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Vonderlin R, Priebe K, Müller-Engelmann M, Fydrich T, Steil R, Resick PA, Schmahl C, Lindauer P, Kleindienst N, Bohus M. Long-term effects of dialectical behaviour therapy for posttraumatic stress disorder and cognitive processing therapy 9 months after treatment termination. Eur J Psychotraumatol 2024; 15:2393061. [PMID: 39221987 PMCID: PMC11370672 DOI: 10.1080/20008066.2024.2393061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
Background: The complexity of posttraumatic stress disorder (PTSD) symptoms related to childhood abuse (CA) present challenges for effective psychotherapeutic treatment. Consequently, there is great interest in the long-term effectiveness of psychological treatments for this population.Objective: This study aims to investigate the long-term outcomes of Dialectical Behaviour Therapy for PTSD (DBT-PTSD) and Cognitive Processing Therapy (CPT) 9 months after treatment termination.Method: This is a long-term analysis from a randomised-controlled trial of DBT-PTSD versus CPT (registration number DRKS00005578). Initially, 193 individuals with CA-related PTSD were randomly allocated to receive either DBT-PTSD (n = 98) or CPT (n = 95). The primary outcome the Clinician-administered PTSD-Scale for DSM-5 (CAPS-5) was administred at baseline, treatment completion (15 months post-randomization) and at the 9-month follow-up. Secondary outcomes included self-reported PTSD severity (PCL-5), dissociation (DSS), severity of borderline symptoms (BSL-23), and psychosocial functioning (GAF).Results: No significant changes were observed in the primary (CAPS) and all other outcomes from post-intervention to 9-months follow-up in both the DBT-PTSD (CAPS: Mpost = 15.60, Mfollow-up = 14.93) and CPT group (CAPS: Mpost = 18.80, Mfollow-up = 17.41). Between-group analyses at 9-months follow-up were significantly in favour of DBT-PTSD compared to CPT with small to medium effect sizes on all outcomes ranging from d = 0.35 on the CAPS to d = 0.57 on the BSL-23 and GAF.Conclusions: Our results indicate that treatment effects of psychotherapy addressing complex presentations of PTSD persist 9 months after treatment termination. In addition, the superiority of DBT-PTSD as compared to CPT found at treatment termination, was confirmed at 9-months follow-up.Trial registration: German Clinical Trials Register identifier: DRKS00005578..
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Affiliation(s)
- Ruben Vonderlin
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Kathlen Priebe
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Meike Müller-Engelmann
- Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt, Germany
- Department Psychology, Medical School Hamburg, Hamburg, Germany
| | - Thomas Fydrich
- Department of Psychology, Faculty of Life Sciences, Humboldt University, Berlin, Germany
| | - Regina Steil
- Institute of Psychology, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Petra Lindauer
- Department of Economics and Media, Hochschule Fresenius University of Applied Sciences, Cologne, Germany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- McLean Hospital, Harvard Medical School, Boston, MA, USA
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Cha Y, Links PS, Ba D, Kazi A. Systematic Review of the Effectiveness and Experiences of Treatment for Men With Borderline Personality Disorder. Am J Mens Health 2024; 18:15579883241271894. [PMID: 39215612 PMCID: PMC11367612 DOI: 10.1177/15579883241271894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/16/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024] Open
Abstract
In clinical settings, among individuals diagnosed with borderline personality disorder (BPD), typically 75% are female and 25% male, although this discrepancy is not reported in the community. In the literature, little is known of the effectiveness and experiences of treatment of men with BPD. We aimed to review the effectiveness and experiences of treatment for men with BPD and outline future research priorities to promote better recovery. We searched Ovid MEDLINE and PsycINFO for eligible studies from inception until July 29, 2022. Peer-reviewed primary research articles on treatment effectiveness or experience for men with BPD were included. Data from eligible studies were synthesized in a narrative review. The protocol of our review was pre-registered on PROSPERO (CRD42022351908). Seventeen studies met the inclusion criteria, and men with BPD from eight countries were represented. Psychological therapies included Dialectical Behavioral Therapy, Systems Training for Emotional Predictability and Problem Solving, Mentalization Based Therapy, and psychoanalytic therapy. Pharmacologic treatment included topiramate, divalproex Extended-Release, and high-dose baclofen. Five studies investigated the service utilization of men with BPD. Compared to women, men were less likely to access treatment for BPD or find treatment helpful. Our findings demonstrated the potential efficacy of psychotherapy and pharmacologic interventions in reducing anger, aggression, and rule-breaking behavior, with limited evidence for reduction in suicide-related outcomes. Our findings are limited by inadequate power and heterogeneity of the included studies. Further research with larger sample sizes and qualitative studies is needed to better understand the treatment experience for men with BPD.
