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Impulsiveness in borderline personality disorder predicts the long‐term outcome of a psychodynamic treatment programme


Wrege, Johannes S; Busmann, Mareike; Meyer, Andrea H; Euler, Sebastian; Lang, Undine E; Walter, Marc (2020). Impulsiveness in borderline personality disorder predicts the long‐term outcome of a psychodynamic treatment programme. Clinical Psychology & Psychotherapy:Epub ahead of print.

Abstract

Despite the preponderance of treatment outcome predictors in patients with borderline personality disorder (BPD), the predictive value of measures of impulsiveness is inconclusive. This naturalistic study consecutively included hospitalized patients with BPD (N = 99) who underwent a standardized and structured 12‐week inpatient treatment programme, which integrated cognitive‐behavioural and psychodynamic elements. The Brief Symptom Checklist (BSCL) was applied as outcome measure over four time points: pretreatment, posttreatment, first follow‐up at 6 to 8 weeks and second follow‐up at 1 year after discharge. Impulsiveness was measured using the Barratt Impulsiveness Scale (BIS) at the pretreatment time point. The BSCL significantly decreased between pretreatment and posttreatment, followed by an increase after posttreatment without reaching pretreatment extent. The temporal course of the BSCL significantly varied with pretreatment BIS in that patients with higher impulsiveness revealed a stronger re‐increase of symptom severity from posttreatment to end of follow‐up than those with lower impulsiveness. The least impulsive patients thereby showed no rebound effect. The robustness of the results was examined by cross‐validation. The results indicate that irrespective of the level of impulsiveness, patients with BPD profit from a structured inpatient treatment. However, long‐term treatment success was impaired in patients with high level of impulsiveness at pretreatment. Thus, self‐ratings of impulsiveness in BPD patients can be utilized for treatment planning. After discontinuation of interventions, relapse prevention should be implemented early in high impulsive patients as symptoms recrudesce in the course after discharge.

Abstract

Despite the preponderance of treatment outcome predictors in patients with borderline personality disorder (BPD), the predictive value of measures of impulsiveness is inconclusive. This naturalistic study consecutively included hospitalized patients with BPD (N = 99) who underwent a standardized and structured 12‐week inpatient treatment programme, which integrated cognitive‐behavioural and psychodynamic elements. The Brief Symptom Checklist (BSCL) was applied as outcome measure over four time points: pretreatment, posttreatment, first follow‐up at 6 to 8 weeks and second follow‐up at 1 year after discharge. Impulsiveness was measured using the Barratt Impulsiveness Scale (BIS) at the pretreatment time point. The BSCL significantly decreased between pretreatment and posttreatment, followed by an increase after posttreatment without reaching pretreatment extent. The temporal course of the BSCL significantly varied with pretreatment BIS in that patients with higher impulsiveness revealed a stronger re‐increase of symptom severity from posttreatment to end of follow‐up than those with lower impulsiveness. The least impulsive patients thereby showed no rebound effect. The robustness of the results was examined by cross‐validation. The results indicate that irrespective of the level of impulsiveness, patients with BPD profit from a structured inpatient treatment. However, long‐term treatment success was impaired in patients with high level of impulsiveness at pretreatment. Thus, self‐ratings of impulsiveness in BPD patients can be utilized for treatment planning. After discontinuation of interventions, relapse prevention should be implemented early in high impulsive patients as symptoms recrudesce in the course after discharge.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Klinik für Konsiliarpsychiatrie und Psychosomatik
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Social Sciences & Humanities > Clinical Psychology
Uncontrolled Keywords:Clinical Psychology
Language:English
Date:20 October 2020
Deposited On:03 Feb 2021 13:42
Last Modified:04 Feb 2021 21:01
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1063-3995
OA Status:Closed
Publisher DOI:https://doi.org/10.1002/cpp.2526
PubMed ID:33119970

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