Borderline Personality Characteristics and Treatment Outcome in Cognitive-Behavioral Treatments for PTSD in Female Rape Victims

National Center for PTSD and VA Boston Healthcare System, USA.
Behavior Therapy (Impact Factor: 2.43). 04/2008; 39(1):72-8. DOI: 10.1016/j.beth.2007.05.002
Source: PubMed

ABSTRACT Many studies report that comorbid borderline personality pathology is associated with poorer outcomes in the treatment of Axis I disorders. Given the high rates of comorbidity between borderline personality pathology and posttraumatic stress disorder (PTSD), it is essential to determine whether borderline symptomatology affects PTSD treatment outcome. This study examined the effects of borderline personality characteristics (BPC) on 131 female rape victims receiving cognitive-behavioral treatment for PTSD. Higher BPC scores were associated with greater pretreatment PTSD severity; however, individuals with higher levels of BPC were just as likely to complete treatment and also as likely to show significant treatment response on several outcome measures. There were no significant interactions between type of treatment and BPC on the outcome variables. Findings suggest that women with borderline pathology may be able to benefit significantly from cognitive-behavioral treatment for PTSD.

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Available from: Patricia A Resick, Jan 05, 2015
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    • "These results contrast sharply with previous findings on trauma-focused treatment, showing that the presence of Axis II disorders – especially BPD – was associated with enhanced drop-out rates (McDonagh et al., 2005), while studies investigating borderline features (Clarke, Rizvi, & Resick, 2008; Feeny, Zoellner, & Foa, 2002; Karatzias et al., 2007; Van Minnen, Arntz, & Keijsers, 2002) in trauma-focused treatment have found no differential drop-out rates or treatment effects, but this latter finding probably does not generalize to the more severe BP Disorder patients. Taken together, these findings indicate that trauma-focused treatment is most suitable and effective for PTSD patients without co-morbid PD, whereas stabilizing CBT is appropriate for non-adaptive child-abused patients with co-morbid PD. "
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    ABSTRACT: In the empirical and clinical literature, complex posttraumatic stress disorder (PTSD) and personality disorders (PDs) are suggested to be predictive of drop-out or reduced treatment effectiveness in trauma-focused PTSD treatment. In this study, we aimed to investigate if personality characteristics would predict treatment compliance and effectiveness in stabilizing complex PTSD treatment. In a randomized controlled trial on a 20-week stabilizing group cognitive behavioral treatment (CBT) for child-abuse-related complex PTSD, we included 71 patients of whom 38 were randomized to a psycho-educational and cognitive behavioral stabilizing group treatment. We compared the patients with few PD symptoms (adaptive) (N=14) with the non-adaptive patients (N=24) as revealed by a cluster analysis. We found that non-adaptive patients compared to the adaptive patients showed very low drop-out rates. Both non-adaptive patients, classified with highly different personality profiles "withdrawn" and "aggressive," were equally compliant. With regard to symptom reduction, we found no significant differences between subtypes. Post-hoc, patients with a PD showed lower drop-out rates and higher effect sizes in terms of complex PTSD severity, especially on domains that affect regulation and interpersonal problems. Contrary to our expectations, these preliminary findings indicate that this treatment is well tolerated by patients with a variety of personality pathology. Larger sample sizes are needed to study effectiveness for subgroups of complex PTSD patients.
    European Journal of Psychotraumatology 11/2013; 4. DOI:10.3402/ejpt.v4i0.21171 · 2.40 Impact Factor
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    • "This is consistent with recommendations in the PE manual (Foa et al., 2007), which states that patients should not be excluded from PE on the basis of any Axis II diagnosis, but individuals with severe degrees of personality disorders may be excluded for other reasons (e.g., cases of BPD with serious self-injurious behaviors). When these standard PE exclusion criteria are used, several studies have shown that patients with BPD or borderline personality characteristics (BPC) improve as much as those without BPD/BPC during standard PE (Clarke, Rizvi, & Resick, 2008; Feeny et al., 2002). In addition, four studies of modified PE treatments for childhood abuse-related PTSD have reported including BPD patients in their samples, including an RCT of a 16-week outpatient treatment involving skills training followed by modified PE (Cloitre et al., 2010), an RCT of a 14-week outpatient modified PE treatment (McDonagh et al., 2005), an open trial of a 3-month residential Dialectical Behavior Therapy (DBT) and modified PE program (Bohus, Kruger, Dyer, Priebe, & Steil, 2011), and case studies of a brief (5-day) intensive outpatient treatment based on PE (Hendriks, de Kleine, van Rees, Bult, & van Minnen, 2010). "
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    ABSTRACT: Although prolonged exposure (PE) has received the most empirical support of any treatment for post-traumatic stress disorder (PTSD), clinicians are often hesitant to use PE due to beliefs that it is contraindicated for many patients with PTSD. This is especially true for PTSD patients with comorbid problems. Because PTSD has high rates of comorbidity, it is important to consider whether PE is indeed contraindicated for patients with various comorbid problems. Therefore, in this study, we examine the evidence for or against the use of PE with patients with problems that often co-occur with PTSD, including dissociation, borderline personality disorder, psychosis, suicidal behavior and non-suicidal self-injury, substance use disorders, and major depression. It is concluded that PE can be safely and effectively used with patients with these comorbidities, and is often associated with a decrease in PTSD as well as the comorbid problem. In cases with severe comorbidity, however, it is recommended to treat PTSD with PE while providing integrated or concurrent treatment to monitor and address the comorbid problems.
    European Journal of Psychotraumatology 07/2012; 3. DOI:10.3402/ejpt.v3i0.18805 · 2.40 Impact Factor
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    • "With respect to the Axis II disorders , previous studies have shown that PTSD treatments can be less effective with borderline personality disorder (BPD) patients, or that CBT can suffer from high drop-out rates (e.g., Cloitre & Koenen, 2001; McDonagh et al., 2005; but see Clarke, Rizvi, & Resick, 2008). Despite these inconsistencies in the literature, BPD patients are assumed by clinicians to benefit less from treatments for Axis I disorders, and BPD is typically an exclusion criterion in randomized controlled trials for PTSD (Clarke, et al., 2008). "
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    ABSTRACT: In two recent studies conducted by our group, a treatment combining propranolol with a brief reactivation session subsequently reduced posttraumatic stress disorder (PTSD) symptom severity and diagnosis, as well as reducing psychophysiological responses during trauma-related script-driven imagery. One likely explanation for those results is that memory reconsolidation was blocked by propranolol. We explored the influence of various predictors on treatment outcome (i.e., PTSD severity), and whether the treated individuals improved in other important domains of functioning associated with PTSD. Thirty-three patients with longstanding PTSD participated in a 6-week open-label trial consisting of actively recalling one's trauma under the influence of propranolol, once a week. Treated patients reported a better quality of life, less comorbid depressive symptoms, less negative emotions in their daily life and during trauma recollections. Women were also found to improve more than men. Type of trauma (childhood vs. adulthood), time elapsed since trauma, borderline personality traits, depressive symptoms severity, Axis I comorbidity, and age did not influence treatment outcome. These results must await publication of a randomized-controlled trial to further delineate effectiveness with this novel treatment approach.
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