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Affiliation(s)
- Yevin Cha
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Paul S. Links
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Dong Ba
- Michael G Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ayman Kazi
- Michael G Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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Schreiber AM, Cawood CD. Treatment outcomes of Veteran men in a comprehensive dialectical behavior therapy program: Characterizing sex differences in symptom trajectories. J Psychiatr Res 2023; 164:90-97. [PMID: 37331262 DOI: 10.1016/j.jpsychires.2023.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/13/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023]
Abstract
Dialectical Behavior Therapy (DBT) is one of the primary psychosocial treatments for reducing suicidal behaviors and improving psychosocial outcomes among patients with borderline personality disorder (BPD) and has been shown to reduce BPD symptoms when delivered in a Veteran Affairs medical center setting. Despite evidence of similar rates of BPD in both men and women, the vast majority of treatment outcome research in BPD has focused on women. We sought to characterize sex differences in symptom trajectories among Veterans participating in a comprehensive DBT program. We found that Veteran men and women who entered the DBT program were diagnostically and demographically similar. Participants exhibited reductions in BPD symptoms and improvements in emotion regulation over the course of treatment. Moreover, Veteran men reported BPD symptom reductions that were not statistically inferior to those of Veteran women and exhibited a sharper reduction in these symptoms. This research provides support for the use of DBT as a psychosocial treatment for Veteran men with BPD symptoms.
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Affiliation(s)
- Alison M Schreiber
- Ann Arbor VA Medical Center, Ann Arbor, MI, USA; University of North Carolina, Chapel Hill, NC, USA.
| | - Chelsea D Cawood
- Ann Arbor VA Medical Center, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA.
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Holliday R, Desai A, Edwards ER, Borges LM. Personality Disorder Diagnosis Among Justice-Involved Veterans: An Investigation of VA Using Veterans. J Nerv Ment Dis 2023; 211:402-406. [PMID: 37040142 DOI: 10.1097/nmd.0000000000001627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
ABSTRACT Justice-involved veterans are more likely to experience myriad mental health sequelae. Nonetheless, examination of personality psychopathology among justice-involved veterans remains limited, with studies focused on males within correctional settings. We examined Department of Veterans Affairs (VA) electronic medical records for 1,534,108 (12.28% justice-involved) male and 127,230 (8.79% justice-involved) female veterans. Male and female veterans accessing VA justice-related services were both approximately three times more likely to have a personality disorder diagnosis relative to those with no history of using justice-related services. This effect persisted after accounting for VA use (both overall and mental health), age, race, and ethnicity. Augmenting and tailoring VA justice-related services to facilitate access to evidence-based psychotherapy for personality psychopathology may promote optimal recovery and rehabilitation among these veterans.
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Affiliation(s)
| | - Alisha Desai
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention
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De Wit-De Visser B, Rijckmans M, Vermunt JK, van Dam A. Pathways to antisocial behavior: a framework to improve diagnostics and tailor therapeutic interventions. Front Psychol 2023; 14:993090. [PMID: 36844347 PMCID: PMC9947159 DOI: 10.3389/fpsyg.2023.993090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
The Antisocial Personality Disorder (ASPD), and antisocial behavior (ASB) in general, is associated with significant impact on individuals themselves, their environment, and society. Although various interventions show promising results, no evidence-based treatments are available for individuals with ASPD. Therefore, making informed choices about which treatment can be applied to an individual patient is complicated. Furthermore, contradictory findings on therapy effectiveness and underlying factors of ASB, such as cognitive impairments and personality traits, fuel the debate whether the conceptualization of ASPD in the DSM-5 is accurate and whether this population can be seen as homogeneous. A conceptual framework, based on the reciprocal altruism theory, is presented in which we propose different pathways to ASB. These pathways suggest underlying dynamics of ASB and provide an explanation for previous contradictory research outcomes. This framework is intended to serve as a clinically relevant model that provides directions for improving diagnostics and matching treatments to underlying dynamics in the antisocial population.
