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Biberdzic M, Grenyer BF, Normandin L, Ensink K, Clarkin JF. A bifactor model of personality organization in adolescence: the validity of a brief screening measure assessing severity and core domains of functioning. BMC Psychiatry 2022; 22:459. [PMID: 35804330 PMCID: PMC9270814 DOI: 10.1186/s12888-022-03926-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/07/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Both the latest edition of the DSM-5 as well as the new ICD-11 have established a new focus in the diagnosis of personality disorders: the assessment of personality functioning. This recent shift in focus converges with long-standing psychodynamic conceptualizations of personality pathology, particularly Kernberg's object relations model. Although a significant amount of research supports these models in adults, much less is known about the validity of these frameworks in youth. Considering the paucity of brief measures of personality functioning in adolescents, the current study aimed to develop and investigate the validity of the Inventory of Personality Organization for Adolescents-Short Form, a theoretically-informed measure assessing severity and core domains of functioning in adolescents. METHODS A total sample of N = 525 adolescents aged 13 to 19 years were recruited through a community University-Health Psychology Clinic as current patients (n = 94) or who responded to an online research call (n = 431). RESULTS Results indicate that a bifactor model provided the best fit to the data and consisted of a general factor reflecting core self-other functioning and three specific factors, representing additional dimensions of personality organization. CONCLUSIONS A brief 15-item version of the IPO-A was successfully derived for time-efficient screening of personality pathology in youth. Similarities with the ICD-11 framework are discussed.
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Affiliation(s)
- M. Biberdzic
- grid.1007.60000 0004 0486 528XIllawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - B. F. Grenyer
- grid.1007.60000 0004 0486 528XIllawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - L. Normandin
- grid.23856.3a0000 0004 1936 8390Department of Psychology, Laval University, Quebec, QC Canada
| | - K. Ensink
- grid.23856.3a0000 0004 1936 8390Department of Psychology, Laval University, Quebec, QC Canada
| | - J. F. Clarkin
- grid.5386.8000000041936877XPersonality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, NY USA
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Clarkin JF, Foelsch PA, Levy KN, Hull JW, Delaney JC, Kernberg OF. The development of a psychodynamic treatment for patients with borderline personality disorder: a preliminary study of behavioral change. J Pers Disord 2001; 15:487-95. [PMID: 11778390 DOI: 10.1521/pedi.15.6.487.19190] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examines the effectiveness of a modified psychodynamic treatment called Transference Focused Psychotherapy (TFP) designed specifically for patients, with borderline personality disorder (BPD). Twenty-three female patients diagnosed with DSM-IV BPD began twice-weekly TFP. Patients were assessed at baseline and at the end of 12 months of treatment with diagnostic instruments, measures of suicidality, self-injurious behavior, and measures of medical and psychiatric service utilization. Compared to the year prior to treatment, the number of patients who made suicide attempts significantly decreased, as did the medical risk and severity of medical condition following self-injurious behavior. Compared to the year prior, study patients during the treatment year had significantly fewer hospitalizations as well as number and days of psychiatric hospitalization. The dropout rate was 19.1%. This uncontrolled study is highly suggestive that this structured and manualized psychodynamic treatment modified for borderline patients shows promise for the ambulatory treatment of these patients and warrants further study.
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Affiliation(s)
- J F Clarkin
- Personality Disorders Institute, Department of Psychiatry, Weill Medical College of Cornell University, White Plains, NY, USA.
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Perlick DA, Rosenheck RA, Clarkin JF, Sirey JA, Salahi J, Struening EL, Link BG. Stigma as a barrier to recovery: Adverse effects of perceived stigma on social adaptation of persons diagnosed with bipolar affective disorder. Psychiatr Serv 2001; 52:1627-32. [PMID: 11726754 DOI: 10.1176/appi.ps.52.12.1627] [Citation(s) in RCA: 325] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of concerns about stigma on social adaptation among persons with a diagnosis of bipolar affective disorder. METHODS The sample comprised 264 persons who were consecutively admitted to a psychiatric inpatient or outpatient service at a university-affiliated hospital and who met research diagnostic criteria for bipolar I disorder, bipolar II disorder, or schizoaffective disorder, manic type. Patients were evaluated with use of the Schedule for Affective Disorders and Schizophrenia, Lifetime Version (SADS-L), the Brief Psychiatric Rating Scale (BPRS), and a measure of perceived stigma. Social adjustment was measured at baseline and seven months later with the Social Adjustment Scale (SAS). RESULTS As predicted, patients who had concerns about stigma showed significantly more impairment at seven months on the social leisure subscale but not on the SAS extended family subscale, after baseline SAS score and symptom level had been controlled for. More refined models using SAS-derived factors as dependent variables indicated that concerns about stigma predicted higher avoidance of social interactions with persons outside the family and psychological isolation at seven-month follow-up, after baseline SAS and BPRS scores had been controlled for. CONCLUSIONS Concerns about the stigma associated with mental illness reported by patients during an acute phase of bipolar illness predicted poorer social adjustment seven months later with individuals outside the patient's family. Greater attention to patients' concerns about stigma is needed from both researchers and clinicians.
