Alternative Model of Personality Disorders (DSM-5) Predicts Dropout in Inpatient Psychotherapy for Patients With Personality Disorder

Abstract

Objective Criterion A serves as the fundamental diagnostic criterion of the Alternative Model of Personality Disorders in section III of the Diagnostic and Statistical Manual 5. Consisting of a self- and an interpersonal dimension, it defines the construct of personality functioning as a general and dimensional factor of personality disorders. This study aimed to explore criterion A along with well-established treatment dropout predictors, e.g., sociodemographic factors, personality disorder diagnosis, symptom severity, and the therapeutic alliance. Methods The sample consisted of 132 patients diagnosed with personality disorder in a psychotherapeutic inpatient treatment. Cox proportional hazard regression models and a lasso model were applied. Results 28% of the sample prematurely discontinued treatment. The risk for dropout was 2.3 times higher for patients with high impairments in self-functioning as assessed with criterion A. Moreover, a positive therapist-rated therapeutic alliance was associated with a lower dropout risk. Conclusion The study suggests criterion A is a useful clinical indicator by identifying patients with personality disorder with a higher risk for dropout. An individualized therapeutic approach for such patients might be required.

A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders

“…The convergent validity of the LPFS as an expert rating has been demonstrated to be substantial with regard to the presence and/or number of section II PDs [34,[42][43][44]46], the number of PD symptoms [34,40,41], psychodynamic conceptualizations of PD severity [43,44,133], as well as selfreported PD severity [34,50,138], maladaptive traits [46], and symptom distress [34,41]. In addition, studies have established associations with psychosocial functioning, short-term risk, proposed treatment intensity, and estimated prognosis [40], lifetime mental health treatment, history of substance use, mental and physical health, and social and relationship adjustment [46], as well as risk for dropout from inpatient treatment [139].…”

Three Dimensional Approaches to Personality Disorders: a Review on Personality Functioning, Personality Structure, and Personality Organization

“…In another study, impairments specific to antisocial PD added incremental validity over the corresponding DSM-IV category in predicting psychopathy [56]. Elsewhere, personality functioning (especially self functioning) was a better predictor for dropout in psychotherapy for PDs than the DSM-IV categories [58]. These findings illustrate that the concept of personality functioning is beginning to empirically prove its expected added value over the current categorical classification of PDs.…”

Vulnerable narcissism as beneficial factor for the therapeutic alliance in borderline personality disorder

“…The treatment was a structured, disorder‐specific treatment (DST) based on evidence‐based approaches (Busmann et al, 2019; Sollberger et al, 2015). The treatment duration was 80 days followed by 10 days of partial hospitalization.…”

“…Spinhoven et al (2007) have shown that a positive alliance was associated with symptom improvement. Moreover, there is evidence that a poor therapeutic alliance predicts premature psychotherapy termination (Busmann et al, 2019; Spinhoven et al, 2007).…”