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Affiliation(s)
- Brenda De Wit-De Visser
- GGZ WNB, Research and Innovation, Halsteren, Netherlands
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
| | - Madeleine Rijckmans
- Fivoor, Fivoor Science and Treatment Innovation, Poortugaal, Netherlands
- Clinical and Forensic Psychology, Department of Developmental Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Jeroen K. Vermunt
- Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Arno van Dam
- GGZ WNB, Research and Innovation, Halsteren, Netherlands
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
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Royston R, Naughton S, Hassiotis A, Jahoda A, Ali A, Chauhan U, Cooper SA, Kouroupa A, Steed L, Strydom A, Taggart L, Rapaport P. Complex interventions for aggressive challenging behaviour in adults with intellectual disability: A rapid realist review informed by multiple populations. PLoS One 2023; 18:e0285590. [PMID: 37200247 DOI: 10.1371/journal.pone.0285590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES Approximately 10% of people with intellectual disability display aggressive challenging behaviour, usually due to unmet needs. There are a variety of interventions available, yet a scarcity of understanding about what mechanisms contribute to successful interventions. We explored how complex interventions for aggressive challenging behaviour work in practice and what works for whom by developing programme theories through contexts-mechanism-outcome configurations. METHODS This review followed modified rapid realist review methodology and RAMESES-II standards. Eligible papers reported on a range of population groups (intellectual disability, mental health, dementia, young people and adults) and settings (community and inpatient) to broaden the scope and available data for review. RESULTS Five databases and grey literature were searched and a total of 59 studies were included. We developed three overarching domains comprising of 11 contexts-mechanism-outcome configurations; 1. Working with the person displaying aggressive challenging behaviour, 2. Relationships and team focused approaches and 3. Sustaining and embedding facilitating factors at team and systems levels. Mechanisms underlying the successful application of interventions included improving understanding, addressing unmet need, developing positive skills, enhancing carer compassion, and boosting staff self-efficacy and motivation. CONCLUSION The review emphasises how interventions for aggressive challenging behaviour should be personalised and tailored to suit individual needs. Effective communication and trusting relationships between service users, carers, professionals, and within staff teams is essential to facilitate effective intervention delivery. Carer inclusion and service level buy-in supports the attainment of desired outcomes. Implications for policy, clinical practice and future directions are discussed. PROSPERO REGISTRATION NUMBER CRD42020203055.
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Affiliation(s)
- Rachel Royston
- Division of Psychiatry, University College London, London, United Kingdom
| | - Stephen Naughton
- Division of Psychiatry, University College London, London, United Kingdom
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Andrew Jahoda
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Afia Ali
- Division of Psychiatry, University College London, London, United Kingdom
| | - Umesh Chauhan
- School of Medicine, University of Central Lancashire, Lancashire, United Kingdom
| | - Sally-Ann Cooper
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Athanasia Kouroupa
- Division of Psychiatry, University College London, London, United Kingdom
| | - Liz Steed
- Wolfson Institute of Population Health, Queen Mary, University of London, London, United Kingdom
| | - Andre Strydom
- Forensic & Neurodevelopmental Sciences, King's College London, London, United Kingdom
| | - Laurence Taggart
- School of Nursing and Paramedic Science, Ulster University, Northern Ireland, United Kingdom
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, United Kingdom
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Qian X, Townsend ML, Tan WJ, Grenyer BFS. Sex differences in borderline personality disorder: A scoping review. PLoS One 2022; 17:e0279015. [PMID: 36584029 PMCID: PMC9803119 DOI: 10.1371/journal.pone.0279015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/28/2022] [Indexed: 12/31/2022] Open
Abstract
Borderline Personality Disorder (BPD) is often perceived to be a female-predominant disorder in both research and clinical contexts. Although there is growing recognition of possible sex differences, the current literature remains fragmented and inconclusive. This scoping review aimed to synthesize available research evidence on potential sex differences in BPD. PsycINFO, PubMed, Scopus and Web-of-Science were searched from January 1982 to July 2022 surrounding the key concepts of sex and BPD. Data searching and screening processes followed the Joanna Briggs Institute methodology involving two independent reviewers, and a third reviewer if necessary, and identified 118 papers. Data regarding BPD symptoms, comorbid disorders, developmental factors, biological markers, and treatment were extracted. Data was summarized using the vote counting method or narrative synthesis depending on the availability of literature. Males with BPD were more likely to present externalizing symptoms (e.g., aggressiveness) and comorbid disorders (e.g., substance use), while females with BPD were more likely to present internalizing symptoms (e.g., affective instability) and comorbid disorders (e.g., mood and eating disorders). This review also revealed that substantially more research attention has been given to overall sex differences in baseline BPD symptoms and comorbid disorders. In contrast, there is a dearth of sex-related research pertaining to treatment outcomes, developmental factors, and possible biological markers of BPD. The present scoping review synthesized current studies on sex differences in BPD, with males more likely to present with externalizing symptoms in contrast to females. However, how this might change the prognosis of the disorder or lead to modifications of treatment has not been investigated. Most studies were conducted on western populations, mainly North American (55%) or European (33%), and there is a need for future research to also take into consideration genetic, cultural, and environmental concomitants. As the biological construct of 'sex' was employed in the present review, future research could also investigate the social construct 'gender'. Longitudinal research designs are needed to understand any longer-term sex influence on the course of the disorder.
