Psychological treatment of depression and anxiety in patients with co‐morbid personality disorder: A scoping study of trial evidence

Abstract

It is unclear what the best psychological treatment is for depression and anxiety in people with co-morbid personality disorder. Trials of different psychological treatment options for this patient group have been conducted, but this evidence has not previously been systematically reviewed or critically appraised. We set out to conduct a scoping review in order to describe which psychological therapies appear most effective in treating depression and/or anxiety in patients with co-morbid personality disorder. PsycINFO, Cochrane library trials, Medline and Embase databases were searched for studies involving randomized, controlled, experimental, parallel-arm comparisons, examining any well-defined, psychotherapeutic intervention for adults, in an outpatient setting, with a clearly defined diagnosis of depression and/or anxiety, and co-morbid personality disorder. A total of 1662 papers were identified. Fifteen met criteria for inclusion and were reviewed. There was weak evidence to support the use of cognitive behavioural therapy as a psychological treatment for depression in patients with co-morbid personality disorder. However, the literature is characterized by considerable methodological heterogeneity, and further research is needed before there is sufficient evidence to indicate which psychological treatment would be most effective in treating anxiety and/or depression in this patient group. Copyright © 2017 John Wiley & Sons, Ltd.

Subthreshold personality disorder: how feasible is treatment in primary care?

“…Initial findings suggest that individuals with as little as one BPD trait still experience a degree of disability and distress that rivals the impairment of full-syndrome BPD (Bos et al, 2011;Kaess et al, 2017;Lu et al, 2017;Zimmerman et al, 2013). Furthermore, individuals experiencing subthreshold BPD traits possess higher rates of co-morbidity, in particular depression and anxiety, posing poorly for treatment outcomes and full-syndromes alike (French et al, 2017;Gorwood et al, 2010;Hepgul et al, 2016;Hill et al, 2016;Karukivi et al, 2017;Newton-Howes et al, 2006).…”

“…However, the presentation of patients within primary care is a complicated issue. Individuals meeting diagnostic criteria for personality disorder had already been utilising IAPT services, which have adversely affected and been identified as a prognosis risk factor to treatment outcomes (French et al, 2017;Goddard et al, 2015;Hepgul et al, 2016). The presence of subthreshold BPD difficulties has led to possible misclassification between conditions and an increased risk of developing depression and anxiety in later life (Moran et al, 2016a,b).…”

From the Editor's desk

“…Treatment-resistant mood disorders continue to be one of the most significant challenges in clinical care; there are significant obstacles to recovery in unipolar depression and comorbid depression with schizophrenia or borderline personality disorder 3 – 8 . I am making a call for papers on treatment-resistant mood disorders.…”

GPs’ views and experiences of managing patients with personality disorder: a qualitative interview study

“…Primary care is the frontline of service delivery in the National Health Service, but how GPs should manage these patients remains unclear due to the lack of evidence about which treatment or management approach would be most effective 16. We also know very little about how GPs currently manage these patients as, to date, no study has explored their views and experiences of doing so.…”