Article

Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study

Cornell University, Итак, New York, United States
American Journal of Psychiatry (Impact Factor: 12.3). 07/2007; 164(6):922-8. DOI: 10.1176/appi.ajp.164.6.922
Source: PubMed

ABSTRACT

The authors examined three yearlong outpatient treatments for borderline personality disorder: dialectical behavior therapy, transference-focused psychotherapy, and a dynamic supportive treatment.
Ninety patients who were diagnosed with borderline personality disorder were randomly assigned to transference-focused psychotherapy, dialectical behavior therapy, or supportive treatment and received medication when indicated. Prior to treatment and at 4-month intervals during a 1-year period, blind raters assessed the domains of suicidal behavior, aggression, impulsivity, anxiety, depression, and social adjustment in a multiwave study design.
Individual growth curve analysis revealed that patients in all three treatment groups showed significant positive change in depression, anxiety, global functioning, and social adjustment across 1 year of treatment. Both transference-focused psychotherapy and dialectical behavior therapy were significantly associated with improvement in suicidality. Only transference-focused psychotherapy and supportive treatment were associated with improvement in anger. Transference-focused psychotherapy and supportive treatment were each associated with improvement in facets of impulsivity. Only transference-focused psychotherapy was significantly predictive of change in irritability and verbal and direct assault.
Patients with borderline personality disorder respond to structured treatments in an outpatient setting with change in multiple domains of outcome. A structured dynamic treatment, transference-focused psychotherapy was associated with change in multiple constructs across six domains; dialectical behavior therapy and supportive treatment were associated with fewer changes. Future research is needed to examine the specific mechanisms of change in these treatments beyond common structures.

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    • "The focus of this treatment is on systematic interpretations of object relations as they manifest through transference reactions in the here-and-now therapeutic encounter . RCTs have demonstrated that transferencefocused therapy is superior to control conditions (Doering et al., 2010) and is as effective as alternative treatments (dialectical–behavioral therapy and supportive treatment; Clarkin et al., 2007) for BPD. "

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    • "An important element of the debate on the benefits of using transference interpretations is research concerning transference-focused psychotherapy (TFP; Clarkin, Yeomans, & Kernberg, 2006 ), based on Kernberg's model and developed especially for patients with personality disorders. Several studies have demonstrated the effectiveness of this approach in the treatment of patients with borderline personality disorder (Clarkin, Yeomans, & Kernberg, 2006; Clarkin, Levy, Lenzenweger, & Kernberg, 2007; Levy et al., 2006; Doering et al., 2010). One of them was a randomized controlled study comparing TFP, supportive psychodynamic therapy (without transference interpretation ), and dialectic-behavioral therapy. "

    Full-text · Article · Dec 2015
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    • "Zanarini et al. (2010) found at a twoyear follow-up 34.9% of patients had achieved remission (defined as not meeting criteria for a two-year period), and at a ten year followup 93% no longer met criteria for the disorder. The most prominent evidence-based treatments for BPD are Dialectical Behavioral Therapy (DBT) (see Linehan, 2001, 1987, 1993), Mentalization Based Therapy (see Choi-Kain and Gunderson, 2008; Bateman and Fonagy, 2009) and Transference-Focused Psychotherapy (see Clarkin et al., 2007). Nonetheless, 3e10% of patients with a BPD diagnosis die from suicide (Soloff and Chiappetta, 2012) and one study found more than 70% attempted suicide (Soloff et al., 2000). "
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    ABSTRACT: A diagnosis of Borderline Personality Disorder (BPD) often signals the quintessential "difficult patient" status to clinicians, with at least one scholar arguing the condition itself was created to name and group difficult patients. While patients who are deemed difficult are often dispreferred for care, does this have an impact on their overall status as medicalized patients who have successfully achieved a sick role? This study relies on (n = 22) in-depth interviews with mental health clinicians in the United States from 2012 to evaluate how they describe patients with BPD, how the diagnosis of BPD affects the treatment clinicians are willing to provide, and the implications for patients. My findings suggest patients with BPD are routinely labeled "difficult," and subsequently routed out of care through a variety of direct and indirect means. This process creates a functional form of demedicalization where the actual diagnosis of BPD remains de jure medicalized, but the de facto or treatment component of medicalization is harder to secure for patients. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Aug 2015 · Social Science [?] Medicine
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