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Affiliation(s)
- Xinyu Qian
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michelle L. Townsend
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Wan Jie Tan
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Yang C, Wang J, Shao Y, Liu M, Geng F. Antisocial and borderline personality traits and childhood trauma in male prisoners: Mediating effects of difficulties in emotional regulation. CHILD ABUSE & NEGLECT 2022; 132:105822. [PMID: 35944450 DOI: 10.1016/j.chiabu.2022.105822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/10/2021] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the prevalence of probable antisocial personality disorder (ASPD) and borderline personality disorder (BPD) among prisoners, and further examine the mediating effect of difficulties in emotional regulation (ER) between childhood trauma and symptoms of ASPD and BPD. METHODS A total of 1491 male participants (35.4 ± 9.69 years) were recruited from a prison in Guangdong, China. The symptoms of ASPD and BPD, childhood trauma, difficulties in ER, and suicidal behaviors were measured by self-administered structured questionnaires. Logistic regressions were performed to investigate the associations of ASPD and BPD with suicidal behaviors. Path analysis was used to examine the mediating effects of difficulties in ER between childhood trauma and symptoms of ASPD and BPD. RESULT Approximately, 21.2 % and 11.2 % of the participants were screened as ASPD and BPD, respectively. Probable ASPD and BPD were associated with higher risk of suicidal behaviors. Childhood trauma and difficulties in ER were significantly associated with suicidal behaviors in prisoners with probable ASPD and BPD. Path analyses showed that partial mediating effects of difficulties in ER were significant in the dimensions of clarity and strategies on ASPD, and in the dimensions of clarity, impulse, and strategies on BPD. CONCLUSION ASPD and BPD are two of the common personality disorders in prisoners. Difficulties in ER are key to understanding the relationships between childhood trauma and personality disorders.
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Affiliation(s)
- Chenxiao Yang
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Jian Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yuan Shao
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Mingfan Liu
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Fulei Geng
- School of Psychology, Jiangxi Normal University, Nanchang, China.
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Gillespie C, Murphy M, Joyce M. Dialectical Behavior Therapy for Individuals With Borderline Personality Disorder: A Systematic Review of Outcomes After One Year of Follow-Up. J Pers Disord 2022; 36:431-454. [PMID: 35913768 DOI: 10.1521/pedi.2022.36.4.431] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Dialectical behavior therapy (DBT) has a growing evidence base for treating individuals with a diagnosis of borderline personality disorder (BPD). Less is known about the long-term effects of the treatment, which is an important consideration when treating a chronic disorder such as BPD. The current systematic review explores outcomes after 1 year of follow-up for individuals who engaged in DBT. A systematic search of four databases (PsycInfo, PubMed, Scopus, CINAHL) was performed. Controlled and uncontrolled studies were included. A total of 10 articles were identified pertaining to seven primary research studies. Overall, improvements following treatment with DBT extended over the follow-up period. These findings suggest that the effects of DBT in treating BPD are maintained at least 1 to 2 years postintervention. Given a lack of long-term follow-up in randomized controlled trials, evidence for the efficacy of DBT in the longer term is unclear.
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Affiliation(s)
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Ireland
| | - Mary Joyce
- National Suicide Research Foundation, Cork, Ireland
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Ciesinski NK, Sorgi-Wilson KM, Cheung JC, Chen EY, McCloskey MS. The effect of dialectical behavior therapy on anger and aggressive behavior: A systematic review with meta-analysis. Behav Res Ther 2022; 154:104122. [DOI: 10.1016/j.brat.2022.104122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/02/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
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Sex and gender in treatment response to dialectical behaviour therapy: current knowledge, gaps, and future directions. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Borderline personality disorder (BPD) is a mental health condition characterized by emotion dysregulation, interpersonal impairment, and high suicidality. Dialectical behaviour therapy (DBT) is the most widely studied psychotherapeutic treatment for BPD. To date, the vast majority of DBT research has focused on cisgender women, with a notable lack of systematic investigation of sex and/or gender differences in treatment response. In order to encourage effective, equitable treatment of BPD, further investigation into treatment targets in this population is critical. Here, we employed a systematic strategy to delineate gaps in the DBT literature pertaining to sex and gender differences and propose directions for future research. Findings demonstrate a significant discrepancy in measurement of sex and gender, particularly among gender-diverse individuals. Exploring DBT treatment response across the full spectrum of genders will facilitate the provision of more tailored, impactful care to all individuals who suffer from BPD.
