Strengthening the Status of Psychotherapy for Personality Disorders: An Integrated Perspective on Effects and Costs

Bartak, Anna; Soeteman, Djøra I.; Verheul, Roel; Busschbach, Jan J. V.

doi:10.1177/070674370705201208

Cited by 23 publications

(22 citation statements)

References 49 publications

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“…However, outcomes of addiction treatments in other domains of antisocial symptomatology have not, to our knowledge, been assessed within a DSM-relevant framework. Similarly, while clinical benefits of treatment of ADHD and comorbid personality disorders have been clearly documented,127-129,133,134 the potential contributions of these treatments to desistance of antisociality also warrant investigation.…”

Section: Discussionmentioning

confidence: 99%

Three-Year Follow-Up of Syndromal Antisocial Behavior in Adults

Grant¹

2009

J. Clin. Psychiatry

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Objective-To present nationally representative findings on total antisocial personality disorder (ASPD) symptoms, major violations of others' rights (MVOR), and violent symptoms over a 3-year follow-up in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions among adults diagnosed at Wave 1 with ASPD versus syndromal adult antisocial behavior without conduct disorder before age 15 (AABS, not a codable DSM-IV disorder).Method-Face-to-face interviews were conducted with 34,653 respondents 18 years and older. Antisocial syndromes and comorbid lifetime substance use, mood, and 6 additional personality disorders were diagnosed at Wave 1 using the Alcohol Use Disorder and Associated Disabilities Interview Schedule -DSM-IV Version. The Wave 2 Alcohol Use Disorder and Associated Disabilities Interview Schedule -DSM-IV Version assessed antisocial symptoms over follow-up, lifetime attention-deficit/hyperactivity (ADHD) and posttraumatic stress disorders, and borderline, narcissistic, and schizotypal personality disorders.Results-In unadjusted analyses, respondents with ASPD reported significantly more total, MVOR, and violent symptoms over follow-up than respondents with AABS. Adjustment for baseline sociodemographics and psychiatric comorbidity attenuated these associations; after further adjustment for parallel antisocial symptom counts from age 15 to Wave 1, associations with antisocial syndromes disappeared. Independent Wave 1 predictors of persistent antisociality over follow-up included male sex, not being married or cohabiting, low income, high school or less education, and lifetime drug use disorders, additional personality disorders, and ADHD.Conclusions-The distinction between ASPD and AABS holds limited value in predicting shortterm course of antisocial symptomatology among adults. However, the prediction of persistent antisociality by psychiatric comorbidity argues for comprehensive diagnostic assessments, treatment of all identified disorders, and investigation of whether treatment of comorbidity might hasten remission of antisociality.Antisocial personality disorder (ASPD) affects 3% to 5% of U.S. adults [1][2][3] and is associated with substantial burden on affected individuals, their families, and society, both in its own right and because of its high comorbidity with medical illnesses and injuries 4-15 as well as mood, 1,3,16,17 anxiety, 1,3,16,17 substance use, 1,3,18 and other personality disorders. 19 Individuals with ASPD are high utilizers of medical care 7,20 and are at elevated risk of premature death NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript from both natural and unnatural causes. 10,21 Despite the clinical, public health, and economic significance of ASPD, however, data concerning its course and outcomes remain limited. This paucity of data reflects ASPD's association with increased mortality, as well as the tendencies of affected individuals to be difficult to locate and uncooperative toward researchers, 22 especially if they are a...

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Section: Discussionmentioning

confidence: 99%

Three-Year Follow-Up of Syndromal Antisocial Behavior in Adults

Grant¹

2009

J. Clin. Psychiatry

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“…Second, as theoretical orientation was associated with setting and duration, a different research design would have been necessary to explore the effect of theoretical orientations in addition to treatment modalities. Furthermore, studies for PD typically show that theoretical orientations only account for small differences in effectiveness (Bartak et al ., ). Nevertheless, we consider this study to be a starting point for further research.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, few studies have focused on the differences in effectiveness of different treatment modalities, despite the fact that they account for large differences in costs. These differences in costs are likely to have a high impact on cost‐effectiveness ratios and become still more important given current restricted health care budgets (Bartak et al ., ). Recently, a study on the effectiveness of five treatment modalities for cluster C PDs was conducted and showed that the effectiveness of psychotherapy differed substantially across the various modalities at 12 months after baseline (Bartak et al ., ).…”

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confidence: 97%

Effectiveness of Psychotherapy in Personality Disorders Not Otherwise Specified: A Comparison of Different Treatment Modalities

Horn

Bartak

Meerman

et al. 2014

Clin Psychology and Psychoth

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The effectiveness of different modalities of psychotherapy in patients with PDNOS (i.e., short-term vs long-term; outpatient versus day hospital versus inpatient psychotherapy) has not yet been compared. Different modalities of psychotherapy are effective for patients with PDNOS, and positive effects remain after 5 years. In patients with PDNOS short-term (less than 6 months) outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the four other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness.

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“…Whereas long-term psychosocial or psychotherapeutic approaches are generally cited as the state of the art treatment of BPD (Bartak, Soeteman, Verheul, & Busschbach, 2007;Stoffers, Völlm, Rücker, Timmer, Huband, & Lieb, 2012), short-term approaches should not be neglected for the treatment of specific and somewhat less far-reaching intervention goals (Sollberger, Gremaud-Heitz, Riemenschneider, Agarwalla, Benecke, Schwald, Küchenhoff, Walter, & Dammann, in press;Van den Bosch, Sinnaeve, & Nijs, 2013). Short treatments are located at the low end of the dose-effect relationship curve (Howard et al, 1986).…”

Section: Introductionmentioning

confidence: 99%