Bliton Chloe F, Rosenstein Lia K, Pincus Aaron L
Department of Psychology, The Pennsylvania State University, University Park, PA, United States.
Front Psychol. 2022 Feb 14;13:794624. doi: 10.3389/fpsyg.2022.794624. eCollection 2022.
The - Alternative Model for Personality Disorders (AMPD) dimensionally defines personality pathology using severity of dysfunction and maladaptive style. As the empirical literature on the clinical utility of the AMPD grows, there is a need to examine changes in diagnostic profiles and personality expression in treatment over time. Assessing these changes in individuals diagnosed with borderline personality disorder (BPD) is complicated by the tendency for patients to cycle through multiple therapists over the course of treatment leaving the potential for muddled diagnostic clarity and disjointed case conceptualizations. Following patient trajectories across therapists offers a unique opportunity to examine the AMPD's sensitivity to and utility for capturing personality stability and change over time for patients with BPD. This article demonstrates the utility of the AMPD for two clinical cases in three distinct ways: (i) highlighting heterogeneity in BPD between patients, (ii) comparing improvements in personality severity and style over time, and (iii) elucidating profile change across therapist ratings. We present two patients diagnosed with -5 Section II BPD, crossing between two therapists over the course of 3 years of psychodynamic psychotherapy. Treating clinicians rated patients for their respective treatment phases using the Level of Personality Functioning Scale (LPFS), capturing severity, and the Personality Inventory for the - (PID-5), capturing style. AMPD diagnostic profiles differentiated patients with BPD in both severity and style, and captured within-patient change beyond within-therapist response bias. Results indicated greater improvements in personality severity while personality style remained more stable. Implications for the patients' treatment progress and associated challenges are discussed, as are considerations for the utility of the AMPD in therapy.
人格障碍替代模型（AMPD）从功能失调的严重程度和适应不良风格维度对人格病理学进行界定。随着关于AMPD临床效用的实证文献不断增加，有必要考察治疗过程中诊断概况和人格表现随时间的变化。对于诊断为边缘型人格障碍（BPD）的个体评估这些变化较为复杂，因为患者在治疗过程中倾向于更换多位治疗师，这可能导致诊断清晰度模糊以及病例概念化脱节。跟踪患者在不同治疗师之间的治疗轨迹，为考察AMPD对于捕捉BPD患者人格稳定性和随时间变化的敏感性及效用提供了独特机会。本文通过三种不同方式展示了AMPD对两个临床病例的效用：（i）突出患者之间BPD的异质性；（ii）比较人格严重程度和风格随时间的改善情况；（iii）阐明不同治疗师评分之间的概况变化。我们呈现了两名诊断为II B型BPD的患者，他们在3年的心理动力心理治疗过程中更换了两名治疗师。治疗临床医生使用人格功能水平量表（LPFS）对患者各自的治疗阶段进行评分，以捕捉严重程度，并用五因素人格问卷（PID-5）捕捉风格。AMPD诊断概况在严重程度和风格方面区分了BPD患者，并捕捉了患者内部超出治疗师内部反应偏差的变化。结果表明人格严重程度有更大改善，而人格风格保持更稳定。讨论了对患者治疗进展及相关挑战的影响，以及AMPD在治疗中的效用考量。
