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PERSOONLIJKHEIDSSTOORNISSENExam Summary
27-10-2024
Maastricht University
Emma Leibbrand
, [ Task 1 – Classification and Aetiology of
Personality Disorders ]
(1) BANYARD: PERSONALITY DISORDERS AND THEIR RELATION TO TREATMENT OUTCOMES
IN COGNITIVE BEHAVIOURAL THERAPY FOR DEPRESSION
ABSTRACT
Previous studies Depressed patients with a comorbid PD tend to benefit less from psychotherapies for
depression; thus personality pathology needs to be the primary focus of treatment.
Focus is on CBT for depression examining influence of comorbid PD on treatment outcomes.
Systematic review and meta-analysis of 11 studies.
Conclusion = The effect of PD on depression outcomes is likely explained by higher intake severity rather than
treatment resistance. They might seem harder to treat for depression because they have more severe
symptoms at the start, not because they can’t be treated. They should still get proper therapy like others.
INTRODUCTION
Personality Disorders (PD) An enduring pattern of inner experiences and interpersonal difficulties that
significantly deviate from the individual’s culture, which are inflexible and pervasive.
Cluster C is most common, then Cluster A, then Cluster B.
Psychotherapy is recommended as first line treatment, but people with PDs are less likely to seek
treatment than those with other mental disorders, especially Cluster A disorders.
Research indicates PDs are highly comorbid with each other and other mental health problems.
They are particularly comorbid with major depressive disorder.
Poorer treatment outcomes were found for depressed patients diagnosed with comorbid PDs. There is a need
to review how effective CBT is for treating depression in patients who also have PDs. Since PD is common in
depressed patients and often leads to poorer treatment outcomes, guidelines suggest treating the PD before
addressing depression.
BUT Problematic regarding treatment availability: evidence based treatments for PD are
underdeveloped, they are costly in time and money.
Psychotherapy for depression is more available and less costly and time consuming.
Solution If psychotherapy for depression is effective for treatment of depression comorbid with PD,
the primary target can be the depressive symptomatology. There would be a large expansion of the
available care for these patients.
METHODS
Primary outcome depression treatment outcome.
o Determined by diagnostic interview, self-rated or clinician-rated depression measures.
Focus papers comparing depression treatment outcomes between participants with and without PD.
RESULTS
Patients with PD tend to improve less than patients without a PD after CBT for depression.
The negative impact of PD on depression outcomes decreased in studied offering longer CBT treatments.
The lower improvement in PD patients is likely due to their higher severity of depression when starting
treatment, rather than resistance to treatment itself.
Patients with PD can still benefit from CBT, especially if therapy is closely supervised and lasts long enough
They should not be excluded from evidence-based depression treatments like CBT.
,(2)BODNER: STAFF ATTITUDE TOWARD PATIENTS WITH BORDERLINE PD
ABSTRACT
This paper wanted to develop 2 inventories to measure cognitive and emotional attitudes toward BPD
patients and their treatment + use these tools to compare attitudes of psychiatrists, psychologists, and
nurses toward BPD patients.
Results Psychologists scored lower than psychiatrists and psychologists on antagonistic judgements,
whereas nurses scored lower than psychiatrists and psychologists on empathy.
o Suicidal tendencies of BPD mainly explained the negative emotions and the difficulty in treating
these patients.
o All 3 groups were interested in learning more about the treatment of these patients.
Conclusions
o Suicidal tendencies of BPD patients provoke antagonistic judgements among the 3 professions.
o Nevertheless, psychiatrists, psychologists, and nurses hold distinctive cognitive and emotional
attitudes toward these patients. Mapping these differences can improve the education and
training in the management of BPD patients.
INTRODUCTION
BPD patients have a bad ‘reputation’ and the diagnosis of BPD is considered difficult and destructive.
Suicidal behaviours, self-harm behaviours, and emotional dysregulation make it hard to treat.
Acting-out behaviours leave the staff helpless in assisting them.
High drop-out rate from therapy can infuriate therapists or create a split between staff members.
Comparison of attitudes of psychiatric nurses toward BPD, schizophrenia, and depression found more
negativity and less sympathy and optimism for BPD compared to the other 2 diagnoses.
o Nurses also perceived BPD patients are more dangerous and were more socially rejecting of them.
