Interpersonal problems in personality disorder influences psychotherapy

A study investigating which patients with personality disorder (PD) can best benefit from time-limited dynamic psychotherapy have found that specific interpersonal problems impact on the effectiveness of manualised or non-manualised treatment.There is an increasing need for manualised evidence-based psychotherapy (EBP) as a means to use limited resources as effectively and efficiently as possible. Currently, EBP guidelines target specific, axis I psychiatric Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) disorders that can be differentiated from other psychiatric disorders. However, a large number of psychiatric patients also suffer from personality disorders (PD; axis II DSM-IV) that do not have distinct and clearly delineated symptoms. Furthermore, the presence of a PD diagnosis has been found to negatively impact treatment and outcome, across both expressive and supportive dynamic psychotherapy, all of which complicate EBP-based therapy. Vinnars et al. examined measures of DSM-IV PD, namely psychodynamic character, psychological mindedness, interpersonal patterns and personality traits, to establish which PD patients would benefit most from manualised or non-manualised psychotherapy.A total of 156 consecutive PD patients were randomised to manualised time-limited supportive-expressive psychotherapy (SEP; n = 76) or non-manualised open-ended community delivered psychodynamic treatment (CDPT; n = 80). Significant predictors were tested together to examine whether they moderated or predicted the reduction of psychiatric symptoms (as assessed by Symptoms Check List-90).They found that those patients with a greater number of positive PD criteria experienced slower rates of improvement, but those patients with more severe levels of vindictiveness (as assessed by the Inventory of Interpersonal Problems [IIP]) experienced higher rates of improvement. Furthermore, high levels of IIP dominance were found to be significantly associated with a higher rate of improvement in the CDPT group compared with their SEP treatment group counterparts."The results of the present study provide preliminary evidence for the value of assessing patients' variables complementary to DSM-IV PD diagnoses, namely interpersonal variables and 'personality disorderness', as predictors of dynamic therapy outcome," the authors stated.They concluded that the evaluation of interpersonal pathology is important for identifying high-dominant patients who may benefit more from non-manualised psychotherapy, and that more severe PD patients may benefit from longer treatment duration.Reference...