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: 3.69). 04/2008; 39(1):72-8. DOI: 10.1016/j.beth.2007.05.002
Source: PubMed


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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    • "trauma exposure is neither necessary nor helpful for the patient (neuner 2008, Beutel and subic-wrana 2012). another obstacle for offering trauma focused therapy is the fact that Bpd had frequently been an exclusion criterion in studies examining treatments for dsm-axis i disorders because of the presumption that patients with BPD will not benefit from such treatments, will have a poorer outcome or would be unlikely to complete treatment (clarke and resick 2008). in their investigation of female rape victims, comparing cognitive behavioral therapy (cBt), prolonged exposure (pE) and a waitlist control, clarke et al. (2008) demonstrated – in contrast to other investigations (mcdonagh et al. 2005) – that patients with borderline personality characteristics (Bpc) can benefit from treatment for PTSD even though some of them started with more severe symptoms. they found no evidence for a relation between Bpc and treatment dropout. in the meantime, a number of different disorder-specific therapeutic approaches have been developed for both Bpd and ptsd (Bohus 2002, Jacob and Lieb 2007, Maercker 2009). "
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    ABSTRACT: Objective: frequently patients with borderline personality disorder (BPD) report a history of exposure to traumatic stressors and, as a consequence, symptoms of Posttraumatic Stress disorder (PTSD). BPD and PTSD combined exacerbate suffering beyond a simple additive effect. To assist these complex cases, we have tested the efficacy of Narrative Exposure Therapy (NET), an evidence-based treatment for survivors of different, multiple or continued traumatic stressors and compared the outcome with the one from a standard Treatment by Experts for Borderline Personality Disorder (TBE)
    Full-text · Article · Jan 2014
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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.
    Full-text · Article · Nov 2013 · European Journal of Psychotraumatology
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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.
    Full-text · Article · Jul 2012 · European Journal of Psychotraumatology
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