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Seretis D, Hart CM, Maguire T. Validity of a Revised Obsessive-Compulsive Personality Disorder (OCPD) Trait Profile and Its Relationship with Social Interaction Anxiety and Coping. J Pers Assess 2023; 105:647-656. [PMID: 36469688 DOI: 10.1080/00223891.2022.2145963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022]
Abstract
There is evidence suggesting that the conceptualization and operationalization of Obsessive-Compulsive Personality Disorder (OCPD) is not satisfactory (Watters et al., 2019). In this study, we used an online sample (N = 1008) to investigate the construct validity of the PID-5 OCPD trait measure. Regression analyses supported our hypothesis that rigid perfectionism captured the core phenomenology of OCPD whereas restricted affectivity and intimacy avoidance were not conceptually related to the OCPD construct. Based on the biosocial theory for overcontrol (Lynch, 2018), we introduced anxiousness and workaholism to the PID-5 OCPD trait profile. In establishing the validity of the revised OCPD trait profile, we investigated, for the first time, the role of social interaction anxiety and maladaptive coping in OCPD. Our revised OCPD profile showed good validity and was characterized by marked social interaction anxiety and dysfunctional coping mechanisms. The findings may lead to a new conceptualization of OCPD which prioritizes deficits in social interaction and coping. We identify areas that need to be prioritized in the evaluation of OCPD by mental health professionals and offer avenues for new clinical research in the field.
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Affiliation(s)
- Dionysis Seretis
- Department of Psychology, University of Southampton, Southampton, UK
| | - Claire M Hart
- Department of Psychology, University of Southampton, Southampton, UK
| | - Tess Maguire
- Department of Psychology, University of Southampton, Southampton, UK
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Johnson LN, Fierstein R, Cahn SC, Hoch AL, Twardzik LN. Implementation of Radically Open Dialectical Behavior Therapy in a University or College Counseling Setting: A Case Study. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2023. [DOI: 10.1080/87568225.2023.2191879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
| | - Robin Fierstein
- Wellness Center, Rowan University, Glassboro, New Jersey, USA
| | - Stacey C. Cahn
- Wellness Center, Rowan University, Glassboro, New Jersey, USA
| | - Amy L. Hoch
- Wellness Center, Rowan University, Glassboro, New Jersey, USA
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Simpson S, Azam F, Brown S, Hronis A, Brockman R. The impact of personality disorders and personality traits on psychotherapy treatment outcome of eating disorders: A systematic review. Personal Ment Health 2022; 16:217-234. [PMID: 34866357 DOI: 10.1002/pmh.1533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/15/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022]
Abstract
A significant proportion of those with eating disorders (EDs) do not respond to first-line treatments. This systematic review was conducted to identify whether personality disorders (PDs)/traits predict or moderate ED treatment outcomes and whether these outcomes were differentially influenced by ED or PD diagnostic subtypes, or treatment approach. A comprehensive systematic literature search was conducted using the PRISMA guidelines. A total of seven randomised controlled trials (RCTs) plus four follow-up studies were reviewed investigating the impact of PD and PD traits on treatment outcomes for EDs. The majority indicated that PD had some impact on treatment outcomes. Outcome measures and time-point measurements varied across studies. Included studies suggested that bulimia nervosa treatment outcomes were not hindered by co-morbidity of borderline PD; however, psychiatric impairment remained high at post-treatment and follow-up. Cluster C PDs were found to negatively impact treatment outcomes for binge ED and attrition rates for anorexia nervosa. Included studies suggested that interventions that addressed aspects of personality pathology showed greater main effects for ED treatment outcomes. There is an urgent need for future RCTs on ED treatments to include routine measures of core personality features to allow their impacts to be more thoroughly examined and for psychotherapies to be tailored accordingly.
