Academic journal article European Journal of Psychotraumatology

Treatment Compliance and Effectiveness in Complex PTSD Patients with Co-Morbid Personality Disorder Undergoing Stabilizing Cognitive Behavioral Group Treatment: A Preliminary Study

Academic journal article European Journal of Psychotraumatology

Treatment Compliance and Effectiveness in Complex PTSD Patients with Co-Morbid Personality Disorder Undergoing Stabilizing Cognitive Behavioral Group Treatment: A Preliminary Study

Article excerpt

CLINICAL RESEARCH ARTICLE

Treatment compliance and effectiveness in complex PTSD patients with co-morbid personality disorder undergoing stabilizing cognitive behavioral group treatment: a preliminary study

Ethy Dorrepaal1,2,3,4*, Kathleen Thomaes1,2*, Johannes H. Smit1,2,3, Dick J. Veltman1,2, Adriaan W. Hoogendoorn1, Anton J. L. M. van Balkom1,2,3 and Nel Draijer1,2,3

1GGZ inGeest, Amsterdam, The Netherlands; 2Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; 3EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands; 4PsyQ, Parnassiagroep, The Hague, The Netherlands

Abstract

Background: In the empirical and clinical literature, complex posttraumatic stress disorder (PTSD) and personality disorders (PDs) are suggested to be predictive of drop-out or reduced treatment effectiveness in trauma-focused PTSD treatment.

Objective: In this study, we aimed to investigate if personality characteristics would predict treatment compliance and effectiveness in stabilizing complex PTSD treatment.

Method: In a randomized controlled trial on a 20-week stabilizing group cognitive behavioral treatment (CBT) for child-abuse-related complex PTSD, we included 71 patients of whom 38 were randomized to a psycho-educational and cognitive behavioral stabilizing group treatment. We compared the patients with few PD symptoms (adaptive) (N =14) with the non-adaptive patients (N =24) as revealed by a cluster analysis.

Results: We found that non-adaptive patients compared to the adaptive patients showed very low drop-out rates. Both non-adaptive patients, classified with highly different personality profiles "withdrawn" and "aggressive," were equally compliant. With regard to symptom reduction, we found no significant differences between subtypes. Post-hoc , patients with a PD showed lower drop-out rates and higher effect sizes in terms of complex PTSD severity, especially on domains that affect regulation and interpersonal problems.

Conclusion: Contrary to our expectations, these preliminary findings indicate that this treatment is well tolerated by patients with a variety of personality pathology. Larger sample sizes are needed to study effectiveness for subgroups of complex PTSD patients.

Keywords: Personality disorders; treatment outcome; child abuse; posttraumatic stress disorder; cognitive behavioral treatment; complex PTSD; dissociative subtype

*Correspondence to: Ethy Dorrepaal, PsyQ Psychotrauma, Parnassiagroep, Carel Reinierszkade 197, 2593 HR, The Hague, The Netherlands, Email: e.dorrepaal@psyq.nl; k.thomaes@vumc.nl

For the abstract or full text in other languages, please see Supplementary files under Article Tools online

Received: 19 April 2013; Revised: 5 September 2013; Accepted: 14 September 2013; Published: 6 November 2013

European Journal of Psychotraumatology 2013. © 2013 Ethy Dorrepaal et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Citation: European Journal of Psychotraumatology 2013, 4 : 21171 - http://dx.doi.org/10.3402/ejpt.v4i0.21171

Child physical abuse and rape are known to result in a very high prevalence (50%) of posttraumatic stress disorder (PTSD) (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), frequently complicated by additional sequelae-like problems in affect regulation, memory and attention, self-perception, interpersonal relations, somatization and systems of meaning (Herman, 1992), referred to as "PTSD with associated features" in DSM-IV-TR or "complex PTSD" (Pelcovitz et al. …

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