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Affiliation(s)
- D A Perlick
- Northeast Program Evaluation Center, VA Connecticut Healthcare Systems, West Haven, CT 06516, USA.
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Lenzenweger MF, Clarkin JF, Kernberg OF, Foelsch PA. The Inventory of Personality Organization: psychometric properties, factorial composition, and criterion relations with affect, aggressive dyscontrol, psychosis proneness, and self-domains in a nonclinical sample. Psychol Assess 2001; 13:577-91. [PMID: 11793901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
This report describes 2 studies of the psychometric characteristics of the primary clinical scales of the Inventory of Personality Organization (IPO; O. F. Kernberg & J. F. Clarkin, 1995), which assess reality testing, primitive psychological defenses, and identity diffusion, in a nonclinical sample. The 3 IPO scales display adequate internal consistency and good test-retest reliability. Item-level confirmatory factor analysis supported a two-factor structure of the IPO consistent with O. F. Kernberg's (1984, 1996) model of borderline personality organization. Each of the 3 IPO scales was associated with increased negative affect, aggressive dyscontrol, and dysphoria as well as lower levels of positive affect consistent with Kernberg's model of borderline personality organization. The IPO Reality Testing scale is closely related to various measures of psychotic-like phenomena.
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Abstract
Studies have suggested that family burden adversely affects clinical outcome in the major mental disorders. Logistic regression analysis was used to evaluate the effect of family burden reported at baseline (acute model), or 7 months (stabilization model), on the risk of having a subsequent affective episode, in a sample of 264 patients with Research Diagnostic Criteria-diagnosed bipolar illness. Higher levels of baseline burden and a depressive index episode significantly increased the risk for a major episode at 7 months. Higher 7-month burden significantly increased the risk for a major episode at 15 months among patients with relatively low 7-month BPRS symptom levels. Caregiver burden reported at times of symptom relapse and during stabilization predicts subsequent adverse clinical outcomes among patients with bipolar disorder and suggests a need for family support.
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Affiliation(s)
- D A Perlick
- Northeast Program Evaluation Center, Department of Veterans Affairs and the Department of Psychiatry and Epidemiology, Yale University School of Medicine, West Haven, Connecticut 06516, USA
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Clarkin JF. Personality-Guided Therapy. Psychother Res 2000. [DOI: 10.1093/ptr/10.3.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
This article is the result of a panel discussion on future directions in personality disorders held at the 1998 Meeting of the Society for Psychotherapy Research in Snowbird Utah. Three experts in the field of personality disorders were invited to participate in a dialogue on priorities and directions for research, practice, and policy in this area. Topics discussed amongst the panelists included the following: 1) relevance of psychotherapy process research for treatments of personality disorders, and potential fruitful directions for such research; 2) what has been learned from outcome research in treatment of personality disorders, and directions for such research that are likely to be most productive in improving treatments; 3) the extent to which research has influenced clinical practice and how existing gaps might be addressed; 4) policy questions related to payment for treatment of personality disorders.
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Abstract
The controversial move toward the development of a consensus on evidence-based or empirically supported therapies may be seen as an international crisis facing psychotherapists. Researchers long have complained that practicing therapists all too often continue to guide what they do therapeutically on the basis of their clinical experience and not the available research findings. Practicing therapists long have complained that therapy research bears only a remote resemblance to what goes on in actual clinical practice and that research reports are written for other researchers, not for clinicians. In the hope of turning our current crisis into an opportunity, this panel involved a dialogue that was designed to bridge this clinical-research gap.
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Affiliation(s)
- M R Goldfried
- Department of Psychology, State University of New York at Stony Brook, 11794-2500, USA
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Abstract
BACKGROUND Family members of patients with schizophrenia frequently report burdens associated with caring for their relatives. AIMS We evaluate the impact of illness beliefs on the burden reported by family care-givers of people with bipolar illness. METHOD The multivariate relationships between patient symptomatology and family illness beliefs and report of burden were examined at baseline among care-givers of 266 patients with Research Diagnostic Criteria-diagnosed bipolar illness who were subsequently followed for 15 months. RESULTS At baseline, 93% of care-givers reported moderate or greater distress in at least one burden domain. As a group, care-giver illness beliefs (illness awareness, perception of patient and family control) explained an additional 18-28% of variance in burden experienced beyond the effects of the patient's clinical state and history. CONCLUSIONS Care-givers of patients with bipolar illness report widespread burden that is influenced by beliefs about the illness.
