The objective of this study was to ascertain changes in symptoms of patients with borderline personality disorder undergoing psychodynamic day treatment with a duration of 9 months and the factors that predict clinical outcome or dropouts from the program.In an observational study, demographic characteristics (age, number of psychiatric hospitalizations, number of suicide attempts, current involvement in work or study activities), day doses of antipsychotic and antidepressant medication, psychiatric symptoms, and social functioning (Health of the Nation Outcome Scales), and symptoms of dissociation (Dissociative Experiences Scale) were assessed in patients at the beginning of treatment (N = 105). Further, psychiatric symptoms and social functioning were assessed at 3 stages: beginning of the program, end of the program, and 1-year follow-up. To study the differences between baseline values and values at the end of the treatment and follow-up values, the Wilcoxon signed-rank test was used. To discover baseline factors related to the effect of the treatment, Spearman correlation coefficients were calculated. To evaluate the differences between patients who completed the program (N = 67) and patients who dropped out (N = 38), differences in baseline factors between both groups were compared, using the Mann-Whitney test for independent samples.Improvement in symptoms (Health of the Nation Outcome Scales - version for external evaluators) at the end of the therapy (N = 67, P < .001) and at the 1-year follow-up (N = 46, P < .001) was found. Experience of an intimate relationship was positively related to clinical improvement at follow-up examinations (P < .001). Predictors of dropout included a higher number of psychiatric hospitalizations (P = .004), suicide attempts (P = .004), more severe pretreatment symptoms (P = .002), and symptoms of dissociation (P = .046).The results indicate that a psychodynamic day treatment is feasible for the treatment of less clinically disturbed patients with a history of intimate relationships. Patients with a higher number of previous psychiatric hospitalizations, more suicide attempts in the past, more severe pretreatment symptoms, and symptoms of dissociation are more likely not to complete the program.

Center for Neuropsychiatric Research of Traumatic Stress Department of Psychiatry and UHSL 1st Faculty of Medicine and Department of Psychiatry Faculty of Medicine Pilsen Charles University

ESET Psychotherapeutic and Psychosomatic Clinic Prague Czech Republic

Zobrazit více v PubMed

Gunderson JG. Clinical practice. Borderline personality disorder. N Engl J Med 2011;364:2037–42. PubMed

Stoffers JM, Völlm BA, Rücker G, et al. . Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2012;2012:CD005652. PubMed PMC

Kallert TW, Glöckner M, Priebe S, et al. . A comparison of psychiatric day hospitals in five European countries. Implications of their diversity for day hospital research. Soc Psychiatry Psychiatr Epidemiol 2004;39:777–88. PubMed

Bateman A, Fonagy P. Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999;156:1563–9. PubMed

Bateman A, Fonagy P. Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry 2001;158:36–42. PubMed

Antonsen BT, Kvarstein EH, Urnes Ø, et al. . Favorable outcome of long-term combined psychotherapy for patients with borderline personality disorder: six-year follow-up of a randomized study. Psychother Res 2017;27:51–63. PubMed

Arnevik E, Wilberg T, Urnes Ø, et al. . Psychotherapy for personality disorders: Short-term day hospital psychotherapy versus outpatient individual therapy - a randomized controlled study. Eur Psychiatry 2009;24:71–8. PubMed

Barnicot K, Katsakou C, Bhatti N, et al. . Factors predicting the outcome of psychotherapy for borderline personality disorder: a systematic review. Clin Psychol Rev 2012;32:400–12. PubMed

Bohus M, Haaf B, Simms T, et al. . Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behav Res Ther 2004;42:487–99. PubMed

Kleindienst N, Limberger MF, Ebner-Priemer UW, et al. . Dissociation predicts poor response to dialectal behavioral therapy in female patients with borderline personality disorder. J Pers Disord 2011;25:432–47. PubMed

Bateman A, Fonagy P. Impact of clinical severity on outcomes of mentalisation-based treatment for borderline personality disorder. Br J Psychiatry 2013;203:221–7. PubMed

Kvarstein EH, Pedersen G, Folmo E, et al. . Mentalization-based treatment or psychodynamic treatment programmes for patients with borderline personality disorder - the impact of clinical severity. Psychol Psychother 2019;92:91–111. PubMed PMC

Sahin Z, Vinnars B, Gorman BS, et al. . Clinical severity as a moderator of outcome in psychodynamic and dialectical behavior therapies for borderline personality disorder. Personal Disord 2018;9:437–46. PubMed

Korzekwa MI, Dell PF, Links PS, et al. . Dissociation in borderline personality disorder: a detailed look. J Trauma Dissociation 2009;10:346–67. PubMed

Zanarini MC, Frankenburg FR, Jager-Hyman S, et al. . The course of dissociation for patients with borderline personality disorder and Axis II comparison subjects: a 10-year follow up. Acta Psychiatr Scand 2008;118:291–6. PubMed PMC

Zanarini MC, Jager-Hyman S. Dell PF, O’Neil JA. Dissociation in borderline personality disorder. Dissociation and the Dissociative Disorders. DSM-V and Beyond. New York, NY: Routledge; 2009. 487–93.

