Changes in Personality Functioning After Inpatient Psychodynamic Therapy: A Dimensional Approach to Personality Disorders.
OBJECTIVE
Patients with mental disorders do not only show specific symptoms but also impairments in personality functioning, especially those with personality disorders. Recent developments in DSM-5 and ICD-11 suggest a dimensional approach to personality disorders. Few studies, however, have examined changes in personality functioning.


METHODS
In a large sample of 2,596 patients treated by inpatient psychodynamic therapy, changes in personality functioning were studied. Two patient groups were examined, one with (N = 1152, BPO) and one without a presumptive diagnosis of a borderline personality organization (N = 1444, NBPO). For the assessment of personality functioning, the Borderline-Personality Inventory (BPI) was used. The BPI taps personality functioning as defined by Kernberg's structural criteria of personality organization. Symptom distress and interpersonal problems were examined with the Symptom Checklist SCL-90-R and the Inventory of Interpersonal Problems (IIP). Patients were assessed at admission and discharge.


RESULTS
In the BPO sample significant and substantial pre-post effect sizes in overall personality functioning, identity integration, and defense mechanisms/object relations were found (d = 0.68, 0.60, 0.78). In addition, large improvements in symptoms (SCL-90-R) were achieved (d = 0.97). For interpersonal problems effect sizes were medium (0.56). At discharge 36% of the BPO patients scored below the BPI-Cut-Off score for a BPO (remission). Pre-post effect sizes in the NPBO sample (N = 1444) were significant but small for changes in personality functioning (d = 0.31-0.46) and substantial for improvements in symptoms (d = 0.77).


CONCLUSIONS
Both personality functioning and symptom distress can be substantially improved by inpatient psychodynamic therapy. Future research is recommended to study both improvements in symptoms and personality functioning.
['Leichsenring|Falk|F|', 'Jaeger|Ulrich|U|', 'Masuhr|Oliver|O|', 'Dally|Andreas|A|', 'Dümpelmann|Michael|M|', 'Fricke-Neef|Christian|C|', 'Steinert|Christiane|C|', 'Spitzer|Carsten|C|']
D000328:Adult D005260:Female D006801:Humans D007297:Inpatients D008297:Male D008875:Middle Aged D010551:Personality D010554:Personality Disorders D010555:Personality Inventory D064889:Psychotherapy, Psychodynamic D016896:Treatment Outcome D055815:Young Adult
personality functioning personality disorders psychodynamic treatment