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Affiliation(s)
- D Perlick
- Northeast Program Evaluation Center, West Haven, VAMC, CT 06516, USA
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10
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Abstract
OBJECTIVE Symptoms that were risk factors for hospital readmission among psychiatric inpatients diagnosed as having bipolar affective disorder were evaluated. METHODS Subjects were 100 persons consecutively admitted to a psychiatric inpatient unit at a university-affiliated hospital who met Research Diagnostic Criteria for bipolar I or II disorder or schizoaffective disorder, manic type. Patients were assessed using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L) and the Brief Psychiatric Rating Scale (BPRS) within one week of discharge, and their hospitalization status was documented by monthly phone contacts over a period of 15 months. RESULTS Twenty-four patients (24 percent) were rehospitalized within six months of discharge, and 44 (44 percent) were readmitted within 15 months. Survival analysis using the Cox proportional hazard regression model demonstrated that patients with high scores on a BPRS-derived mania factor were at significantly decreased risk of rehospitalization, whereas those scoring high on a factor consistent with neurovegetative depression were at significantly increased risk. A greater number of previous psychiatric admissions and younger age were also associated with significantly increased risk of rehospitalization. CONCLUSIONS The findings suggest that patients with bipolar disorder presenting with a depressive episode characterized by prominent neurovegetative features should be treated more aggressively with both pharmacotherapy and intensive outpatient services to reduce the relatively high risk of rehospitalization that appears to be associated with this type of depression.
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Affiliation(s)
- D A Perlick
- Northeast Program Evaluation Center, West Haven Veterans Affairs Medical Center, CT 06516, USA
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Abstract
The NEO Personality Inventory was given to 33 married patients with bipolar disorder. Consistent with previous findings, patients with bipolar disorder did not show an abnormal personality profile as a group. Extremely wide variation on all scales indicated that the group profile tells little about individual patients. Trait neuroticism robustly predicted psychiatric symptoms at entry to the study when assessed retrospectively for the two years prior to entry and when averaged over a year of treatment. Neuroticism also negatively predicted the self-confidence of the patients in this sample. The patients identified as outliers on neuroticism form a clinically difficult group for whom the distinction between Axes I and II appears to be less meaningful.
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Goodman G, Hull JW, Clarkin JF, Yeomans FE. Childhood antisocial behaviors as predictors of psychotic symptoms and DSM-III-R borderline criteria among inpatients with borderline personality disorder. J Pers Disord 1999; 13:35-46. [PMID: 10228925 DOI: 10.1521/pedi.1999.13.1.35] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Structured clinical interviews of 107 female inpatients diagnosed with borderline personality disorder (BPD) were used to determine whether antisocial personality disorder (APD) diagnostic criteria evident prior to age 15 could be used to predict current Axis I and Axis II psychopathology. Diagnostic information was gathered using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). Childhood APD criteria were subjected to principal-components analysis, and three factors--rule-breaking, assault, and sadism--emerged. The severity of the childhood APD criteria was related to psychotic symptoms, as well as to the unstable relationships and labile affect BPD criteria and the current overall severity of BPD criteria. Sadism predicted psychotic symptoms and BPD severity, while rule-breaking predicted unstable relationships and BPD severity. Childhood APD severity also had a larger effect on BPD severity than on psychotic symptoms. Possible explanations for these findings are explored and discussed.
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Affiliation(s)
- G Goodman
- Department of Psychiatry, Cornell University Medical College
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Affiliation(s)
- T E Smith
- Department of Psychiatry, Weill Medical College of Cornell University, New York, New York, USA
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Abstract
This study compares the efficacy of two time-limited group psychotherapies for depression and functional disability in late life. Goal-focused group psychotherapy (GFGP) utilized focused psychoeducation and skills training to assist each patient in the achievement of individualized goals. Reminiscence therapy (RT) emphasized individual life review to facilitate discussion. Subjects (N = 13), ages 55 and above, with major depression were randomly assigned to one of the two groups. Most were receiving antidepressant treatment. All had failed to achieve full remission. Whereas both treatment groups improved in depressed mood and disability, GFGP subjects had a far greater change in depressive symptomatology and also improved in the areas of hope, hopelessness, anxiety and social functioning.
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Affiliation(s)
- E J Klausner
- New York Hospital-Cornell Medical Center, White Plains 10605, USA
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15
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Abstract
Structured clinical interviews of 63 female inpatients diagnosed with borderline personality disorder were used to study the relations of comorbid mood disorders to treatment response. Diagnostic information was gathered using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). Information about psychotic symptoms was also based upon responses to the SCID-P. Treatment response was assessed through weekly ratings on the Symptom Checklist-90-Revised over 25 weeks of hospitalization. Initial depression but not initial or previous bipolar disorder was found to predict treatment course. Initial psychotic symptoms were also found to predict treatment course among patients with initial bipolar disorder and tended to modify the trajectory of symptoms over time among patients with initial depression. Possible explanations for these findings are explored and discussed.
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Affiliation(s)
- G Goodman
- Department of Psychiatry, Cornell University Medical College, White Plains, New York 10605, USA
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16
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Abstract
The relative benefit of adding a structured psychoeducational intervention to standard medication treatment for married patients with bipolar disorder and their spouses was assessed. Patients were randomly assigned to receive either medication management or medication management plus a marital intervention with their spouses for an 11-month period. Patients' symptoms, functioning, and adherence to their medication regimens were measured at study entry and at 11 months. Significant effects favoring the combined treatments were observed for overall patient functioning but not for symptom levels. The marital intervention was associated with improved medication adherence. Combined psychosocial and medication treatment does not affect patients' symptom levels beyond the effects of medication alone, but it does result in significant incremental gains in overall patient functioning.