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Affiliation(s)
- Susan Simpson
- Regional Eating Disorders Unit, NHS Lothian, Edinburgh, UK.,Department of Justice and Society, University of South Australia, Adelaide, South Australia, Australia
| | - Fatima Azam
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - SiennaMarisa Brown
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Anastasia Hronis
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Robert Brockman
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Institute for Positive Psychology and Education, Australian Catholic University, Melbourne, Victoria, Australia
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Baudinet J, Watson C, Brothwood PL, Parham R, Smith L, Snowden N, Konstantellou A, Hunt K, Simic M. Adolescent experience of radically open dialectical behaviour therapy: a qualitative study. BMC Psychiatry 2022; 22:466. [PMID: 35836210 PMCID: PMC9281135 DOI: 10.1186/s12888-022-04114-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radically Open Dialectical Behaviour Therapy (RO DBT) is a novel transdiagnostic treatment that targets 'maladaptive overcontrol'; a transdiagnostic cluster of traits associated with excessive emotional and behavioural inhibitory control. Outcomes are promising for adults with a range of psychiatric disorders. No study to date has explored the adolescent experience of RO DBT. METHODS Of the 25 eligible adolescents who received RO DBT between March 2015 and April 2017, 15 (14-17 years) consented and completed a semi-structured interview about their experience of treatment within 1 month of discharge. Interviews were recorded and then transcribed manually. Free text responses were analysed using reflexive thematic analysis. RESULTS The majority (n = 13) had a primary diagnosis of anorexia nervosa, although comorbidity was the norm, with 80.0% having two or more predicted comorbid psychiatric diagnoses. All had received some prior psychological treatment. Four themes were identified from analysis of transcripts: 1) Broadening Horizons, 2) Building Connections, 3) Flexibility, 4) Information Overload. Generally, RO DBT was perceived as helpful in both content and process. The focus on social and broader well-being, rather than specific mental health symptoms, was considered beneficial by many. Adolescents appreciated the group-based format of skills classes and reported benefiting from learning and practicing skills each week. The fourth theme, Information Overload, highlighted that for some, the amount of content felt overwhelming and that it was hard to remember and digest all the information, suggesting that adaptations, or simplifications, may be required to ensure accessibility for adolescents. CONCLUSIONS RO DBT is perceived as a relevant and beneficial new treatment for adolescents with maladaptive overcontrol. The broad treatment focus is perceived as unique and of particular benefit. It is reported to help with general and social functioning and foster cognitive and behavioural flexibility. Nevertheless, the amount and complexity of material was felt to be very large by some and may suggest the need for modified adolescent-specific materials.
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Affiliation(s)
- Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK. .,Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
| | - Charlotte Watson
- grid.439833.60000 0001 2112 9549Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ UK
| | | | - Rhian Parham
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Lindsay Smith
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Natasha Snowden
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Anna Konstantellou
- grid.439833.60000 0001 2112 9549Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ UK
| | - Katrina Hunt
- grid.37640.360000 0000 9439 0839South London and Maudsley NHS Foundation Trust, London, UK
| | - Mima Simic
- grid.439833.60000 0001 2112 9549Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ UK
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Baudinet J, Stewart C, Bennett E, Konstantellou A, Parham R, Smith K, Hunt K, Eisler I, Simic M. Radically open dialectical behaviour therapy adapted for adolescents: a case series. BMC Psychiatry 2021; 21:462. [PMID: 34551741 PMCID: PMC8456700 DOI: 10.1186/s12888-021-03460-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overcontrol is a transdiagnostic cluster of traits associated with excessive psychological, behavioural and social inhibitory control. It is associated with psychiatric diagnoses of depression, restrictive eating disorders and/or obsessive-compulsive personality disorder. Radically Open Dialectical Behaviour Therapy is a transdiagnostic treatment for maladaptive overcontrol. This case series evaluates an adolescent adaption (RO-A) for a transdiagnostic group of adolescents identified as overcontrolled. METHODS Twenty-eight adolescents were consecutively referred for RO-A from two different National and Specialist Child and Adolescent Mental Health Services between June 2017 and February 2020. Baseline self-report measures assessed overcontrol characteristics, relationship and attachment quality and mental health symptoms of depression and eating disorders, which were repeated at discharge. RESULTS Adolescents in this case series reported high rates of depression (78.6%), self-harm (64.3%) and eating disorders (78.6%). Most (85.7%) had two or more mental health diagnoses and all had previous mental health treatments before starting RO-A. The mean number of RO-A sessions attended was 18 group-based skills classes and 21 individual sessions over a mean period of 34 weeks. Significant improvements with medium and large effect sizes were reported in cognitive flexibility (d = 1.63), risk aversion (d = 1.17), increased reward processing (d = .79) and reduced suppression of emotional expression (d = .72). Adolescents also reported feeling less socially withdrawn (d = .97), more connected to others (d = 1.03), as well as more confident (d = 1.10) and comfortable (d = .85) in attachment relationships. Symptoms of depression (d = .71), eating disorders (d = 1.06) and rates of self-harm (V = .39) also significantly improved. Exploratory correlation analyses suggest improvements in overcontrol are moderately to strongly correlated with improvements in symptoms of depression and eating disorders. CONCLUSIONS This case series provides preliminary data that RO-A may be an effective new treatment for adolescents with overcontrol and moderate to severe mental health disorders like depression and eating disorders. RO-A led to improved management of overcontrol, improved relationship quality and reduced mental health symptoms. Further evaluation is indicated by this case series, particularly for underweight young people with eating disorders. More rigorous testing of the model is required as conclusions are only tentative due to the small sample size and methodological limitations.
