Kvarstein Elfrida H, Frøyhaug Mathias, Pettersen Mona S, Carlsen Sara, Ekberg Andreas, Fjermestad-Noll Jane, Ulvestad Dag A, Gikling Elisabeth L, Hjermann Eirik, Lindberget Kenneth, Omvik Siri, Eikenæs Ingeborg U-M, Hummelen Benjamin, Morken Katharina T E, Wilberg Theresa, Pedersen Geir A F
Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Front Psychiatry. 2023 May 9;14:1163347. doi: 10.3389/fpsyt.2023.1163347. eCollection 2023.
Evidence-based personality disorder (PD) treatments are dominated by interventions targeting Borderline PD, although clinical populations characteristically include different PD features and severity. Personality functioning is a new concept intended to capture common features across PDs. This study aimed to investigate longitudinal improvement of personality functioning in a clinical sample assigned to PD treatment.
An observational, large, longitudinal study of patients in PD treatments on specialist mental health service levels ( = 1,051). DSM-5 PDs were systematically assessed on referral. Personality functioning was repeatedly assessed (LPFS-BF-2.0), supplemented by symptom distress (anxiety: PHQ-GAD-7, depression: PHQ-9), and social/occupational activity (WSAS, work/study activity). Statistics were linear mixed models.
Thirty per cent had personality difficulties below PD threshold. Among PDs, 31% had Borderline (BPD), 39% Avoidant (AvPD), 15% not otherwise specified, 15% other PDs, and 24% > one PD. More severe initial LPFS-BF was associated with younger age, presence of PD and increasing number of total PD criteria. Across PD conditions, LPFS-BF, PHQ-9 and GAD-7 improved significantly (overall effect size 0.9). Mean duration of PD treatment was 15 (SD 9) months. Drop-out rates were low (12%). LPFS-BF improvement-rates were higher for BPD. Younger age was moderately associated with slower PHQ-9 improvement. Work/study activity was initially poor, poorer levels associated with AvPD and younger age, and improvement was non-significant across PD conditions. AvPD was associated with slower WSAS improvement-rates.
Personality functioning improved across PD conditions. The results highlight BPD improvements. The study points to challenges concerning AvPD treatment, poor occupational activity and age-related differences.
基于证据的人格障碍（PD）治疗主要以针对边缘型人格障碍的干预措施为主，尽管临床患者群体通常具有不同的人格障碍特征和严重程度。人格功能是一个旨在捕捉各种人格障碍共同特征的新概念。本研究旨在调查接受人格障碍治疗的临床样本中人格功能的纵向改善情况。
对专科心理健康服务水平下接受人格障碍治疗的患者进行一项观察性、大型纵向研究（n = 1051）。在转诊时对《精神疾病诊断与统计手册》第5版（DSM-5）中的人格障碍进行系统评估。对人格功能进行反复评估（LPFS-BF-2.0），并辅以症状困扰（焦虑：PHQ-GAD-7，抑郁：PHQ-9）以及社会/职业活动（WSAS，工作/学习活动）。统计方法为线性混合模型。
30%的人存在低于人格障碍阈值的人格困难。在人格障碍患者中，31%为边缘型（BPD），39%为回避型（AvPD），15%为未另行规定型，15%为其他人格障碍，24%患有不止一种人格障碍。初始LPFS-BF越严重，与年龄越小、存在人格障碍以及总的人格障碍标准数量增加相关。在各种人格障碍情况下，LPFS-BF、PHQ-9和GAD-7均有显著改善（总体效应大小为0.9）。人格障碍治疗的平均时长为15（标准差9）个月。脱落率较低（12%）。边缘型人格障碍的LPFS-BF改善率更高。年龄越小与PHQ-9改善越慢呈中度相关。工作/学习活动最初较差，较差水平与回避型人格障碍和年龄较小相关，并且在各种人格障碍情况下改善不显著。回避型人格障碍与WSAS改善率较慢相关。
在各种人格障碍情况下，人格功能均有改善。结果突出了边缘型人格障碍的改善情况。该研究指出了回避型人格障碍治疗、职业活动较差以及年龄相关差异方面的挑战。