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Affiliation(s)
- J F Clarkin
- Cornell University Medical College, New York Hospital-Cornell Medical Center, White Plains 10605, USA. JClarkin%
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17
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Affiliation(s)
- J F Clarkin
- Psychology Office, New York Hospital, White Plains, New York 10605, USA
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Abstract
This article reviews the empirical evidence supporting the role of psychotherapy and psychosocial interventions in the treatment of patients with depression. Treatment models and the evidence for their effectiveness in the acute-and maintenance-treatment phases are reviewed. Whereas the sophistication of research designs and data analysis for the study of psychotherapy have substantially improved, the review highlights current gaps in our knowledge. Most important for reform of the health care system is the need for studies of efficacy to lead to large-scale investigations of effectiveness.
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Affiliation(s)
- J F Clarkin
- Department of Psychiatry, New York Hospital-Cornell University Medical College Westchester Division, White Plains, USA
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Abstract
The comorbidity of DSM-III-R axis II personality disorders in patients with bipolar disorder has received less attention than for unipolar depression perhaps because of the potential confounding of state vs. trait qualities. The current study took steps to separate pathological traits of personality from behaviors evidenced during discrete affective episodes in a sample of married, outpatient bipolar patients. Data indicated that 22% of our patients met criteria for a categorical diagnosis of personality disorder. Axis II pathology as represented by both categorical and dimensional scores was associated with increased psychiatric symptoms during subsequent treatment and poorer social adjustment.
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Affiliation(s)
- D Carpenter
- Department of Psychiatry, Cornell University Medical College, White Plains, NY, USA
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Perlick D, Clarkin JF, Sirey JA. Caregiver burden. Psychiatr Serv 1995; 46:836. [PMID: 7583491 DOI: 10.1176/ps.46.8.ps468836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Clarkin JF. Are case formulations useful for outcomes research? Arch Gen Psychiatry 1995; 52:645; discussion 654-6. [PMID: 7632115 DOI: 10.1001/archpsyc.1995.03950200035008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J F Clarkin
- Department of Psychiatry, Cornell Medical Center, White Plains, NY 10605, USA
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Glick ID, Dulit RA, Wachter E, Clarkin JF. The family, family therapy, and borderline personality disorder. J Psychother Pract Res 1995; 4:237-246. [PMID: 22700254 PMCID: PMC3330391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/16/1993] [Revised: 06/27/1994] [Accepted: 07/12/1994] [Indexed: 06/01/2023]
Abstract
The authors review recent controlled studies on the interrelationship of the family and its members with borderline disorder and propose a new model for understanding and managing this relationship. The focus of the model is on psychopathology, evaluation, and treatment of patient and family as they influence each other. In the authors' view this illness originates in cerebral dysfunction, in the patient in combination with impaired relationships among family members. When the family is available, we believe that the treatment of choice is a multimodal approach involving family psychoeducation and family systems or dynamic intervention where possible, in combination with medications, individual psychotherapy, or both.
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Affiliation(s)
- I D Glick
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5546
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Smith TE, Koenigsberg HW, Yeomans FE, Clarkin JF, Selzer MA. Predictors of dropout in psychodynamic psychotherapy of borderline personality disorder. J Psychother Pract Res 1995; 4:205-213. [PMID: 22700251 PMCID: PMC3330395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/18/1994] [Revised: 08/11/1994] [Accepted: 08/23/1994] [Indexed: 06/01/2023]
Abstract
This study aimed to identify patient factors that predict early dropout from psychodynamic psychotherapy for borderline personality disorder (BPD). Thirty-six BPD patients began an open-ended course of twice per week psychodynamic psychotherapy that was defined in a treatment manual and supervised. Dropout rates were 31% and 36% at 3 and 6 months of therapy, respectively. Survival analysis techniques demonstrated that age and hostility ratings predicted early dropout, with continuers more likely to be older and expressing lower levels of hostility than dropouts. Many variables hypothesized to predict dropout failed to do so. Both the positive and negative findings are discussed relative to the literature.
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Affiliation(s)
- T E Smith
- Department of Psychiatry, Cornell University Medical College, and the New York Hospital, Westchester Division, New York
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Abstract
This article tests the hypothesis that psychiatric inpatients at high risk for presenting difficulties in aftercare planning can be accurately identified on admission to an inpatient unit. A 16-item high-risk screening list is presented that was developed through an earlier analysis of discharge-delayed cases in a psychiatric hospital. The capacity of the list to accurately predict high-risk status was tested by comparing admission and discharge high-risk scores for 448 patients with a range of psychiatric disorders. Sixty-six percent of the patients rated high risk at admission were identically rated at discharge. Differences among risk groups were also found with respect to key demographic variables. The high-risk screen permits early identification of patients who will require immediate and intensive environmental interventions. Such data are critical to psychiatric social work in preventing overstays and in deploying department resources with maximum effectiveness.
