De Viersprong, Viersprong Institute for Studies on Personality Disorders, Halsteren, the Netherlands (Smits, Luyten, Feenstra, Bales); Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium, and Research Department of Clinical, Educational and Health Psychology, University College London, London (Luyten); Department of Psychology, University of Amsterdam, Amsterdam (Kamphuis); Department of Research, Arkin Mental Health Care, and Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Dekker); Lentis, Groningen, the Netherlands (Verheul); Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, the Netherlands (Busschbach).
Am J Psychother. 2022 Jan 1;75(1):12-20. doi: 10.1176/appi.psychotherapy.20210027. Epub 2022 Jan 31.
Recent meta-analyses suggest that many patients with borderline personality disorder have a history of complex trauma. Although trauma is central in mentalization-based approaches to the understanding of borderline personality disorder, surprisingly little is known about the effects of trauma on outcomes of mentalization-based treatment (MBT). This article investigates the prevalence and impact of childhood trauma among patients with borderline personality disorder participating in a randomized controlled trial (RCT) comparing day hospital MBT (MBT-DH) and intensive outpatient MBT (MBT-IOP).
All 114 patients from the original multicenter RCT in the Netherlands were included in this study. Childhood trauma was assessed at baseline (with the Childhood Trauma Questionnaire), and its impact on symptom severity, interpersonal functioning, and borderline pathology was investigated through multilevel modeling for 36 months after the start of treatment.
Childhood trauma was common among patients with borderline personality disorder referred to MBT, with more than 85% meeting cutoff criteria for substantial childhood trauma. Childhood trauma had little impact on outcomes of either MBT-DH or MBT-IOP in terms of improved borderline personality disorder features or interpersonal functioning. However, patients with substantial childhood trauma seemed to improve more rapidly with MBT-DH, as compared with MBT-IOP, in terms of symptom severity. In addition, patients with a history of emotional neglect showed more rapid changes in symptoms of borderline personality disorder with MBT-DH compared with MBT-IOP.
Findings are discussed in the context of a social communicative approach to borderline personality disorder, with a focus on the need to address trauma in MBT.
最近的荟萃分析表明，许多边缘型人格障碍患者都有复杂创伤史。尽管创伤是理解边缘型人格障碍的心理化方法的核心，但令人惊讶的是，我们对创伤对心理化治疗（MBT）结果的影响知之甚少。本文调查了参加比较日间医院 MBT（MBT-DH）和强化门诊 MBT（MBT-IOP）的边缘型人格障碍患者的创伤发生率和影响。
本研究纳入了来自荷兰多中心 RCT 的 114 名患者。采用儿童期创伤问卷（Childhood Trauma Questionnaire）在基线时评估儿童期创伤，并通过多层次模型研究其对治疗开始后 36 个月的症状严重程度、人际关系功能和边缘型病理的影响。
边缘型人格障碍患者中，儿童期创伤较为常见，超过 85%的患者符合大量儿童期创伤的标准。从改善边缘型人格障碍特征或人际关系功能的角度来看，儿童期创伤对 MBT-DH 或 MBT-IOP 的疗效影响不大。然而，与 MBT-IOP 相比，大量儿童期创伤的患者在 MBT-DH 治疗中似乎更快地改善了症状严重程度。此外，有情感忽视史的患者在 MBT-DH 治疗中与 MBT-IOP 相比，边缘型人格障碍的症状变化更快。
研究结果在边缘型人格障碍的社会交际方法的背景下进行了讨论，重点是需要在 MBT 中解决创伤问题。
