for youth (15–25 years). The project was undertaken as a partnership between public mental health services and a non-government organisation in regional Australia. DBT is an evidence-based treatment for Borderline Personality Disorder (BPD) but is rarely accessible within public mental health services. Method: Participants completed an Adverse Childhood Experiences (ACE) questionnaire, repeated measures of the Borderline Symptom List (BSL-23), supplementary behaviour questionnaire (BSL-Supp) and general well-being questionnaires. Hospital and emergency service use was examined for the year prior to referral to the programme and for the year following completion. The characteristics of those people who did not complete the programme were also described. Results: Borderline personality symptoms were correlated with the number of reported adverse childhood experiences. Participants who remained in the programme for at least twelve weeks had significant reductions in BSL-23 scores with several reporting no symptoms after completing the programme. Participants had high rates of hospital and emergency department use in the year before participation and significantly less use in the year following completion. Discussion: It is feasible to deliver a high fidelity DBT programme to youth in a regional centre in Australia and achieve reductions in symptoms and use of hospital and emergency services in a regional public mental health service.

The effectiveness of cognitive analytic therapy for borderline personality disorder: Utilizing a withdrawal experimental design to improve sensitivity to abandonment.

A primary methodological weakness of the single-case experimental design (SCED) outcome studies conducted of the treatment of personality disorder with cognitive analytic therapy (CAT) is that they have failed to employ a withdrawal phase or cross-over design and so are deemed quasi-experimental. This study sought to implement a withdrawal design, in order to improve the internal validity of the study to make it a true SCED, and also in order to enable the patient to explore abandonment dynamics. The study employed an A1 /B1 /A2 /B2 with extended follow-up SCED with a female patient treated with CAT meeting diagnostic criteria for borderline personality disorder (BPD). Following the 6-week baseline period 'A1 ', treatment occurred in two phases (21 sessions 'B1 ' and 24 sessions 'B2 ') sandwiching a 12-week treatment withdrawal phase ('A2 ') and a 24-week structured follow-up phase. Seven idiographic daily measures were collected that created a N=698day timeline. Nomothetic outcome measures were collected at baseline and at the end of each phase of the study, and the Session Impact Scale was completed after each treatment session. There was a significant increase in the task focus of treatment sessions. Ideographically, CAT was an effective treatment for improving the participant's self-to-self relationship, as their self-hate reduced and their sense-of-self increased. There was a broad pattern of deterioration during the second treatment phase (B2 ) and follow-up phase across the ideographic measures, and CAT was ineffective for BPD ideographic emotional or self-to-other measures. Reliable change occurred on the primary BPD nomothetic outcome measure from baseline to end of first treatment phase. The study suggests that the CAT intervention was partially successful and that it is possible to integrate good research practice with clinical innovation. The methodological strengths and limitations of the design and the clinical implications of the results are discussed. Cognitive analytic therapy was partially effective in the treatment of BPD in a case that had been unresponsive to other psychological interventions. Therapists need to complete lengthy and structured follow-up to capture any emerging relapse. Therapists need to discuss the patient's thoughts and feelings about termination regularly in a relationally informed manner.

Access to psychotherapy for patients with personality disorders.

The best evidence for effective treatment of personality disorder supports the use of specialized forms of psychotherapy. However, these forms of treatment are generally unavailable in health care systems. This may be partly due to the expense of routinely offering long-term therapies. There is evidence that psychotherapy for personality disorder is cost-effective. One way to address this problem is to treat most patients more briefly. © 2020 John Wiley & Sons, Ltd.

The course of (comorbid) trauma-related, dissociative and personality disorders: two year follow up of the Friesland study cohort

ABSTRACT Background: There is substantial comorbidity between trauma-related disorders (TRDs), dissociative disorders (DDs) and personality disorders (PDs), especially in patients who report childhood trauma and emotional neglect. However, little is known about the course of these comorbid disorders, despite the fact that this could be of great clinical importance in guiding treatment. Objective: This study describes the two-year course of a cohort of patients with (comorbid) TRDs, DDs and PDs and aims to identify possible predictors of course. Possible gender differences will be described, as well as features of non-respondents. Method: Patients (N = 150) referred to either a trauma treatment program or a PD treatment program were assessed using five structured clinical interviews for diagnosing TRDs, DDs, PDs and trauma histories. Three self-report questionnaires were used to assess general psychopathology, dissociative symptoms and personality pathology in a more dimensional way. Data on demographics and received treatment were obtained using psychiatric records. We described the cohort after a two-year follow-up and used t-tests or chi-square to test possible differences between respondents and non-respondents and between women and men. We used regression analysis to identify possible course predictors. Results: A total of 85 (56.7%) of the original 150 patients participated in the follow-up measurement. Female respondents reported more sexual abuse than female non-respondents. Six patients (4.0%; all women) died because of suicide. Levels of psychopathology significantly declined during the follow-up period, but only among women. Gender was the only significant predictor of change. Conclusions: Comorbidity between TRDs, DDs and PDs was more the rule than the exception, pleading for a more dimensional and integrative view on pathology following childhood trauma and emotional neglect. Courses significantly differed between men and women, advocating more attention to gender in treatment and future research.