Spitzer C, Barnow S, Freyberger HJ, et al. . Dissociation predicts symptom-related treatment outcome in short-term inpatient psychotherapy. Aust N Z J Psychiatry 2007;41:682–7. PubMed

Lagerlöf S, Sigrell B. A Discussion of models for the selection of patients for supervised psychoanalysis. J Clin Psychoanal 1999;8:149–72.

Kernberg OF. Identity: recent findings and clinical implications. Psychoanal Q 2006;75:969–1003. PubMed

Karterud S, Pedersen G, Bjordal E, et al. . Day treatment of patients with personality disorders: experiences from a Norwegian treatment research network. J Pers Disord 2003;17:243–62. PubMed

Ogrodniczuk JS, Joyce AS, Lynd LD, et al. . Predictors of premature termination of day treatment for personality disorder. Psychother Psychosom 2008;77:365–71. PubMed

Barnicot K, Katsakou C, Marougka S, et al. . Treatment completion in psychotherapy for borderline personality disorder - a systematic review and meta-analysis. Acta Psychiatr Scand 2011;123:327–38. PubMed

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed (Text Revised). New York: American Psychiatric Association; 2001

First MB, Gibbon M, Spitzer RL, et al. . Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, DC: American Psychiatric Press, Inc; 1997.

World Health Organization. International Statistical Classification of Diseases and Related Health Problems (10th revision, edition 2010). Geneva: World Health Organization; 2010

Raven JC. Guide to the Standard Progressive Matrices. London, UK: HK Lewis; 1960.

Atkins M, Burgess A, Bottomley C, et al. . Chlorpromazine equivalents: a consensus of opinion for both clinical and research applications. Psychiatric Bulletin 1997;21:224–6.

Hayasaka Y, Purgato M, Magni LR, et al. . Dose equivalents of antidepressants: Evidence-based recommendations from randomized controlled trials. J Affect Disord 2015;180:179–84. PubMed

Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry 2003;64:663–7. PubMed

Behr H, Hearst L. Behr H, Hearst L. The symptom in its group context. Group-analytic Psychotherapy. A Meeting of Minds. London, UK: Whurr; 2005. 66–80.

Lappalainen PH. Conflicts as triggers of personal growth: post-traumatic growth in the organizational setup. SciMed 2019;1: doi: 10.28991/SciMedJ-2019-0103-2

Mohd-Nor N, Bit-Lian Y, Knowledge. Attitude and practices of standard precaution among nurses in Middle-East Hospital. SciMed 2019;1: doi: 10.28991/SciMedJ-2019-0104-4

Wing JK, Curtis RH, Beevor AS. HoNOS: Health of the Nation Outcome Scales: Report on Research and Development July 1993-December 1995. London, UK: Royal College of Psychiatrists; 1996.

Barbato A, Agnetti G, D’Avanzo B, et al. . Outcome of community-based rehabilitation program for people with mental illness who are considered difficult to treat. J Rehabil Res Dev 2007;44:775–84. PubMed

Pec O, Cechova D, Pecova J, et al. . HoNOS (Health of the Nations Outcome Scales) - an adaptation of the tool for the assessment of symptoms and social functions in serious mentally ill in the Czech conditions and its use. [HoNOS (Hodnocení zdravotního stavu) - adaptace nástroje na hodnocení symptom a sociálních funkcí u závažně duševně nemocných v českých podmínkách a jeho použití]. Ceska Slov Psychiatr 2009;105:245–9.

Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986;174:727–35. PubMed

Waller NG, Putnam FW, Carlson EB. Types of dissociation and dissociative types: a taxometric analysis of dissociative experiences. Psychol Methods 1996;1:300–21.

Bob P. Dissociation processes and their measurement. [Disociativni procesy a jejich mereni] Ceska Slov Psychiatr 2000;96:301–9.

Ptacek R, Bob P, Paclt I. Dissociative experiences scale - Czech version. [Skala disociativnich zkuseností - ceska verze ] Cesk Psychol 2006;50:262–72.