Literature gap Previous studies portray picture about attitudes of mental health staff toward BPD, but most
only examined psychiatric nurses and did not look at the relationship betw. emotional and cognitive attitudes.
This study = develop tools for measuring emotional and cognitive attitudes of psychiatrists,
psychologists, and psychiatric nurses toward BPD patients.
METHODS
Participants 25 psychiatric nurses, 13 psychologists, and 19 psychiatrists.
Two inventories: Cognitive + Emotional (see table).
Cognitive The inventory was constructed by the authors based on previous brainstorming and review
Attitudes of the literature on BPD patients.
and
Treatment 47 items concerning cognitive perceptions of BPD patients, suitable treatment for them,
Inventory the perception of suicidal attempts committed by them, and some prejudiced perceptions
clinicians hold about BPD.
(BPD-CAT) Participants rated their level of agreement on a 5-point Likert scale.
The analysis revealed three factors.
o Factor 1 21 items representing the required treatment characteristics of BPD
patients.
o Factor 2 contained 13 items that related to attitudes toward BPD suicidal
tendencies.
o Factor 3 consisted of 7 items that seemed to express antagonistic judgements
of BPD patients and their behaviour.
3 scores were computed for each participant based on the means of the responses on the
items of each factor.
, Emotional This inventory was formulated for the present study by the authors in a similar manner. It
Attitudes consisted of 20 items concerning emotional attitudes toward BPD patients on a 5- point Likert
Inventory scale.
(BPD-EA) The analysis again revealed three factors:
o Factor 1 9 items concerning negative emotions toward BPD patients.
o Factor 2 6 items related to difficulties experienced while treating BPD patients.
o Factor 3 5 items describing empathy feelings toward BPD patients.
3 scores were formed for each participant based on the means of the responses on the
items of each factor.
Higher scores indicate agreement with the factor.
RESULTS + DISCUSSION
Differences between clinicians on the BPD-CAT (=cognitive inventory):
In comparison with psychiatrists and nurses, psychologists had less antagonistic judgements (=Factor 3).
o Example = They were less likely to view these patients as manipulative and supported
hospitalization more frequently. This may reflect psychologists' empathetic and understanding
approach, contrasting with the more authoritarian styles of other professionals.
o There were no differences on Factor 1 and Factor 2 = they agreed on the importance of treatment
for BPD patients and perceived the suicide risk among BPD patients as serious.
Differences between clinicians on the BPD-EA (=emotional inventory):
Nurses score sign. lower compared with psychiatrists and psychologists on the empathy factor (=Factor 3).
o This may reflect the fact that nurses are on the frontline with these patients, especially in the
psychiatric ward. They may be frustrated + burnt out because of the conflicts with these patients.
o BPD patients are seen as difficult, annoying, manipulative, and ‘bad’ and not ‘ill’.
o Nurses see BPD patients as being more in control of negative behaviour than other patients and
attributions of control were inversely related to staff sympathy.
There were no differences between the 3 professions on Factor 1 and Factor 2.
o This means that all professions expressed high frustration feelings when treating BPD patients
(feelings of anger and agitation). These negative emotions were closely tied to the patients’
suicidal tendencies, which they perceived as dangerous and a source of frustration.
Seniority was associated with reduced negative emotions toward BPD patients, suggesting that more
experienced practitioners are less likely to view these patients negatively.
o Practitioners who sought to improve their diagnostic + therapeutic skills reported lower negative
emotions and treatment difficulties.
The less negative the practitioners’ evaluations, the higher their empathy toward BPD patients (=logical).
There is a need for better training and improved empathy among mental health professionals, especially
nurses, in dealing with BPD patients.
(3)CRAWFORD: INSECURE ATTACHMENT AND PD: A TWIN ADULT STUDY
ABSTRACT
Aim How anxious and avoidant attachment are related to PD.
Result Self-reported anxious attachment and 11 PD scales loaded onto one factor (=emotional
dysregulation). Avoidant attachment and 4 PD scales loaded onto a second factor (=inhibitedness).
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