Six-Year Follow-Up of Three Treatment Programs to Personality Disorder

Abstract

Previous studies of long-term outcome for personality disorder (PD) were either retrospective in design or did not include a control condition. In this paper we report results for three PD cohorts (N = 111) treated in two different specialist psychosocial programs (step-down and long-term inpatient) and in general psychiatric treatment as usual (TAU), which were prospectively followed up for 72-months after intake. The three PD samples were compared on symptom severity, social adjustment, global functioning and other clinical indicators (self-mutilation, parasuicide and readmission rates) at intake, 6, 12, 24, and 72 months. Results indicated that a specialist step-down model showed significantly greater change than a purely inpatient model and TAU in most key dimensions of functioning, a difference maintained at 72-months follow-up. Improvement in the samples was not associated with amount of intercurrent treatment received in the year prior to the follow-up assessment. This study confirms that a step-down program retains significant improvement associated with a specialist psychosocial approach for PD. However, this conclusion should be qualified by design limitations. The samples were not randomly allocated to the three conditions and the naturalistic geographical allocation used in the study created a potential for a number of confounds. Whilst we used extensive statistical controls, the possibility that the differences found between the groups may be due to population differences cannot be discounted.

Favourable outcome of long-term combined psychotherapy for patients with borderline personality disorder: Six-year follow-up of a randomized study

“…Despite differences between treatment conditions in the three-to six-year course of psychosocial functioning, final GAF scores in the sample nevertheless averaged around 60 (CP,64;OIP,58), and indicate some persistent difficulties in psychosocial function in both treatment conditions. Similar GAF levels have been found in six-and eight-year followup studies of other combination models (Bateman & Fonagy, 2009;Chiesa, Fonagy, & Holmes, 2006). The results are also consistent with findings from naturalistic follow-along studies of subjects with BPD, such as the Collaborative Longitudinal Personality Disorders Study (Gunderson et al, 2011) and the McLean Study of Adult Development (Zanarini, Frankenburg, Reich, & Fitzmaurice, 2010).…”

Effectiveness of Outpatient, Day Hospital, and Inpatient Psychotherapeutic Treatment for Patients with Cluster B Personality Disorders

“…So until now, hardly any study has addressed possible differences in treatment effectiveness between different settings and across theoretical schools. Exceptions are the studies by Chiesa et al [36,37,38] comparing inpatient treatment and step-down/outpatient treatment and the study by Arnevik et al [39] comparing day hospital treatment and outpatient treatment. …”

Clinical Associations of Deliberate Self-Injury and Its Impact on the Outcome of Community-Based and Long-Term Inpatient Treatment for Personality Disorder

“…In a previous report we presented evidence that long-term specialist residential treatment in a therapeutic community setting had superior outcomes for individuals with severe PD than treatment as usual, but was significantly less effective compared to a less intense but longer step-down program [15]. However, the results showed a considerable variability between the treatment responses of individual subjects.…”