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Affiliation(s)
- Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Catherine Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Eleanor Bennett
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Rhian Parham
- National and Specialist Child and Adolescent Dialectical Behaviour Therapy Service (N&S CAMHS DBT), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Keren Smith
- National and Specialist Child and Adolescent Dialectical Behaviour Therapy Service (N&S CAMHS DBT), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Katrina Hunt
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
- National and Specialist Child and Adolescent Dialectical Behaviour Therapy Service (N&S CAMHS DBT), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Ivan Eisler
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
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Gecaite-Stonciene J, Fineberg NA, Podlipskyte A, Neverauskas J, Juskiene A, Mickuviene N, Burkauskas J. Mental Fatigue, But Not other Fatigue Characteristics, as a Candidate Feature of Obsessive Compulsive Personality Disorder in Patients with Anxiety and Mood Disorders-An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218132. [PMID: 33153220 PMCID: PMC7662240 DOI: 10.3390/ijerph17218132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Obsessive compulsive personality disorder (OCPD) is commonly associated with anxiety and mood disorders (AMDs), in which fatigue and executive dysfunction represent key symptoms. Executive dysfunction has also been demonstrated in subjects with OCPD, and is additionally found to be a cardinal feature of fatigue. This study aimed to investigate the associations between fatigue, executive dysfunction, and OCPD in patients with AMDs. METHODS In this cross-sectional study, 85 AMD patients (78% females, mean age 39 ± 11 years) were evaluated for OCPD traits by using the observer-rated Compulsive Personality Assessment Scale. The Multidimensional Fatigue Inventory-20 was used to measure different aspects of fatigue, and the Trail Making Test was employed to assess executive functioning. The Hamilton rating scales were used to evaluate anxiety and depression symptoms. RESULTS Controlling for potential confounders, there was a significant link between OCPD and mental fatigue (OR, 1.27; 95% CI, 1.02 to 1.58; p = 0.033). No associations were found between the presence of OCPD and other relevant fatigue characteristics, including general fatigue, physical fatigue, reduced activity, and reduced motivation, as well as executive functions. CONCLUSIONS To the best of our knowledge, this study is the first to report associations between OCPD and mental fatigue in patients with AMDs, suggesting mental fatigue as a clinically important symptom when considering particular personality pathologies.
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Affiliation(s)
- Julija Gecaite-Stonciene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, LT-00135 Palanga, Lithuania; (A.P.); (J.N.); (A.J.); (N.M.); (J.B.)
- Correspondence: ; Tel.: +370-460-30012
| | - Naomi A. Fineberg
- National Obsessive Compulsive Disorders Specialist Service, Hertfordshire Partnership University, NHS Foundation Trust, Welwyn Garden City AL8 6HG, UK;
| | - Aurelija Podlipskyte
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, LT-00135 Palanga, Lithuania; (A.P.); (J.N.); (A.J.); (N.M.); (J.B.)
| | - Julius Neverauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, LT-00135 Palanga, Lithuania; (A.P.); (J.N.); (A.J.); (N.M.); (J.B.)
| | - Alicja Juskiene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, LT-00135 Palanga, Lithuania; (A.P.); (J.N.); (A.J.); (N.M.); (J.B.)
| | - Narseta Mickuviene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, LT-00135 Palanga, Lithuania; (A.P.); (J.N.); (A.J.); (N.M.); (J.B.)
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, LT-00135 Palanga, Lithuania; (A.P.); (J.N.); (A.J.); (N.M.); (J.B.)
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Petrov ME, Emert SE, Lichstein KL. Obsessive-compulsive personality disorder features and response to behavioral therapy for insomnia among patients with hypnotic-dependent insomnia. Behav Sleep Med 2019; 17:740-752. [PMID: 29869891 PMCID: PMC6281779 DOI: 10.1080/15402002.2018.1483369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: To compare therapeutic response to behavioral therapy for insomnia (BT-I) among hypnotic-dependent insomnia (HDI) patients with and without Cluster C personality disorders. Participants: Twenty-three adults with HDI (17 females), aged between 33 and 68 (M = 53; SD = 9.9) were included in the study. Methods: Participants completed a personality disorder assessment (baseline), as well as sleep diaries, polysomnography (PSG), and an insomnia severity assessment (baseline, posttreatment, and one-year follow-up). Treatment consisted of eight weeks of individual BT-I and gradual hypnotic medication withdrawal. Multilevel mixed-effects linear regression models examined the interaction between study visit and Cluster C personality disorders status on treatment response to BT-I. Results: Obsessive-compulsive personality disorder (OCPD) was the most prevalent of the Cluster C personality disorders with 38% (n = 8) of participants meeting criteria. There were no significant treatment differences by OCPD status across time as measured by sleep diaries and insomnia severity status. However, there were significant treatment differences by OCPD status by one-year follow-up on PSG outcomes, indicating that patients with OCPD status had shorter and more disrupted sleep than patients without OCPD status. Conclusions: Based on self-reported sleep measures, patients with insomnia and features of OCPD responded equivalently to BT-I at one-year follow-up compared to patients without features of OCPD. However, polysomnography outcomes indicated objective sleep deteriorated in these patients, which may suggest greater vulnerability to relapse.
