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

Bibliographic Data

ID15519535
AuthorsFranziska Konvalin (LMU Klinikum), Fabienne Grosse-Wentrup (Ludwig-Maximilians-Universität München), Tabea Nenov-Matt (LMU Klinikum), Kai Fischer (0000-0001-8615-6230, LMU Klinikum), Barbara B Barton (0000-0003-3614-9918, Ludwig-Maximilians-Universität München), Stephan Goerigk (0000-0002-3021-0346, Ludwig-Maximilians-Universität München), Eva-Lotta Brakemeier (0000-0001-9589-3697, Universität Greifswald), Richard Musil (0000-0002-0792-8413, Ludwig-Maximilians-Universität München), Andrea Jobst (0000-0002-1506-0749, LMU Klinikum), Frank Padberg (0000-0001-7638-8310, LMU Klinikum), Matthias A Reinhard (0000-0002-8374-5467, Ludwig-Maximilians-Universität München, corresponding author)
Year2021
Volume12
Pages608271-608271
Publication date2021-03-12
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueFrontiers in Psychiatry (JOURNAL)
Journal identifiersISSN: 1664-0640 • E-ISSN: 1664-0640
PublisherFrontiers Media (PUBLISHER • CH)
DOI10.3389/fpsyt.2021.608271
PMID33790813
OpenAlexW3136002810
LanguageEN
Citations received3
References cited60

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

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