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Affiliation(s)
- W R Christ
- New York Hospital-Westchester Division, Cornell Medical Center, White Plains 10605
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Abstract
This study investigated the construct validity of two dietary restraint subscales, flexible control (FC) and rigid control (RC), identified by Westenhoefer (1991; Appetite, 16, 45-55) as a subset of the restraint scale items from the Three-Factor Eating Questionnaire (TFEQ, Stunkard & Messick. [1985]. Journal of Psychosomatic Research, 29, 71-83). The subjects were 31 women on long-term personality disorder units. Based on the Structured Clinical Interview for DSM-III-R (SCID), 68% has past anorexia and/or bulimia diagnoses and 94% were borderline. The subjects completed the TFEQ and supplied weight and height data for body mass index (BMI) calculations. The results supported the validity of the two restraint constructs by showing that FC was inversely related to BMI and predicted an anorexia diagnosis. In contrast, RC directly predicted BMI when tested concurrently with FC. RC was also more associated with a history of bulimia and problems with weight fluctuations than FC was. Thus, the FC-RC distinction was valid and useful in this population of women.
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Affiliation(s)
- E N Shearin
- New York Hospital-Cornell Medical Center, Westchester Division, White Plains 10605
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Yeomans FE, Gutfreund J, Selzer MA, Clarkin JF, Hull JW, Smith TE. Factors Related to Drop-outs by Borderline Patients : Treatment Contract and Therapeutic Alliance. J Psychother Pract Res 1994; 3:16-24. [PMID: 22700170 PMCID: PMC3330357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/30/1993] [Revised: 08/24/1993] [Accepted: 09/08/1993] [Indexed: 06/01/2023]
Abstract
High patient drop-out rates have traditionally interfered with both treatment and study of patients with borderline personality disorder (BPD). The authors tested hypotheses that an adequate treatment contract, a positive therapeutic alliance, and the severity of illness would all correlate with continuation of treatment versus drop-out in a BPD cohort receiving psychodynamic psychotherapy. Therapists' contributions to the contract and to the alliance correlated with the length of treatment. Patients' impulsivity was negatively related to length of treatment. This study supports the view that the therapist's technique plays a role in engaging the borderline patient to remain in treatment.
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Affiliation(s)
- F E Yeomans
- Department of Psychiatry, Cornell University Medical College, and the New York Hospital, Westchester Division
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27
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Clarkin JF, Hull J, Yeomans F, Kakuma T, Cantor J. Antisocial traits as modifiers of treatment response in borderline inpatients. J Psychother Pract Res 1994; 3:307-312. [PMID: 22700198 PMCID: PMC3330371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 12/28/1993] [Revised: 05/11/1994] [Accepted: 05/17/1994] [Indexed: 06/01/2023]
Abstract
The relationship of antisocial traits to treatment response in 35 female inpatients with borderline personality disorder was studied. Antisocial traits were measured with the Personality Assessment Inventory. Treatment response was measured by weekly ratings on the Symptom Checklist-90-Revised over 25 weeks of hospitalization. Treatment course was found to be significantly associated with the level of antisocial behavior reported at admission.
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Affiliation(s)
- J F Clarkin
- Department of Psychiatry, Cornell University Medical College, and Westchester Division, The New York Hospital
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28
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Abstract
Twenty-seven female inpatients with borderline personality disorder were assigned to two groups on the basis of whether they did (N = 14) or did not (N = 13) report experiencing pain during self-injurious episodes. Ratings of depression, anxiety, impulsiveness, dissociation, and trauma symptoms were higher in the women who did not experience pain while injuring themselves, as were the number of suicide attempts and the prevalence of childhood sexual abuse.
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Affiliation(s)
- M J Russ
- Department of Psychiatry, New York Hospital-Cornell Medical Center/Westchester Division, White Plains 10605
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Affiliation(s)
- J W Hull
- Department of Psychiatry, Cornell University Medical College, New York
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30
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Glick ID, Clarkin JF, Haas GL, Spencer JH. Clinical significance of inpatient family intervention: conclusions from a clinical trial. Hosp Community Psychiatry 1993; 44:869-73. [PMID: 8225301 DOI: 10.1176/ps.44.9.869] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To test whether the statistically significant results of a randomized clinical trial of an inpatient family intervention were clinically significant for hospital practice, the authors reanalyzed outcome data using a measure of clinical significance based on the extent to which patients had recovered during the course of the intervention. METHODS A total of 169 hospitalized subjects and their families were randomly assigned to a psychoeducational inpatient family intervention or to a comparison group. Patient and family outcome measures were assessed at admission, discharge, and six and 18 months after admission. Analyses of statistically significant differences in outcome suggested that inpatient family intervention was effective for certain patient subgroups identified by gender and diagnosis. Global Assessment Scale scores two or more standard deviations above the pretreatment (admission) mean were used as indicators for clinically significant improvement. RESULTS The reanalysis confirmed that inpatient family intervention was associated with clinically significant improvement at discharge, especially for female patients and patients with chronic schizophrenia and bipolar disorder. These effects were maintained six months after admission before attenuating at 18 months. CONCLUSIONS Inpatient family intervention results in clinically meaningful outcomes for certain subgroups of patients and their families.
