Effectiveness of Day Hospital Mentalization‐Based Treatment for Patients with Severe Borderline Personality Disorder: A Matched Control Study

The present study extends the body of evidence regarding the effectiveness of day hospital Mentalization‐Based Treatment (MBT) by documenting the treatment outcome of a highly inclusive group of severe borderline personality disorder (BPD) patients, benchmarked by a carefully matched group who received other specialized psychotherapeutic treatments (OPT). Structured diagnostic interviews were conducted to assess diagnostic status at baseline. Baseline, 18‐month treatment outcome and 36‐month treatment outcome (after the maintenance phase) on psychiatric symptoms (Brief Symptom Inventory) and personality functioning (118‐item Severity Indices of Personality Problems) were available for 29 BPD patients assigned to MBT, and an initial set of 175 BPD patients assigned to OPT. Propensity scores were used to determine the best matches for the MBT patients within the larger OPT group, yielding 29 MBT and 29 OPT patients for direct comparison. Treatment outcome was analysed using multilevel modelling. Pre to post effect sizes were consistently (very) large for MBT, with a Cohen's d of −1.06 and −1.42 for 18 and 36 months, respectively, for the reduction in psychiatric symptoms, and ds ranging from 0.81 to 2.08 for improvement in domains of personality functioning. OPT also yielded improvement across domains but generally of moderate magnitude. In conclusion, the present matched control study, executed by an independent research institute outside the UK, demonstrated the effectiveness of day hospital MBT in a highly inclusive and severe group of BPD patients, beyond the benchmark provided by a mix of specialized psychotherapy programmes. Interpretation of the (large) between condition effects warrants cautionary caveats given the non‐randomized design, as well as variation in treatment dosages. Copyright © 2014 John Wiley & Sons, Ltd.     

Negative reward expectations in Borderline Personality Disorder patients: Neurophysiological evidence

Borderline Personality Disorder (BPD) patients present profound disturbances in affect regulation and impulse control which could reflect a dysfunction in reward-related processes. The current study investigated these processes in a sample of 18 BPD patients and 18 matched healthy controls, using an event-related brain potentials methodology. Results revealed a reduction in the amplitude of the Feedback-Related Negativity of BPD patients, which is a neurophysiological index of the impact of negative feedback in reward-related tasks. This reduction, in the effect of negative feedback in BPD patients, was accompanied by a different behavioral pattern of risk choice compared to healthy participants. These findings confirm a dysfunctional reward system in BDP patients, which might compromise their capacity to build positive expectations of future rewards and decision making.     

Disorganized attachment and Borderline Personality Disorder: A clinical perspective

The aim of this paper is to explore the links between the attachment-theory derived concept of disorganized attachment, and the psychiatric diagnosis of Borderline Personality Disorder (BPD). Disorganized attachment can be understood in terms of an approach-avoidance dilemma for infants for whom stressed or traumatized/traumatizing caregivers are simultaneously a source of threat and a secure base. Interpersonal relationships in BPD including those with care givers is similarly seen in terms of approach-avoidance dilemmas, which manifests themselves in disturbed transference/countertransference interactions between therapists and BPD sufferers. Possible ways of handling these phenomena are suggested, based on Main's () notion of ‘meta-cognitive monitoring’, in the hope of re-instating meaning and more stable self-structures, in these patients' lives.     

合并与非合并边缘型人格障碍抑郁症患者的比较研究

目的 比较合并与非合并边缘型人格障碍(BPD)抑郁症患者(MD)的一般资料及其相关因素的差异.方法 采用自编一般资料调查表、贝克抑郁量表(BDI)、症状自评量表(SCL- 90)对30名合并BPD的MD患者、30名非合并BPD的MD患者施测.结果 共病与非共病组在生源地、婚姻、受教育年限无显著差异(P＞0.05),在年...     

Dialectic behavioural therapy has an impact on self‐concept clarity and facets of self‐esteem in women with borderline personality disorder

Identity disturbance and an unstable sense of self are core criteria of borderline personality disorder (BPD) and significantly contribute to the suffering of the patient. These impairments are hypothesized to be reflected in low self‐esteem and low self‐concept clarity. The objective of this study was to evaluate the impact of an inpatient dialectic behavioral therapy (DBT) programme on self‐esteem and self‐concept clarity. Forty women with BPD were included in the study. Twenty patients were treated with DBT for 12 weeks in an inpatient setting and 20 patients from the waiting list served as controls. Psychometric scales were used to measure different aspects of self‐esteem, self‐concept clarity and general psychopathology. Patients in the treatment group showed significant enhancement in self‐concept clarity compared with those on the waiting list. Further, the scales of global self‐esteem and, more specifically, the facets of self‐esteem self‐regard, social skills and social confidence were enhanced significantly in the intervention group. Additionally, the treatment had a significant impact on basic self‐esteem in this group. On the other hand, the scale of earning self‐esteem was not significantly abased in patients with BPD and did not show significant changes in the intervention group. Our data provide preliminary evidence that DBT has an impact on several facets of self‐esteem and self‐concept clarity, and thus on identity disturbance, in women with BPD. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: ? Self‐concept clarity, which refers to the BPD criterion identity disturbance, and facets of self‐esteem, are impaired in patients with BPD compared with reference data from healthy controls. ? Our study replicates that depressive symptoms and general psychopathology are improved after a 12‐week DBT programme in BPD patients compared with a waiting list. ? The 12‐week inpatient DBT treatment programme shows significant enhancement in self‐concept clarity and facets of self‐esteem compared with the waiting list. ? Thus, in BPD patients, self‐esteem and the diagnostic criteria identity disturbance, captured by self‐concept clarity, can be influenced with short‐term psychotherapy.