Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study

Clarkin, John F.

doi:10.1176/appi.ajp.164.6.922

Cited by 404 publications

(391 citation statements)

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“…Indeed, a growing number of studies suggest that general symptomatic distress may be a good proxy of the general severity of PD pathology (Caspi et al, 2014;Patalay et al, 2015) and may actually overlap with a general psychopathology factor (Caspi et al, 2014). In SCP, Dependency, and Symptomatic Distress in PD Patients 11 addition, many outcome studies in the field primarily focus on changes in general symptomatic distress as the primary outcome measure (e.g., Clarkin et al, 2007;Leichsenring & Leibing, 2003). Finally, only a brief symptom measure lends itself more easily to multiple assessments across treatment and is more sensitive to modeling change than other features of PD pathology.…”

Section: Discussionmentioning

confidence: 99%

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Self-critical perfectionism, dependency, and symptomatic distress in patients with personality disorder during hospitalization-based psychodynamic treatment: A parallel process growth modeling approach.

Lowyck

Luyten

Vermote

et al. 2017

Personality Disorders: Theory, Research, and Treatment

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There is growing evidence for the efficacy and effectiveness of psychotherapy in patients with personality disorder (PD), but very little is known about the factors underlying these effects. Two-polarities models of personality development provide an empirically supported approach to studying therapeutic change. Briefly, these models argue that personality pathology is characterized by an imbalance between development of the capacity for self-definition and for relatedness, with an exaggerated emphasis on issues regarding selfdefinition and relatedness being expressed in high levels of self-critical perfectionism (SCP) and dependency, respectively. This study used data from a study of 111 patients with PD who received long-term hospitalization-based psychodynamic treatment to investigate whether (a) treatment was related to changes in SCP, dependency, and symptomatic distress; (b) these changes could be explained by pretreatment levels of SCP, dependency, and/or symptomatic distress; and (c) changes in these personality dimensions over time were associated with symptomatic improvement. SCP, dependency, and symptomatic distress were assessed at admission (baseline), at 12 and 24 weeks into treatment, and at discharge. Parallel process multilevel growth modeling showed that (a) treatment was associated with a significant decrease in levels of SCP, dependency, and symptomatic distress, whereas (b) pretreatment levels of each of these three factors did not predict the decreases observed, and (c) changes in SCP, but not dependency, were associated with the rate of decrease in symptomatic distress over time. Implications of these findings for our understanding of therapeutic change in the treatment of PD are discussed.

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Section: Discussionmentioning

confidence: 99%

“…Besides pharmacological treatment, guidelines currently recommend psychotherapy as a primary intervention in PDs (e.g., Clarkin, Levy, Lenzenweger, & Kernberg, 2007;Fonagy, 2015). Yet, very little is known about the factors underlying these effects.…”

mentioning

confidence: 99%

Self-critical perfectionism, dependency, and symptomatic distress in patients with personality disorder during hospitalization-based psychodynamic treatment: A parallel process growth modeling approach.

Lowyck

Luyten

Vermote

et al. 2017

Personality Disorders: Theory, Research, and Treatment

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“…Whether the results of the study would have been different if a substantial percentage of those with borderline personality disorder had participated in one of the psychotherapeutic approaches specifically developed for the treatment of borderline personality disorder (dialectical behavioral treatment or DBT [11], mentalization-based treatment or MBT [12], transference-focused psychotherapy or TFP [13], and schema-focused therapy or SFT [14]) is impossible to determine.…”

Section: Discussionmentioning

confidence: 99%

Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders

Hörz¹,

Zanarini²,

Frankenburg³

et al. 2010

Psychiatric Services

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Objective This study has two main objectives. The first is to detail the prevalence rates of three key treatment modalities reported by patients with borderline personality disorder and axis II comparison participants over a decade of follow-up. The second is to determine time-to-cessation and time-to resumption of these three treatment modalities reported by patients with borderline personality disorder. Methods The treatment history of 290 reliably diagnosed inpatients with borderline personality disorder and 72 axis II comparison participants was assessed using an interview of proven reliability during their index admission. Treatment history was reassessed at five contiguous two-year follow-up periods. Results In terms of prevalence rates, there was a significant decrease in the percentage of patients with borderline personality disorder (and axis II comparison participants) participating in the three treatment modalities studied. In terms of time-to-cessation and resumption, 52% of patients with borderline personality disorder stopped individual therapy and 44% stopped taking standing medications for a period of two years or more. However, 85% of those who had stopped psychotherapy resumed it and 67% of those who stopped taking medications later resumed taking them. In contrast, 88% had no hospitalizations for at least two years but almost half of these patients were subsequently rehospitalized. Conclusions Taken together, these results suggest that patients with borderline personality disorder tend to use outpatient treatment without interruption over prolonged periods of time. They also suggest that inpatient treatment is used far more intermittently and by only a relative small minority of those with borderline personality disorder.

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“…In the past two decades, a variety of treatment approaches have been developed, studied, and empirically validated. A variety of psychotherapies with empirically demonstrated efficacy have been developed (eg, dialectical behavioral therapy [DBT] [11][12][13], mentalization [14,15], and transferencefocused therapy [16], as well as cognitive behaviorally based group treatments (eg, Systems Training for Emotional Predictability and Problem Solving [STEPPS] [17,18] and schema-focused approaches [19]). These studies are a testa-ment to the interest in clarifying and treating BPD.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes in Borderline Psychopathology: Old Assumptions, Current Findings, and New Directions

Sanislow

Marcus

Reagan

2011

Curr Psychiatry Rep

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Borderline personality disorder (BPD) and historical variants of the diagnosis were long held to represent an intractable syndrome of psychopathology consisting of interpersonal, intrapsychic, and affective disturbances. For years, patients labeled "borderline" were regarded pejoratively due at least in part to the lack of effective treatments. Prospective data from recent naturalistic follow-along studies along with the development of treatments with empirically demonstrated efficacy have changed how BPD is viewed. It is now less common to hide the diagnosis from the patient, and BPD has become a useful label to guide the treatment process and help the patient make sense of his or her suffering. Although it is now accepted that BPD is a treatment-responsive disorder and that remission is the norm, more work is needed to help patients achieve a higher level of functioning, and targeting persistent trait-like features suggests new directions for future efforts in treatment development.

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Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study

Cited by 404 publications

References 0 publications

Self-critical perfectionism, dependency, and symptomatic distress in patients with personality disorder during hospitalization-based psychodynamic treatment: A parallel process growth modeling approach.

Self-critical perfectionism, dependency, and symptomatic distress in patients with personality disorder during hospitalization-based psychodynamic treatment: A parallel process growth modeling approach.

Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders

Long-Term Outcomes in Borderline Psychopathology: Old Assumptions, Current Findings, and New Directions

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