Debranding Treatment for Borderline Personality Disorder: A Call to Balance Access to Care with Therapeutic Purity.

Debranding Treatment for Borderline Personality Disorder: A Call to Balance Access to Care with Therapeutic Purity.

Complex post-traumatic stress disorder: a breakthrough in treating personality disorders

Complex post-traumatic stress disorder: a breakthrough in treating personality disorders

Depression symptoms’ impact on personality disorder treatment: Depression symptoms amplifying the interpersonal benefits of negative-affect expression

BackgroundWhile there is some evidence that patients with elevated depression symptoms experience greater benefits from negative-affect expression, this amplifying effect has not been investigated within a psychotherapeutic context. This is particularly notable considering the substantial evidence linking affect expression with desired outcomes across psychotherapeutic approaches. The primary purpose of the present study was to investigate if depression symptoms amplified (i.e., moderated) the association between negative-affect expression and reductions in interpersonal problems for patients in a psychiatric day treatment for personality disorders. The secondary purpose was to investigate milieu (i.e., other patients concurrently enrolled) negative-affect intensity and its association with patients’ reductions in interpersonal problems. MethodsParticipants (N = 239) were patients consecutively admitted into a psychiatric day treatment program for people with personality disorders. Patients completed measures of (1) depression symptoms at pre-treatment, (2) interpersonal problems at pre- and post-treatment, and (3) negative-affect expression each week of treatment. ResultsThe association between patient negative-affect expression and reductions in interpersonal problems was amplified by depression symptoms. Depression symptoms also amplified the association between milieu negative-affect intensity and reductions in interpersonal problems. ConclusionsOur findings indicate that depression symptoms amplified the therapeutic value of negative-affect expression and amplified the value of an affectively intense milieu. Practical and theoretical implications are discussed.

Diagnosis and Treatment of Borderline Personality Disorder in Young People.

We review recent research concerning the diagnosis and treatment of borderline personality disorder (BPD) in young people. We examine evidence for the need to define an appropriate age for detection, and the suitability of current classification methods and treatment. Evidence supports early detection and intervention for subsyndromal borderline pathology or categorical BPD across an extended developmental period. A range of structured treatments are effective for BPD in young people, although the role of treatment components in successful outcomes is unclear. Substantial evidence suggests that a stronger focus on functional outcomes, especially social and vocational outcomes, is warranted. Effective treatments for BPD are rarely available internationally. There is a need to assess whether less complex interventions might be developed that are scalable across health systems. A clinical staging model should be considered, addressing clinical distress and co-occurring psychopathology, as well as diagnosis.

Mechanisms of change in brief treatments for borderline personality disorder: a protocol of a randomized controlled trial

BackgroundBorderline personality disorder (BPD) is one of the most frequent, most debilitating and lethal mental conditions and is associated with a serious burden of disease. Treatment for patients with BPD involves structured psychotherapy, and may involve brief psychiatric treatment as first-line intervention. No controlled study has assessed the effectiveness of such brief intervention. Whereas most psychotherapy studies in patients with BPD focus on the effectiveness of the intervention, we still lack an understanding of how and why these effects are produced from a patient process perspective. It is therefore of utmost importance to study the treatment-underlying mechanisms of change. The present study plans to apply novel measurement methods for assessing change in two central psychobiological processes in BPD: emotion and socio-cognitive processing. The study uses theory-driven and ecologically valid experimental tasks, which take the patient’s individual experience as the anchor, by integrating methodology from psychotherapy process and neurofunctional imagery research.MethodsThe aim of this two-arm, randomized controlled study is to test the effects (i.e., symptom reduction) and the underlying mechanisms of change associated with a brief psychiatric treatment (10 sessions over 4 months), compared with treatment as usual. Participants (N = 80 patients with BPD) undergo assessments at four points (intake, 2 months, discharge, and 12-month follow up). In addition to symptom measures, individuals undergo a 2-step assessment for the potential mechanisms of change (i.e., emotion and socio-cognitive processing): (1) behavioral and (2) (for a sub-sample) neurofunctional. We hypothesize that change in the mechanisms explains the treatment effects.DiscussionThis study uses an easy-to-implement treatment of BPD, and a sophisticated assessment procedure to demonstrate the critical role of psychobiological change in emotion and socio-cognitive processing in brief treatments. It will help increase the effectiveness of brief treatment for BPD and help diminish the societal burden of disease related to BPD, in these early stages of treatment.Trial registration {2}ClinicalTrials.gov: NCT03717818. Registered on 24 October 2018). Protocol version {3} number 2 from 9 February 2018.

Management of Suicidality with Borderline and Narcissistic Features

General suicide risk assessment and management should include consideration of core borderline and narcissistic vulnerabilities of interpersonal hypersensitivity and self-esteem dysregulation. Understanding the oscillating phenomenology of these vulnerabilities using the basic personality disorder treatment approach of Good Psychiatric Management provides a coherent, practical method for assessing and managing suicide risk not only in patients with these personality disorders but more broadly in those with some traits of personality disorder but not meeting full diagnostic criteria. [ Psychiatr Ann . 2020;50(4):139–145.]