Leichsenring Falk, Jaeger Ulrich, Masuhr Oliver, Dally Andreas, Dümpelmann Michael, Fricke-Neef Christian, Steinert Christiane, Spitzer Carsten
University of Giessen, Germany.
Asklepios Clinic Tiefenbrunn, Germany.
Psychodyn Psychiatry. 2019 Summer;47(2):183-196. doi: 10.1521/pdps.2019.47.2.183.
Patients with mental disorders do not only show specific symptoms but also impairments in personality functioning, especially those with personality disorders. Recent developments in and ICD-11 suggest a dimensional approach to personality disorders. Few studies, however, have examined changes in personality functioning.
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 ( = 1152, BPO) and one without a presumptive diagnosis of a borderline personality organization ( = 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.
In the BPO sample significant and substantial pre-post effect sizes in overall personality functioning, identity integration, and defense mechanisms/object relations were found ( = 0.68, 0.60, 0.78). In addition, large improvements in symptoms (SCL-90-R) were achieved ( = 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 ( = 1444) were significant but small for changes in personality functioning ( = 0.31-0.46) and substantial for improvements in symptoms ( = 0.77).
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.
患有精神障碍的患者不仅表现出特定症状，而且在人格功能方面存在损害，尤其是那些患有人格障碍的患者。《精神疾病诊断与统计手册》（DSM）和《国际疾病分类》第11版（ICD - 11）的最新进展表明对人格障碍采用维度方法。然而，很少有研究考察人格功能的变化。
在一个由2596名接受住院心理动力治疗的患者组成的大样本中，研究人格功能的变化。考察了两个患者组，一组有（n = 1152，BPO）而另一组没有边缘性人格组织的假定诊断（n = 1444，NBPO）。为评估人格功能，使用了边缘性人格量表（BPI）。BPI依据克恩伯格的人格组织结构标准来衡量人格功能。使用症状自评量表90修订版（SCL - 90 - R）和人际问题量表（IIP）来检查症状困扰和人际问题。在入院时和出院时对患者进行评估。
在BPO样本中，发现总体人格功能、身份整合以及防御机制/客体关系方面存在显著且较大的前后效应量（Cohen's d = 0.68、0.60、0.78）。此外，症状（SCL - 90 - R）有大幅改善（Cohen's d = 0.97）。人际问题的效应量为中等（0.56）。出院时，36%的BPO患者得分低于BPI针对BPO的临界分数（缓解）。NPBO样本（n = 1444）的前后效应量在人格功能变化方面显著但较小（Cohen's d = 0.31 - 0.46），在症状改善方面较大（Cohen's d = 0.77）。
住院心理动力治疗可使人格功能和症状困扰都得到显著改善。建议未来的研究同时考察症状改善和人格功能改善情况。