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Affiliation(s)
- I D Glick
- Payne Whitney Clinic, Cornell University Medical College, New York, New York 10021
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Abstract
This study examined the course of 40 hospitalized female borderline personality disorder patients over 25 weeks of inpatient treatment. Course was measured through weekly administration of the SCL-90-R. Level of identity and interpersonal problems, hypothesized by Kernberg to be at the center of the borderline patient's pathology, were found to be powerful predictors of treatment course. Patients with the most severe identity and interpersonal problems reported more symptoms throughout treatment and increasing symptom levels over time. This was very different from patients with the lowest level of identity and interpersonal problems, who reported fewer symptoms overall and decreasing symptoms over time.
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Affiliation(s)
- J W Hull
- Department of Psychiatry, New York Hospital-Cornell Medical Center, Westchester Division, White Plains 10605
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32
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Abstract
This paper illustrates the advantages of time series analysis in documenting treatment effects through a case study of a trial of fluoxetine in a borderline woman being treated in a long-term inpatient unit for severe personality disorders. Data consisted of weekly self-reports of symptomatology over 58 weeks of hospitalization. Intervention analysis carried out after the patient was discharged documented the effectiveness of the medication and the differential timing of response in individual symptoms.
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Affiliation(s)
- J W Hull
- New York Hospital-Cornell Medical Center, Westchester Division, White Plains 10605
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33
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Clarkin JF, Kendall PC. Comorbidity and treatment planning: summary and future directions. J Consult Clin Psychol 1992; 60:904-8. [PMID: 1460151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This summary blends the commentaries from the 6 articles in the special section on comorbidity. Included is a discussion of various definitions of comorbidity, the merits and demerits of a hierarchical diagnostic system, and consideration of the extent, patterning, and nature of comorbidity. Directive comments with reference to future intervention planning mention both assessment (distinguishing overlapping constructs) and treatment (sequencing and treatment manuals) issues.
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Affiliation(s)
- J F Clarkin
- Cornell University Medical College, New York
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34
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Kendall PC, Clarkin JF. Introduction to special section: comorbidity and treatment implications. J Consult Clin Psychol 1992; 60:833-4. [PMID: 1460146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article initiates the special section on comorbidity and treatment implications. The presence of comorbidity is recognized, the multiple meanings of comorbidity are mentioned, and an invitation for much-needed research on comorbidity and related treatment is extended.
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Affiliation(s)
- P C Kendall
- Department of Psychology, Temple University, Philadelphia, Pennsylvania 19122
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35
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Yeomans FE, Clarkin JF, Altschul E, Hull JW. The role of figurative language in the induction phase of an expressive psychotherapy. J Psychother Pract Res 1992; 1:270-279. [PMID: 22700103 PMCID: PMC3330295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/17/1991] [Revised: 07/24/1991] [Accepted: 07/29/1991] [Indexed: 06/01/2023]
Abstract
Figurative language has long been recognized as playing a role in psychotherapy, mostly in terms of interpreting "within the patient's metaphor." The therapist's use of metaphor has been less studied. The authors examine figurative language used by a therapist in psychodynamic psychotherapy with a borderline patient. Hypotheses that figures of speech are more frequent in interpretations than in other types of therapist interventions and that a high percentage of interpretations contain figurative language were supported. The discussion considers how figurative language may aid in gaining access to defended-against material and in communicating concepts in a personalized way to the patient.
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Affiliation(s)
- F E Yeomans
- Department of Psychiatry, the New York Hospital, Cornell University Medical Center, Westchester Division, White Plains, New York
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36
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Abstract
The authors review clinical and empirical studies on the effectiveness of group treatments and family-marital treatments for borderline patients. These studies support the use of the group format in treating borderline patients, but no empirical study has examined whether group treatment combined or sequenced with individual treatment, or individual treatment alone, is better than group treatment alone. Empirical studies of family interventions with borderline patients are lacking, but further research is warranted, since many studies have shown that family pathology, especially physical and sexual abuse, is related to the development of borderline pathology.
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37
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Glick ID, Spencer JH, Clarkin JF, Haas GL, Lewis AB, Peyser J, DeMane N, Good-Ellis M, Harris E, Lestelle V. A randomized clinical trial of inpatient family intervention. IV. Followup results for subjects with schizophrenia. Schizophr Res 1990; 3:187-200. [PMID: 2278982 DOI: 10.1016/0920-9964(90)90036-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This is the last of a series of four papers, here focussing on schizophrenia, which report followup data up to 18 months from a randomized clinical trial of a psychoeducational family intervention (IFI), which was added to medication and limited to the inpatient phase of treatment, after which post-hospital care was not controlled. Our data suggested that patients with poor prehospital functioning (i.e., the chronic patients) may benefit from inpatient family intervention, but this therapeutic effect appears to be limited to females and does not appear until 18 months postadmission. Families of patients with schizophrenia also show benefit from having received IFI, the effect is seen earlier than with the patients, and is associated with achieving the goals of IFI. The results in the IFI group could not be accounted for by improved post-hospital medication compliance, but they may be related to this group's greater tendency to obtain further family treatment after discharge.
