Multiple integrated treatment of borderline personality disorders

This paper describes a pilot study of the effectiveness of a specific outpatient programme for Cluster B Personality Disorder. According to this model, the patient is offered a pathway of two-year duration, which includes once a week supportive individual psychotherapy combined with fortnightly group psychotherapy (Dialectical Behavioural Therapy), as well as general psychiatric management. We present the results of a prospective research study based on data collected on a first group of six patients treated in the programme. The sample, screened by using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID II), for presence of a Cluster B disorder, was evaluated at regular intervals using the Symptom Check List-90 (SCL-90), for the affective symptoms, the Barratt Impulsiveness Scale, version 11 (BIS-11) and the Aggression Questionnaire (AQ), for the dimensions of Impulsiveness and Aggression. The level of disability perceived has been measured by the Dissociative Disorders Interview Schedule (DISS). Finally, the referring psychiatrist filled in the Global Assessment of Functioning (GAF) and Brief Psychiatric Rating Scale (BPRS). At the end of treatment improvement was found in all measures. The results, based on a limited sample, suggest that improvements in the dimensions of impulsiveness, affectivity, degree of disability and readmission to hospital can be achieved with Cluster B patients in an outpatient setting by utilizing different concurrent psychotherapeutic approaches. This is encouraging concerning the intensive outpatient psychotherapeutic treatment with severe personality disorder.