Psychotherapy for personality disorders

Abstract

Personality disorders are widely prevalent among those seeking mental health services, resulting in substantial distress and a heavy burden on public assistance and health resources. We conducted a qualitative review of randomized controlled trials (RCTs) of psychosocial interventions for personality disorders. Articles were identified through searches of electronic databases and classified based on the focus of the psychological intervention. Data regarding treatment, participants and outcomes were identified. We identified 33 RCTs that evaluated the efficacy of various psychosocial treatments. Of these studies, 19 focused on treatment of borderline personality disorder, and suggested that there are several efficacious treatments and one well-established treatment for this disorder. In contrast, only five RCTs examined the efficacy of treatments for Cluster C personality disorders, and no RCTs tested the efficacy of treatments for Cluster A personality disorders. Although other personality disorders, especially Cluster A, place heavy demands on public assistance, and in spite of recommendations that psychosocial interventions should be the first line of treatment for these disorders, our review underscored the dearth of treatment research for many of these personality disorders. We highlight some obstacles to such research and suggest directions for future research.     

Psychotherapy of personality disorders

This article reviews recent research examining the effectiveness of treating personality disorders with psychotherapy. Despite the prevalence and seriousness of these conditions, and the extensive clinical writings about them, research on the treatment of personality disorders has been limited. Much of the research is hampered by a multitude of difficult issues. Research from the past 3 years is reviewed, with an eye toward what new contributions the studies have made to the psychotherapy literature. Implications of their findings are considered and recommendations for future research are made.     

Pharmacotherapy for personality disorders

Abstract Double-blind, placebo-controlled trials of pharmacotherapy for personality disorders (PD) were reviewed, and the indications concluded were as follows:(1) Severe cases of both Borderline Personality Disorder (BDP) and Schizotypal Personality Disorder (SPD) respond to low dose antipsychotic drugs resulting in improvement of a broad spectrum of symptoms. They also respond to monoamine oxidase inhibitor (MAOI). Amitriptyline causes a paradoxical effect. (2) Borderline personality disorder with behavioral dyscontrol responds to carbamazepine which reduces actual episodes of dyscontrol, to an antipsychotic drug and to MAOI. Alprazolam is associated with an increase in suicidality and dyscontrol. Borderline personal disorder or Histrionic Personality Disorder with a tendency to suicide, responds to a depot antipsychotic drug. Personality disorders with aggressive behavior respond to lithium. Moderately severe PD with explosive behavior respond to oxazepam, but at a dose where the side effect is sedation. (3) Borderline personality disorder and SPD with psychotic symptoms respond to an antipsychotic drug which improves psychotic symptoms as well as neurotic symptoms. Emotionally Unstable Character Disorder with a disturbance of mood swings, responds to lithium. Adolescent PD respond to an antipsychotic drug. (4) Comorbid atypical depression of histrionic personality and BPD respond to MAOI or imipramine. Comorbid neurotic disorder of PD responds to dothiepin. Comorbid social phobia of avoidant and dependent PD responds to MAOI.     

Affective disorders,personality and personality disorders

OBJECTIVE: The article deals with the complex conceptual history and current concepts on the relationship between personality, personality disorders and affective disorders. It is discussed whether these concepts represent distinct clinical entities or whether they lie on a continuum. METHOD: We reviewed the classical literature from the 19th and the first half of the 20th centuries as well as analysed recent empirical data in order to summarize the current knowledge on this topic with respect to its historical origin. As a particular example, the position of the depressive personality disorder is evaluated. RESULTS: Considerable heterogeneity can be seen, both theoretically and empirically. The two major concepts are based either on a continuum model or favour distinct clinical entities, corresponding to a more dimensional or category-orientated recording method. CONCLUSION: The relationship between personality disorders and affective disorders is still unclear and is a highly debated issue. There is as yet no consensus, but a certain shift to dimensional models can be recognized.     

Psychotherapy for Vietnam veterans with posttraumatic stress disorders

Past psychotherapeutic approaches to posttraumatic stress disorders are discussed with reference to some of the special problems in treating the disorder in Vietnam combat veterans. In some cases therapy oriented specifically to the effects of combat trauma can be helpful even in veterans seen years after combat; in others the symptoms have become so enmeshed in the veteran's life that trauma-oriented therapy must be combined with more traditional psychotherapeutic principles. Three cases representing a range of the ways in which posttraumatic stress is experienced are presented and their treatment is discussed. These cases illustrate the importance for effective psychotherapy to be based on an understanding of what the combat experience has meant to the veteran and how such meanings continue to be represented in the individual's postwar life.     

Psychotherapy of posttraumatic stress disorders

Since the diagnosis of posttraumatic stress disorder (PTSD) was introduced in DSM-III in 1980, a variety of psychotherapeutic approaches have been developed to address the specific problems and needs of traumatized patients. Successful treatment of PTSD requires a well thought-out therapeutic attitude. The therapist must find a well-balanced position between over-identification and turning away out of helplessness. A sensation-seeking attitude should be avoided as should the danger of vicarious traumatisation. In many instances, PTSD can not be treated sufficiently by psychotherapy alone: a comprehensive, multi-modal treatment plan may include pharmacotherapeutic, physical, social, legal, and other interventions. Early psychotherapeutic interventions in the immediate aftermath of a traumatic event follow the rules of crisis intervention (immediacy, focus on the current problems, time limitation). Special attention should be paid to the issues of developing a trusting therapeutic relationship, creating an atmosphere of safety, helping the patient to regain control over and/or distance himself from intrusive recollections. Eye Movement Desensitization and Reprocessing (EMDR) and other "power therapies" can offer quick relief from symptoms. After collective traumatization, psychological debriefings are widely used although the evidence for their usefulness in preventing PTSD is questionable. In patients with chronic PTSD, the psychotherapist should not work exclusively on the traumatic event and its sequelae: treatment should be oriented towards the future rather than the past. Instead of exploring, the therapist should try to activate the patients' resources and help them to find new meaning in their future life.     

Dialectical behavior therapy for personality disorders

Interest in dialectical behavior therapy (DBT) as a treatment for personality disorders has increased dramatically in recent years. Although originally designed for the outpatient treatment of suicidal individuals with borderline personality disorder (BPD), DBT has been applied to many more diverse populations including comorbid substance dependence and BPD, inpatient treatment for BPD, as well as antisocial behaviors in juveniles and adults. This paper provides a brief overview of DBT, presents and evaluates the most recent literature on the application of DBT to the treatment of personality disorders, and highlights some of the current controversies surrounding the use of DBT.     

Psychotherapy in psychosomatic disorders.

Published controlled studies of various psychotherapeutic techniques in psychosomatic disorders with adequate designs have formed the basis for the following conclusions: Psychotherapeutic techniques are effective in some patients with psychosomatic disorders. Some psychosomatic disorders, for example, bronchial asthma, peptic ulcer, and migraine headaches are perhaps more amenable to psychotherapy than others, for example, hypertension and ulcerative colitis. There is evidence to suggest that there are differences between the effectiveness of various psychotherapeutic techniques; a few patients differ perhaps from the rest in that they are helped most by the technique that is less effective for the majority.