Borderline Personality Features in Patients With Persistent Depressive Disorder and Their Effect on CBASP Outcome

Introduction: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was developed for the treatment of persistent depressive disorder (PDD), where comorbid personality disorders (PD) are common. In contrast to other PD, comorbid borderline personality disorder (BPD) is often regarded as an exclusion criterion for CBASP. In clinical settings, however, subthreshold BPD symptoms are prevalent in PDD and may not be obvious at an initial assessment prior to therapy. As data on their impact on CBASP outcome are very limited, this naturalistic study investigates BPD features in PDD and their relevance for the therapeutic outcome of a multimodal CBASP inpatient program. Method: Sixty patients (37 female, mean age 38.3, SD 11.9 years) meeting DSM-5 criteria for PDD underwent a 10 weeks CBASP inpatient program. BPD features (i.e., number of fulfilled DSM-5 criteria) together with childhood maltreatment and rejection sensitivity were assessed on admission. Before and after treatment, severity of depressive symptoms was measured using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI-II). BPD symptoms were assessed using the Borderline Personality Disorder Severity Index (BPDSI-IV) and the Borderline Symptom List (BSL-23). Intercorrelations of baseline characteristics and symptom change during treatment were analyzed. Results: Patients with PDD met a mean of 1.5 (SD 1.6) BPD criteria with 4 patients fulfilling ≥5 criteria. BPD symptoms and depressive symptoms showed a strong correlation, and BPD symptoms were additionally correlated with emotional abuse and rejection sensitivity. There was no association between BPD features at baseline and improvement on the MADRS, however, BPD features tended to be associated with a lower response according to the BDI-II score after 10 weeks of treatment. Furthermore, BPD symptoms (i.e., abandonment, impulsivity and affective instability) were reduced after 10 weeks of CBASP treatment. Discussion: BPD symptoms are prevalent in patients with PDD and highly intertwined with the experience of depressive symptoms. In this naturalistic study in PDD, BPD features at baseline did not limit the clinical response to CBASP. Future studies may extend the spectrum of PDD to comorbid subsyndromal or even syndromal BPD in order to develop tailored psychotherapeutic treatment for these complex affective disorders

Anxiety · Beck Depression Inventory · Borderline personality disorder · Cognition · Depression (economics · Developmental psychology · Major depressive disorder · Psychiatry · Rating scale · Clinical Psychology · Medicine · Mental Health and Psychiatry · Personality Disorders and Psychopathology · Psychology · Psychotherapy Techniques and Applications

• Evaluating deep learning techniques for identifying tongue features in subthreshold depression

  Open Access•Bo Han, Yue Chang et al.•Frontiers in Psychiatry•2024

  Incluir item

• Comparing the Self-Reported Personality Disorder Traits and Childhood Traumatic Experiences Between Patients With Schizophrenia Vs. Major Depressive Disorder

  Open Access•Nan Zhao, Dianhong Shi et al.•Frontiers in Psychiatry•2021

  Incluir item

• Possible Avoidant Personality Disorder Magnifies the Association Between Bullying Victimization and Depressive Symptoms Among Chinese University Freshmen

  Open Access•Yan‐Min Xu, Yan-Min Xu et al.•Frontiers in Psychiatry•2022

  Incluir item

• Comparison of Beck Depression Inventories-IA and-II in Psychiatric Outpatients

  Aaron T Beck, Robert A Steer et al.•Journal of Personality Assessment•1996

  Incluir item

• Childhood maltreatment and characteristics of adult depression

  Open Access•Janna Nelson, Anne Klumparendt et al.•The British Journal of Psychiatry•2017

  Incluir item

• A New Depression Scale Designed to be Sensitive to Change

  Open Access•Stuart A Montgomery, Stuart Montgomery et al.•The British Journal of Psychiatry•1979

  Incluir item

• Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Borderline Personality Disorder

  Bridget F Grant, S Patricia Chou et al.•The Journal of Clinical Psychiatry•2008

  Incluir item

• Controlling the False Discovery Rate

  Open Access•Yoav Benjamini, Yosef Hochberg•Journal of the Royal Statistical…•1995

  Incluir item

• Loneliness, Social Isolation and Their Difference

  Open Access•Tabea Nenov-Matt, Barbara B Barton et al.•Frontiers in Psychiatry•2020

  Incluir item

• Implications of rejection sensitivity for intimate relationships

  Geraldine Downey, Scott I Feldman•Journal of Personality and Social…•1996

  Incluir item

• A biosocial developmental model of borderline personality

  Sheila E Crowell, Theodore P Beauchaine et al.•Psychological Bulletin•2009

  Incluir item