Treatment response in subtypes of borderline personality disorder

Abstract

Background and Aims Based on the frequently noted heterogeneity in symptom representation and treatment resistance amongst clients with borderline personality disorder (BPD), this study sought to investigate whether a sample of 77 people with severe personality disorder, primarily BPD (n = 74), could be grouped into clinically meaningful subtypes. A follow‐up question was whether the subtypes would respond differently to a specialist intervention. Method Participants were public mental health clients referred to a specialist residential treatment programme in Victoria, Australia. Using an existing data set, cluster analysis was applied in order to identify subtypes based on various demographic, clinical and psychological variables. Post‐treatment analyses were carried out to investigate change in self‐harm, suicide attempts, depression and dissociation. Results Three subtypes were identified, namely: withdrawn–internalizing, severely disturbed–internalizing and anxious–externalizing. Furthermore, the subtypes responded differently to the treatment, with the withdrawn–internalizing subtype showing reduced levels of dissociation and the anxious–externalizing subtype responding by large reductions in levels of depression. The severely disturbed–internalizing subtype did not improve significantly on any of the outcome measures in this study. Discussion These findings suggest that subtypes can be identified amongst clients with BPD, and that the subtypes may be related to treatment outcomes. Copyright © 2009 John Wiley & Sons, Ltd.

Association between level of personality organization as assessed with theory-driven profiles of the Dutch Short Form of the MMPI and outcome of inpatient treatment for personality disorder

“…In contrast to other studies (Digre et al, 2009;Eurelings-Bontekoe et al, 2011;Vermote et al, 2009), there was not an overall effect of PO on outcome. Inspection of the effect sizes associated with changes in symptomatology between beginning and end of treatment and between end of treatment and follow-up showed that all patients had improved by the end of treatment, with patients with highlevel BPO and psychotic BPO profiles showing the largest improvement.…”

“…Personality has been shown to be a predictor of treatment outcome in addition to other variables, such as age, motivation, alcohol and drug abuse, and childhood trauma (Zanarini, Frankenburg, Hennen, Reich, & Silk, 2006). For example, to predict differential treatment outcome, Lenzenweger and Willet (2007) used a neurobehavioral model of personality and Vermote et al (2009) and Digre, Reece, Johnson, and Thomas (2009) applied psychodynamic models of personality. Koelen et al (2012) carried out a systematic review of the impact of level of personality organization (PO; Kernberg, 1984) on treatment outcome and found that, in general, higher initial levels of PO were moderately to strongly associated with better treatment outcome, especially as expressed in terms of self and relational functioning rather than in terms of general symptomatology.…”

Who gets hooked on Facebook? An exploratory typology of problematic Facebook users

“…Cluster analysis is a multivariate method of data reduction that creates homogenous clusters of individuals by appraising inter-relationships among selected variables (Burns & Burns, 2008). Individuals within clusters are expected to be more similar to each other than they are to individuals in other clusters (Digre, Reece, Johnson, & Thomas, 2009). In this way, it was possible to examine whether groups of problematic Facebook users performed Facebook activities that were distinct from other groups of problematic users.…”

Effectiveness of Outpatient, Day Hospital, and Inpatient Psychotherapeutic Treatment for Patients with Cluster B Personality Disorders

“…Therefore, future research should focus more on the question of ‘ideal dosage’ of treatment for patients with PD. As our study covers the whole range of cluster B PD and therefore a heterogeneous group of patients in many aspects, results might be different across specific subgroups of patients [81,82]. For instance, very vulnerable patients may not be able to tolerate the therapeutic ‘pressure’ that is often characteristic of full-time inpatient treatment or the subculture of patients’ living together [65].…”