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Affiliation(s)
- Megan E. Petrov
- College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Sarah E. Emert
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
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Emotional rigidity negatively impacts remission from anxiety and recovery of well-being. J Affect Disord 2018; 236:69-74. [PMID: 29723764 DOI: 10.1016/j.jad.2018.04.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Emotional rigidity is described in clinical literature as a significant barrier to recovery; however, few there are few empirical measures of the construct. The current study had two aims: Study 1 aimed to identify latent factors that may bear on the construct of emotional rigidity while Study 2 assessed the potential impact of the latent factor(s) on anxiety remission rates and well-being. METHOD This study utilized data from 2472 adult inpatients (1176 females and 1296 males) with severe psychopathology. Study 1 utilized exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to identify latent factors of emotional rigidity. Study 2 utilized hierarchical logistic regression analyses to assess the relationships among emotional rigidity factors and anxiety remission and well-being recovery at discharge. RESULTS Study 1 yielded a two-factor solution identified in EFA was confirmed with CFA. Factor 1 consisted of neuroticism, experiential avoidance, non-acceptance of emotions, impaired goal-directed behavior, impulse control difficulties and limited access to emotion regulation strategies when experiencing negative emotions. Factor 2 consisted of lack of emotional awareness and lack of emotional clarity when experiencing negative emotions. Results of Study 2 indicated higher scores on Factor 1 was associated with lower remission rates from anxiety and poorer well-being upon discharge. Factor 2 was not predictive of outcome. CONCLUSIONS Emotional rigidity appears to be a latent construct that negatively impacts remission rates from anxiety. Limitations of the present study include its retrospective design, and inefficient methods of assessing emotional rigidity.
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Fowler JC, Clapp JD, Madan A, Allen JG, Frueh BC, Fonagy P, Oldham JM. A naturalistic longitudinal study of extended inpatient treatment for adults with borderline personality disorder: An examination of treatment response, remission and deterioration. J Affect Disord 2018; 235:323-331. [PMID: 29665515 DOI: 10.1016/j.jad.2017.12.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/02/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Experts express reluctance to hospitalize patients with borderline personality disorder (BPD) for more than a few days, arguing that extended inpatient care leads to deterioration and adverse events. To date, there is no empirical support for these assertions. AIMS The current study examined the assumption of iatrogenic effects among BPD adults. METHODS Clinically significant and reliable change in symptoms, functional capacities, and adverse events were quantified for both inpatients with BPD (n = 245) and a well-matched inpatient reference (n = 220) sample. Latent growth curve (LGC) models were used to evaluate moderators of the trajectory of PHQ-9 depression scores over the course of hospitalization. RESULTS Large effect size improvements were observed in depression, anxiety, suicidal ideation and functional disability among patients with BPD (Cohen's d ≥ 1.0) and those in the reference sample (Cohen's d ≥ .80). Clinical deterioration and adverse events were rare (occurring in no more than 1.1% of BPD and reference patients on any outcome) with no difference across patient cohorts. BPD diagnosis failed to influence the trajectory of continuous depression severity. Rather, trait emotion dysregulation was associated with initial depression severity. CONCLUSIONS Twenty-five years ago it was assumed that adults with BPD could not benefit from psychiatric treatment. Today there are a number of effective evidence-based outpatient treatments for BPD, but beliefs about extended inpatient treatment have changed little. Current results indicate that extended inpatient treatment can result in significant and clinically meaningful symptomatic and functional improvement in BPD patients without iatrogenic effects.
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Affiliation(s)
- J Christopher Fowler
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States; Houston Methodist Hospital, United States.
| | - Joshua D Clapp
- University of Wyoming, 1000 E. University Ave., Laramie, WY 82071, United States
| | - Alok Madan
- The Menninger Clinic, 12301 Main Street, Houston, TX 77035, United States; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States; Houston Methodist Hospital, United States
| | - Jon G Allen
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
| | | | - Peter Fonagy
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States; University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - John M Oldham
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, United States
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