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Affiliation(s)
- I D Glick
- Payne Whitney Clinic, New York Hospital, Cornell University Medical College, New York, NY 10021
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38
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Clarkin JF, Glick ID, Haas GL, Spencer JH, Lewis AB, Peyser J, DeMane N, Good-Ellis M, Harris E, Lestelle V. A randomized clinical trial of inpatient family intervention. V. Results for affective disorders. J Affect Disord 1990; 18:17-28. [PMID: 2136866 DOI: 10.1016/0165-0327(90)90113-m] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This paper reports the results at follow-up of a randomized clinical trial of combining family intervention with drug treatment during hospitalization for patients with affective disorder. The results suggest that female bipolar patients and their families benefited from family intervention, whereas unipolar patients and families did not. Patient outcome was positively correlated with the achievement of the goals of family intervention.
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Affiliation(s)
- J F Clarkin
- Department of Psychiatry, Cornell University Medical College, New York, NY
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39
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Abstract
Several studies document sex differences in premorbid and intermorbid role functioning, showing less functional deficit among females. The specific nature of sex differences in role functioning is still poorly understood. The purpose of the present study was to investigate sex differences in symptomatology and role functioning in a sample of 92 inpatients hospitalized for an episode of DSM-III-diagnosed schizophrenic disorder. Patients were randomized at hospital admission to either of two treatment conditions: (1) multimodal hospital treatment with the addition of an inpatient family intervention (IFI) or (2) multimodal hospital treatment without IFI. Results indicated (1) sex differences in levels of substance abuse and antisocial behavior (worse for males both at admission and followup)--dimensions of psychopathology unrelated to the core features of schizophrenia; (2) superior family and occupational functioning in females at followup; and (3) superior clinical response of females to IFI. Data on family response to IFI suggest some ameliorative effects of IFI on critical family attitudes toward female patients as well as greater family compliance with IFI treatment among the families of females. Sex differences in intermorbid family and occupational functioning and response to a family-based psychosocial intervention are discussed in light of data on rejecting family attitudes toward the patient and sex differences in symptomatology. The possible influence of sex-differentiated social role demands on response to IFI is also discussed.
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Affiliation(s)
- G L Haas
- Payne Whitney Clinic, Cornell University Medical College, New York, NY 10021
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40
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Spencer JH, Glick ID, Haas GL, Clarkin JF, Lewis AB, Peyser J, DeMane N, Good-Ellis M, Harris E, Lestelle V. A randomized clinical trial of inpatient family intervention, III: Effects at 6-month and 18-month follow-ups. Am J Psychiatry 1988; 145:1115-21. [PMID: 3046383 DOI: 10.1176/ajp.145.9.1115] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This paper focuses on the follow-up results of a randomized clinical trial of inpatient family intervention (IFI) that emphasized psychoeducation. Results for the sample of 169 psychiatric patients suggested that adding family treatment to standard hospital treatment was effective; however, the statistical interactions indicated that this therapeutic effect was restricted to female patients with schizophrenia or major affective disorder. The effect of family treatment on male patients with these diagnoses was minimal or slightly negative. In a group of patients with other diagnoses, the Treatment by Sex effect was reversed: male patients did better with the family treatment.
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Affiliation(s)
- J H Spencer
- Payne Whitney Clinic, New York Hospital, Cornell University Medical College, New York, NY 10021
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41
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Haas GL, Glick ID, Clarkin JF, Spencer JH, Lewis AB, Peyser J, DeMane N, Good-Ellis M, Harris E, Lestelle V. Inpatient family intervention: a randomized clinical trial. II. Results at hospital discharge. Arch Gen Psychiatry 1988; 45:217-24. [PMID: 3277578 DOI: 10.1001/archpsyc.1988.01800270025003] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Although family intervention is practiced in most psychiatric hospitals, to our knowledge, no adequately controlled studies of its efficacy exist. This study was designed to answer, in part, the question of the relative efficacy of hospitalization with family intervention as compared with hospitalization without family intervention for patients (1) with major psychiatric disorders, (2) in need of hospital treatment, and (3) for whom both treatments are judged clinically feasible. This article compares treatment results at the time of hospital discharge for 169 patients randomly assigned to the inpatient Family Intervention or comparison conditions. Inpatient Family Intervention had greater efficacy than the comparison treatment, mostly attributable to its effect on female patients, especially those patients (and their families) with affective disorder.
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Affiliation(s)
- G L Haas
- Payne Whitney Clinic, New York Hospital-Cornell Medical Center, New York, NY 10021
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42
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Abstract
The effect of therapeutic alliance on treatment outcome in a stratified sample of 96 hospital inpatients was assessed by means of a 6-point alliance scale as well as by demographic, treatment history, and psychopathological data. Alliance was correlated with improvement at discharge but not with demographic or prior treatment characteristics. Symptom patterns and personality dysfunction were shown to be differentially related to the quality of the alliance. Patients with axis I substance abuse, adjustment, and somatoform disorders had the poorest alliance and the poorest outcomes. The authors generated a model to predict outcome of hospital treatment, using patient alliance ratings, axis I and II diagnoses and their combinations, and admission Global Assessment Scale scores.