Key learning aims
(1)
To date, DBT treatment literature has focused almost exclusively on cisgender women, with only two of 253 DBT studies in current literature accounting for transgender and gender diverse (TGD) individuals.
(2)
Recognize how gender minority stress may impact the prevalence of BPD among TGD individuals.
(3)
Learn how future research initiatives can be employed to rectify this gap in the DBT literature.
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Hesse M, del Palacio-Gonzalez A, Thylstrup B. Impulsive Lifestyle Counselling versus treatment as usual to reduce offending in people with co-occurring antisocial personality disorder and substance use disorder: a post hoc analysis. BMC Psychiatry 2022; 22:392. [PMID: 35689188 PMCID: PMC9188147 DOI: 10.1186/s12888-022-04025-8] [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: 05/17/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To assess the impact of a short psychoeducation intervention for antisocial personality disorder on offending after randomization to treatment. DESIGN Multicentre, superiority, non-blinded randomized controlled trial. Random assignment was conducted in blocks of varying sizes at a central randomization centre. Participants were followed using national register data until 365 days after randomization, migration, or death, whichever occurred first. SETTING Thirteen outpatient uptake areas in Denmark. PARTICIPANTS Patients with antisocial personality disorder in treatment for substance use disorders were randomized to treatment as usual (TAU, n = 80) or Impulsive Lifestyle Counselling (ILC, n = 96). A total of 165 patients could be linked to criminal records (TAU, n = 74; ILC, n = 91). INTERVENTION ILC is a brief psychoeducational program targeting antisocial behavior. The trial was conducted between January 2012 and June 2014. OUTCOMES Number of criminal offences leading to convictions based on national registers. RESULTS The mean number of offences was 2.76 in the TAU group (95% Poisson confidence interval [CI] = 2.39, 3.16) and 1.87 in the ILC group (95% CI = 0.97, 1.43). Negative binomial regression was used to assess total number of convictions, as well as convictions for violent, property, driving under the influence, and drug-related crimes. In both adjusted and unadjusted analyses, random assignment to ILC was associated with a lower number of total offences (incidence rate risk ratio [IRR] = 0.43, p = .013; adjusted IRR = 0.45, p < .001) and convictions related to violence (IRR = 0.19, p = .001 adjusted IRR = 0.19, p = .007) and property offences (unadjusted IRR = 0.30, p = 0.003, adjusted IRR = 0.42, p = 0.010). Differences between conditions were not significant for driving under the influence (unadjusted IRR = 0.49, p = .370; adjusted IRR = 0.53, p = .417) or drug offences (unadjusted IRR = 1.06, p = .907; adjusted IRR = 0.55, p = .223). CONCLUSIONS The ILC program shows promise in reducing offending behavior in people with comorbid substance use and antisocial personality disorder. TRIAL REGISTRATION ISRCTN registry, ISRCTN67266318 , 15/10/2012.
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Affiliation(s)
- Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000, Aarhus C, Denmark.
| | - Adriana del Palacio-Gonzalez
- grid.7048.b0000 0001 1956 2722Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000 Aarhus C, Denmark
| | - Birgitte Thylstrup
- grid.7048.b0000 0001 1956 2722Centre for Alcohol and Drug Research, Aarhus University, Bartholins Allé 10, 8000 Aarhus C, Denmark
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Wiktorsson S, Strömsten L, Renberg ES, Runeson B, Waern M. Clinical Characteristics in Older, Middle-Aged and Young Adults Who Present With Suicide Attempts at Psychiatric Emergency Departments: A Multisite Study. Am J Geriatr Psychiatry 2022; 30:342-351. [PMID: 34470715 DOI: 10.1016/j.jagp.2021.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/08/2021] [Accepted: 08/01/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To study age group differences in clinical characteristics in older, middle-aged and younger adults with actual suicide attempts (SA). DESIGN Cross-sectional cohort study. SETTING 3 Swedish university hospitals. PARTICIPANTS 821 persons who presented with self-harm at psychiatric emergency departments participated. Those with non-suicidal self-injury according to the Columbia Suicide Severity Rating Scale (C-SSRS) were excluded, leaving a total of 683 with an actual SA (18-44 years, n = 423; 45-64 years, n = 164; 65+, n = 96). MEASUREMENTS Suicidal behavior was characterized with the C-SSRS and the Suicide Intent Scale (SIS); symptoms associated with suicide were rated with the Suicide Assessment Scale (SUAS). Diagnoses were set using the Mini-International Neuropsychiatric Interview. Patients self-rated their symptoms with the Karolinska Affective and Borderline Symptoms Scale (KABOSS). RESULTS Older adults scored higher than the younger group on SIS total score and on the subjective subscale, but no age group differences were detected for the objective subscale. Half of the 65+ group fulfilled criteria for major depression, compared to 3-quarters in both the middle-aged and young groups. Anxiety disorders, as well as alcohol and substance use disorders were also less prevalent in the 65+ group, while serious physical illness was more common. Older adults scored lower on all symptom scales; effect sizes were large. CONCLUSIONS While older adults with an SA showed higher suicide intent than young adults, they had lower scores on all ratings of psychiatric symptomatology. Low ratings might interfere with clinicians' assessments of the needs of older adults with intentional self-harm.