Goldstein WN. Dynamically oriented psychotherapy with borderline patients. Am J Psychother 1997;51:14–30. PubMed

Shedler J. The efficacy of psychodynamic psychotherapy. Am Psychol 2010;65:98–109. PubMed

Gullestad FS, Wilberg T, Klungsøyr O, et al. . Is treatment in a day hospital step-down program superior to outpatient individual psychotherapy for patients with personality disorders? 36 months follow-up of a randomized clinical trial comparing different treatment modalities. Psychother Res 2012;22:426–41. PubMed

Colarusso CA, Nemiroff RA. Some observations and hypotheses about the psychoanalytic theory of adult development. Int J Psychoanal 1979;60:59–71. PubMed

Hill J, Stepp SD, Wan MW, et al. . Attachment, borderline personality, and romantic relationship dysfunction. J Pers Disord 2011;25:789–805. PubMed PMC

Jeung H, Herpertz SC. Impairments of interpersonal functioning: empathy and intimacy in borderline personality disorder. Psychopathology 2014;47:220–34. PubMed

Wrege JS, Busmann M, Meyer AH, et al. . Impulsiveness in borderline personality disorder predicts the long-term outcome of a psychodynamic treatment programme. Clin Psychol Psychother 2020. 1–9. doi: 10.1002/cpp.2526. PubMed

Euler S, Nolte T, Constantinou M, et al. . Interpersonal problems in borderline personality disorder: associations with mentalizing, emotion regulation, and impulsiveness. J Pers Disord 2019. 1–7. doi: 10.1521/pedi_2019_33_427. Epub ahead of print. PubMed

Fonagy P, Luyten P, Allison E. Epistemic petrification and the restoration of epistemic trust: a new conceptualization of borderline personality disorder and its psychosocial treatment. J Pers Disord 2015;29:575–609. PubMed

Wehle D. Plunge into the abyss: creativity and trauma psychodynamic group. Group 2016;40:197–221.

Goldman GA, Gregory RJ. Relationships between techniques and outcomes for borderline personality disorder. Am J Psychother 2010;64:359–71. PubMed

Rüsch N, Schiel S, Corrigan PW, et al. . Predictors of dropout from inpatient dialectical behavior therapy among women with borderline personality disorder. J Behav Ther Exp Psychiatry 2008;39:497–503. PubMed

Aubeeluck ND, Luximon-Ramma A. The burdens of family caregivers of schizophrenia in mauritius. SciMed 2020;2: doi: 10.28991/SciMedJ-2020-0203-2.

Krüger C, Röepke S, Kliem S. Reasons for premature termination of dialectical behavior therapy for inpatients with borderline personality disorder. Behav Res Ther 2014;60:46–52. PubMed

DePanfilis C, Marchesi C, Cabrino C, et al. . Patient factors predicting early dropout from psychiatric outpatient care for borderline personality disorder. Psychiatry Res 2012;200:422–9. PubMed

Marcinko D, Bilić V, Pivac N, et al. . Serum cholesterol concentration and structured individual psychoanalytic psychotherapy in suicidal and non-suicidal male patients suffering from borderline personality disorder. Coll Antropol 2011;35: Suppl 1: 219–23. PubMed

Pérez S, Marco JH, García-Alandete J. Comparison of clinical and demographic characteristics among borderline personality disorder patients with and without suicidal attempts and non-suicidal self-injury behaviors. Psychiatry Res 2014;220:935–40. PubMed

Korzekwa MI, Dell PF, Pain C. Dissociation and borderline personality disorder: an update for clinicians. Curr Psychiatry Rep 2009;11:82–8. PubMed

Pompili M, Innamorati M, Lamis DA, et al. . The associations among childhood maltreatment, “male depression” and suicide risk in psychiatric patients. Psychiatry Res 2014;220:571–8. PubMed

Serafini G, Gonda X, Canepa G, et al. . Extreme sensory processing patterns show a complex association with depression, and impulsivity, alexithymia, and hopelessness. J Affect Disord 2017;210:249–57. PubMed

Jahani HJG, Ehsanikenari A, Sharif AS. Role of self-efficacy and negative perfectionism in the prediction of procrastination of narcissistic personality: a study on non-clinical subjects. Emerg Sci J 2018;2:388–99.

Crawford MJ, Price K, Gordon F, et al. . Engagement and retention in specialist services for people with personality disorder. Acta Psychiatr Scand 2009;119:304–11. PubMed

Smith TE, Koenigsberg HW, Yeomans FE, et al. . Predictors of dropout in psychodynamic psychotherapy of borderline personality disorder. J Psychother Pract Res 1995;4:205–13. PubMed PMC

Thormählen B, Weinryb RM, Norén K, et al. . Patient factors predicting dropout from supportive-expressive psychotherapy for patients with personality disorders. Psychother Res 2003;13:493–509. PubMed