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43
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Hurt SW, Clarkin JF, Koenigsberg HW, Frances A, Nurnberg HG. Diagnostic interview for borderlines: psychometric properties and validity. J Consult Clin Psychol 1986. [PMID: 3700815 DOI: 10.1037//0022-006x.54.2.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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44
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Hurt SW, Clarkin JF, Koenigsberg HW, Frances A, Nurnberg HG. Diagnostic Interview for Borderlines: Psychometric properties and validity. J Consult Clin Psychol 1986; 54:256-60. [PMID: 3700815 DOI: 10.1037/0022-006x.54.2.256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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45
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Frances A, Clarkin JF. Considering family versus other therapies after a teenager's suicide attempt. Hosp Community Psychiatry 1985; 36:1041-2, 1046. [PMID: 4054858 DOI: 10.1176/ps.36.10.1041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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46
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Glick ID, Clarkin JF, Spencer JH, Haas GL, Lewis AB, Peyser J, DeMane N, Good-Ellis M, Harris E, Lestelle V. A controlled evaluation of inpatient family intervention. I. Preliminary results of the six-month follow-up. Arch Gen Psychiatry 1985; 42:882-6. [PMID: 3899049 DOI: 10.1001/archpsyc.1985.01790320054007] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although family intervention is practiced in most psychiatric hospitals, there are no adequately controlled studies of its efficacy. This study was designed to answer, in part, the following question: What is the relative efficacy of hospitalization with family intervention as compared with hospitalization without family intervention for patients with major psychiatric disorders who are in need of hospital treatment and for whom both treatments are judged clinically feasible? This is our first report, presenting preliminary data on six-month follow-up for the first three quarters of the total sample of 144 patients (80 with schizophrenic disorder and 64 with major affective disorder).
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47
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Abstract
This study explores the discriminant validity of the MMPI in relationship to the DSM-III and the Diagnostic Interview for Borderlines (DIB) constructs of Borderline Personality Disorder (BPD). A two-way analysis of variance model assessed differences between inpatients (n = 42) and outpatients (n = 42) and between BPD and nonBPD patients. We compare the best discriminant model for the current samples with previous BPD discriminant functions. The present study assesses a wider range of psychopathology in which the MMPI appears to be relatively insensitive to the BPD construct while retaining the high specificity reported in previous studies. Implications for the use of the MMPI as a diagnostic instrument are discussed.
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48
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Hurt SW, Hyler SE, Frances A, Clarkin JF, Brent R. Assessing borderline personality disorder with self-report, clinical interview, or semistructured interview. Am J Psychiatry 1984; 141:1228-31. [PMID: 6486257 DOI: 10.1176/ajp.141.10.1228] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The authors compared three methods of assessing borderline personality disorders. Test-retest reliability for the self-report Personality Diagnostic Questionnaire was adequate and compared favorably with the interrater reliability of the DSM-III-oriented clinical interview and the semistructured research interview. The overall prevalence of personality disorders scored on the questionnaire was similar to that generated by the clinical interview. The specificity and sensitivity of the questionnaire for the diagnosis of borderline personality disorder were slightly higher than 60%, which suggests that it may be a useful and economical instrument for identifying patients with borderline personality disorder.
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49
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Abstract
This study critiques and extends the DSM-III use of fixed and explicit criteria by applying principles and statistics common within actuarial decision theory (eg, conditional probabilities). The value and limitations of sensitivity and specificity rates are discussed and compared with an interesting but rarely used statistic, positive predictive power. The statistics and analyses provided herein also provide an empirical method for developing diagnostic criteria and determining when and how the DSM-III cutoff points might be adjusted, recognize the importance of base rates and utilities to efficient diagnosis, and provide an explicit, quantitative means by which to make optimal differential diagnoses and to make use of the overlap among psychiatric diagnoses. The issues are illustrated in the differential diagnosis of the Borderline Personality Disorder, but they have a relevance to the development and application of the other DSM-III diagnoses.
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50
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Frances A, Clarkin JF, Gilmore M, Hurt SW, Brown R. Reliability of criteria for borderline personality disorder: a comparison of DSM-III and the Diagnostic Interview for Borderline Patients. Am J Psychiatry 1984; 141:1080-4. [PMID: 6465385 DOI: 10.1176/ajp.141.9.1080] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The authors compared the reliability of two methods of distinguishing borderline personality disorder--DSM-III and the Diagnostic Interview for Borderline Patients. The reference group, outpatients with other personality disorders and without major axis I pathology, was more difficult to distinguish from the patients with borderline personality disorder than such groups used in previous samples. The sensitivity and specificity of the Diagnostic Interview for Borderline Patients were calculated, with DSM-III used as a criterion. The findings confirm considerable overlap between borderline and schizotypal personality disorders, more impairment in functioning in borderline patients than in those with other personality disorders, and the high reliability with which borderline personality disorder can be diagnosed.
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