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Affiliation(s)
- Stefan Wiktorsson
- Institute of Neuroscience (SW, MW), Department of Psychiatry, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland (SW, MW), Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden.
| | - Lotta Strömsten
- Department of Clinical Sciences (LS, ESR), Umeå University, Sweden
| | | | - Bo Runeson
- Department of Clinical Neuroscience (BR), Centre for Psychiatry Research, Karolinska Institute, and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Margda Waern
- Institute of Neuroscience (SW, MW), Department of Psychiatry, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland (SW, MW), Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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14
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Borderline personality disorder – some issues for the general practitioner. PSIHIATRU.RO 2022. [DOI: 10.26416/psih.71.4.2022.7328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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van Dam A, Rijckmans M, van den Bosch L. Explaining the willingness of clinicians to work with patients with antisocial personality disorder using the theory of planned behaviour and emotional reactions. Clin Psychol Psychother 2021; 29:676-686. [PMID: 34433227 PMCID: PMC9292584 DOI: 10.1002/cpp.2661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/15/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022]
Abstract
Many clinicians seem to experience negative emotions towards patients with antisocial personality disorder (ASPD), resulting in the exclusion of patients in many treatment programmes. The behaviour of individuals with ASPD has a significant impact on society, which affects ASPD patients and their environment, and therefore, the exclusion from programmes is a serious concern. Relatively, little is known about why some clinicians are willing to work with ASPD patients and others are not and what factors contribute to an increase in the motivation to do so. In this study, clinicians (n = 130) working in a regular and forensic mental health service in the Netherlands completed a questionnaire based on the theory of planned behaviour (TPB) and the Feeling Word Checklist and questions about the relevant experience gained and education received. The current study confirms the limited willingness to work with ASPD patients, especially in regular mental health care. Experience working with ASPD patients, education on cluster B personality disorders and having experienced verbal and/or physical violence in clinical practice did not fully explain whether or not clinicians were motivated to provide treatment to ASPD patients. TPB appeared to predict the intention to provide psychological therapy to ASPD patients adequately. The impact of positive emotions towards ASPD patients on providing treatment appeared to be stronger than negative emotions. This study provides more insight into why so few clinicians are willing to work with ASPD patients and what may increase motivation to include this group in treatment programmes.
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Affiliation(s)
- Arno van Dam
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Research and Innovation, GGZ WNB Mental Health Institute, Halsteren, Netherlands
| | - Madeleine Rijckmans
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Mental Health Institute, Innovation and Quality, GGZ Breburg, Tilburg, Netherlands.,Forensic Psychiatric Institute, Fivoor, Tilburg, Netherlands
| | - Louisa van den Bosch
- Institute for DBT Training and Treatment, Dialexis, Nijmegen, Netherlands.,Consulting in Mental Health, Synthis, Deventer, Netherlands
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16
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Therapeutic Risk Management for Violence: Chain Analysis of Other-directed Violent Ideation and Behavior. J Psychiatr Pract 2021; 27:203-211. [PMID: 33939375 DOI: 10.1097/pra.0000000000000552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Violence risk assessment is a requisite component of mental health treatment. Adhering to standards of care and ethical and legal requirements necessitates a cogent process for conducting, and then documenting, other-directed violence (ODV) risk screening, assessment, and management. In this 5-part series, we describe a model for achieving therapeutic risk management of the potentially violent patient, with essential elements involving: clinical interview augmented by structured screening or assessment tools; risk stratification in terms of temporality and severity; chain analysis to intervene on the functions of ODV ideation and behavior; and a personalized safety plan to mitigate/manage risk. In this fourth column of the series, we describe chain analysis as a critical tool for assessing and intervening on ODV ideation and behavior. We identify the pathways of reinforcement that can cause ODV to persist, and how to navigate potential barriers to completing ODV chains. Using a case example, we demonstrate how to apply chain analysis to ODV ideation and behavior and offer interventional strategies that can be used to disrupt the chain and ultimately reduce the risk for violence.
