Brief Reports: Prospective Assessment of Treatment Use by Patients With Personality Disorders

Harvard University, Cambridge, Massachusetts, United States
Psychiatric Services (Impact Factor: 2.41). 03/2006; 57(2):254-7. DOI: 10.1176/
Source: PubMed


This study examined the utilization of mental health treatments over a three-year period among patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders compared with patients with major depressive disorder and no personality disorder.
A prospective, longitudinal study design was used to measure treatment use for 633 individuals aged 18 to 45 years during a three-year period.
Patients with borderline personality disorder were significantly more likely than those with major depressive disorder to use most types of treatment. Furthermore, all patients continued using high-intensity, low-duration treatments throughout the study period, whereas individual psychotherapy attendance declined significantly after one year.
Although our data showed that patients with borderline personality disorder used more mental health services than those with major depressive disorder, many questions remain about the adequacy of the treatment received by all patients with personality disorders.

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    • "These results are consistent with previous literature suggesting that number of PD criteria met postdict treatment (Hopwood et al., 2008) and that borderline PD demonstrates a particularly strong relationship with treatment seeking (e.g. Bender et al., 2006). Further analyses revealed that a majority of our participants have sought some form of treatment. "
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    ABSTRACT: Sampling issues are extremely important in studies of psychopathology, especially with regard to the investigation of personality disorders (PDs). Many studies rely on clinical samples whereas others have focused on representative samples of community residents. Do people who qualify for a PD diagnosis seek and receive mental health services with greater (or possibly reduced) frequency compared with others in the community? Do community-based studies of PDs include people who have been treated? Analyses presented here examine connections between personality pathology and various aspects of treatment seeking in a representative sample of 1 630 middle-aged adults who completed a semi-structured diagnostic interview (Structured Interview for DSM-IV Personality). Results demonstrate a disorder-specific effect. Antisocial, borderline, avoidant and dependent PDs are associated with increased levels of seeking treatment. Four PDs are associated with greater length of treatment. After accounting for lifetime presence of major depression and alcohol dependence, borderline, avoidant and dependent pathology remained associated with increased treatment seeking. These findings point to several conclusions, including (1) community samples do include a substantial proportion of people who have received various kinds of mental health services; (2) the association between personality pathology and mental health treatment seeking is not fully explained by comorbid depression and alcohol dependence. Copyright © 2012 John Wiley & Sons, Ltd.
    Personality and Mental Health 08/2013; 7(3):203-12. DOI:10.1002/pmh.1198 · 1.10 Impact Factor
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    • "BPD patients are high users of MHS because they need several repeated treatments, including urgent interventions either in community settings or in emergency departments [2,9]. The reduction of dramatic occurrences and unscheduled interventions in both groups of patients underlines that a significant component of borderline malfunction can be reduced correcting therapeutic behaviors that worsen symptoms [28,35] by a specific MHS team training. "
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    ABSTRACT: Individuals affected by severe Borderline Personality Disorder (BPD) are often heavy users of Mental Health Services (MHS). Short-term treatments currently used in BPD therapy are useful to target disruptive behaviors but they are less effective in reducing heavy MHS use. Therefore, alternative short-term treatments, less complex than long-term psychodynamic psychotherapies but specifically oriented to BPD core problems, need to be developed to reduce MHS overuse. This study aimed to evaluate the efficacy of adding Sequential Brief Adlerian Psychodynamic Psychotherapy (SB-APP) to Supervised Team Management (STM) in BPD treatment compared to STM alone in a naturalistic group of heavy MHS users with BPD. Effectiveness was evaluated 6 times along a two-year follow-up. Thirty-five outpatients who met inclusion criteria were randomly assigned to two treatment groups (STM = 17; SB-APP = 18) and then compared. Clinical Global Impression (CGI) and CGI-modified (CGI-M) for BPD, Global Assessment of Functioning (GAF), State-Trait Anger Expression Inventory (STAXI), and Symptom Checklist-90 Revised (SCL-90-R) were administered at T1, T3, T6, T12, T18 and T24. At T12 the Working Alliance Inventory-Short Form (WAI-S) was also completed. At the one-year follow-up, SB-APP group did not receive any additional individual psychological support. MHS team was specifically trained in BPD treatment and had regular supervisions. All patients improved on CGI, GAF, and STAXI scores after 6 and 12 months, independently of treatment received. SB-APP group showed better outcome on impulsivity, suicide attempts, chronic feelings of emptiness, and disturbed relationships. We found a good stabilization at the one year follow-up, even after the interruption of brief psychotherapy in the SB-APP group. Although STM for BPD applied to heavy MHS users was effective in reducing symptoms and improving their global functioning, adding a time-limited and focused psychotherapy was found to achieve a better outcome. In particular, focusing treatment on patients' personality with a specific psychotherapeutic approach (i.e. SB-APP) seemed to be more effective than STM alone. NCT1356069.
    BMC Psychiatry 11/2011; 11(1):181. DOI:10.1186/1471-244X-11-181 · 2.21 Impact Factor
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    • "But outcomes have been monitored since the service started in 2004 via internal audits. A central part of the monitoring concerns patients' use of other services: people with PD receive more medication, psychotherapy, psychiatric inpatient care, day care, and hospital care than people with major depressive disorder (Bender et al. 2001, 2006). Such service use typically declines steeply in those accessing the Oxfordshire Complex Needs Service. "
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    ABSTRACT: Effective treatment of personality disorder (PD) presents a clinical conundrum. Many of the behaviors constitutive of PD cause harm to self and others. Encouraging service users to take responsibility for this behavior is central to treatment. Blame, in contrast, is detrimental. How is it possible to hold service users responsible for harm to self and others without blaming them? A solution to this problem is part conceptual, part practical. I offer a conceptual framework that clearly distinguishes between ideas of responsibility, blameworthiness, and blame. Within this framework, I distinguish two sorts of blame, which I call 'detached' and 'affective.' Affective, not detached, blame is detrimental to effective treatment. I suggest that the practical demand to avoid affective blame is largely achieved through attention to PD service users' past history. Past history does not eliminate responsibility and blameworthiness. Instead, it directly evokes compassion and empathy, which compete with affective blame.
    Philosophy, Psychiatry & Psychology 09/2011; 18(3):209-223. DOI:10.1353/ppp.2011.0032
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