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17
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Shafti M, Taylor PJ, Forrester A, Pratt D. The Co-occurrence of Self-Harm and Aggression: A Cognitive-Emotional Model of Dual-Harm. Front Psychol 2021; 12:586135. [PMID: 33716854 PMCID: PMC7946988 DOI: 10.3389/fpsyg.2021.586135] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/29/2021] [Indexed: 11/29/2022] Open
Abstract
There is growing evidence that some individuals engage in both self-harm and aggression during the course of their lifetime. The co-occurrence of self-harm and aggression is termed dual-harm. Individuals who engage in dual-harm may represent a high-risk group with unique characteristics and pattern of harmful behaviours. Nevertheless, there is an absence of clinical guidelines for the treatment and prevention of dual-harm and a lack of agreed theoretical framework that accounts for why people may engage in this behaviour. The present work aimed to address this gap in the literature by providing a narrative review of previous research of self-harm, aggression and dual-harm, and through doing so, presenting an evidence-based theory of dual-harm – the cognitive-emotional model of dual-harm. This model draws from previous studies and theories, including the General Aggression Model, diathesis-stress models and emotional dysregulation theories. The cognitive-emotional model highlights the potential distal, proximal and feedback processes of dual-harm, the role of personality style and the possible emotional regulation and interpersonal functions of this behaviour. In line with our theory, various clinical and research implications for dual-harm are suggested, including hypotheses to be tested by future studies.
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Affiliation(s)
- Matina Shafti
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Peter James Taylor
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Andrew Forrester
- Division of Psychological Medicine and Clinical Neuroscienecs, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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18
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Honecker H, Bertsch K, Spieß K, Krauch M, Kleindienst N, Herpertz SC, Neukel C. Impact of a Mechanism-Based Anti-Aggression Psychotherapy on Behavioral Mechanisms of Aggression in Patients With Borderline Personality Disorder. Front Psychiatry 2021; 12:689267. [PMID: 34421676 PMCID: PMC8374952 DOI: 10.3389/fpsyt.2021.689267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: Aggressive behavior is highly prevalent in patients with borderline personality disorder (BPD) and represents a major burden for patients and their environment. Previous studies have hypothesized threat hypersensitivity, among other mechanisms, as a biobehavioral mechanism underlying aggressive behavior in patients with BPD. The effects of a 6-week mechanism-based anti-aggression psychotherapy (MAAP) for the group setting were tested in comparison to the effects of a non-specific supportive psychotherapy (NSSP) on this hypothesized mechanism and their relation to the effects on aggressive behavior. Methods: To assess mechanisms of reactive aggression, 38 patients with BPD (20 in MAAP and 18 in NSSP) and 24 healthy controls participated in an emotion classification task before and after therapy or at a similar interval of 7 weeks for controls, respectively. In addition, current reactive aggressive behavior was assessed by the externally directed overt aggression score of the Overt Aggression Scale Modified (OAS-M) at both time points. Mixed linear models were used to test for group differences and differential treatment effects. Results: Consistent with previous findings, patients showed longer response latencies and misclassified faces as angry more often than healthy controls. Comparing pre- and post-treatment measurements, the MAAP group showed an increase in response latency in classifying angry faces, whereas the NSSP group showed a decrease in latency. Furthermore, the difference between pre- and post-treatment response latencies in classifying emotional faces correlated with the reductions in reactive aggression in the MAAP group, but not in the NSSP group or healthy controls. Conclusion: The results suggest an impact of MAAP on threat sensitivity as well as cognitive control, which has also been previously hypothesized as a biobehavioral mechanism underlying reactive aggression in patients with BPD. In addition, our findings shed light on the importance of these two biobehavioral mechanisms underlying reactive aggression as mechanisms of change addressed by MAAP. Further studies are needed to determine whether the behavioral change is stable over time and to what extent this change is related to a stable reduction in reactive aggression in a larger group of patients with BPD.
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Affiliation(s)
- Hannah Honecker
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.,Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Karen Spieß
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Marlene Krauch
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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19
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Herpertz SC, Matzke B, Hillmann K, Neukel C, Mancke F, Jaentsch B, Schwenger U, Honecker H, Bullenkamp R, Steinmann S, Krauch M, Bauer S, Borzikowsky C, Bertsch K, Dempfle A. A mechanism-based group-psychotherapy approach to aggressive behaviour in borderline personality disorder: findings from a cluster-randomised controlled trial. BJPsych Open 2020; 7:e17. [PMID: 33308363 PMCID: PMC7791567 DOI: 10.1192/bjo.2020.131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Aggressive behaviour is a prevalent and harmful phenomenon in patients with borderline personality disorder (BPD). However, no short-term, low-cost programme exists that specifically focuses on aggression. AIMS Attuning therapy modules to pathogenetic mechanisms that underlie reactive aggression in BPD, we composed a 6 week mechanism-based anti-aggression psychotherapy (MAAP) approach for the group setting, which we tested against a non-specific supportive psychotherapy (NSSP). METHOD A cluster-randomised two-arm parallel-group phase II trial of N = 59 patients with BPD and overt aggressive behaviour was performed (German Registry for Clinical Trials, DRKS00009445). The primary outcome was the externally directed overt aggression score of the Modified Overt Aggression Scale (M-OAS) post-treatment (adjusted for pre-treatment overt aggression). Secondary outcomes were M-OAS irritability, M-OAS response rate and ecological momentary assessment of anger post-treatment and at 6 month follow-up, as well as M-OAS overt aggression score at follow-up. RESULTS Although no significant difference in M-OAS overt aggression between treatments was found post-treatment (adjusted difference in mean 3.49 (95% CI -5.32 to 12.31, P = 0.22), the MAAP group showed a clinically relevant decrease in aggressive behaviour of 65% on average (versus 33% in the NSSP group), with particularly strong improvement among those with the highest baseline aggression. Most notably, significant differences in reduction in overt aggression between MAAP and NSSP were found at follow-up. CONCLUSIONS Patients with BPD and aggressive behaviour benefited from a short group psychotherapy, with improvements particularly visible at 6 month follow-up. Further studies are required to show whether these effects are specific to MAAP.
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Affiliation(s)
- S C Herpertz
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - B Matzke
- Department of General Psychiatry, Heidelberg University Hospital, Germany; and Sana HANSE-Klinikum Wismar GmbH, Germany
| | - K Hillmann
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - C Neukel
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - F Mancke
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - B Jaentsch
- Institute of Clinical Psychology at Klinikum Stuttgart, Germany
| | - U Schwenger
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - H Honecker
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - R Bullenkamp
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - S Steinmann
- Department of Psychosomatics and Psychotherapeutic Medicine, Central Institute of Mental Health Mannheim, University of Heidelberg, Germany
| | - M Krauch
- Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - S Bauer
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany; and Center of Psychotherapy, Institute for Psychosocial Prevention, Germany
| | - C Borzikowsky
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany; and Center of Psychotherapy, Institute for Psychosocial Prevention, Germany
| | - K Bertsch
- Department of Clinical Psychology and Psychotherapy, LMU München, and Department of General Psychiatry, Heidelberg University Hospital, Germany
| | - A Dempfle
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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20
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Helle AC, Watts AL, Trull TJ, Sher KJ. Alcohol Use Disorder and Antisocial and Borderline Personality Disorders. Alcohol Res 2019; 40:arcr.v40.1.05. [PMID: 31886107 PMCID: PMC6927749 DOI: 10.35946/arcr.v40.1.05] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Alcohol use disorder (AUD) frequently co-occurs with other psychiatric disorders, including personality disorders, which are pervasive, persistent, and impairing. Personality disorders are associated with myriad serious outcomes, have a high degree of co-occurrence with substance use disorders, including AUD, and incur significant health care costs. This literature review focuses on co-occurring AUD and personality disorders characterized by impulsivity and affective dysregulation, specifically antisocial personality disorders and borderline personality disorders. Prevalence rates, potential explanations and causal models of co-occurrence, prognoses, and the status of existing treatment research are summarized. Several important future research considerations are relevant to these complex, co-occurring conditions. Research assessing mechanisms responsible for co-occurring AUD and antisocial personality disorder or borderline personality disorder will further delineate the underlying developmental processes and improve understanding of onset and courses. In addition, increased focus on the efficacy and effectiveness of treatments targeting underlying traits or common factors in these disorders will inform future prevention and treatment efforts, as interventions targeting these co-occurring conditions have relatively little empirical support.
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Affiliation(s)
- Ashley C Helle
- Ashley C. Helle, Ph.D., is a Postdoctoral fellow in the Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | - Ashley L Watts
- Ashley L. Watts, Ph.D., is a Postdoctoral fellow in the Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | - Timothy J Trull
- Timothy J. Trull, Ph.D., is a Curators' Distinguished Professor and a Byler Distinguished Professor in the Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | - Kenneth J Sher
- Kenneth J. Sher, Ph.D., is a Curators' Distinguished Professor in the Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
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