Jintanachote Varit, Wongpakaran Tinakon, Wongpakaran Nahathai
Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand.
Heliyon. 2024 Aug 29;10(17):e37183. doi: 10.1016/j.heliyon.2024.e37183. eCollection 2024 Sep 15.
Personality disorders are significant entities in the field of psychiatry and serve as predisposing factors for Axis I clinical disorder. The Treatment of choice is psychotherapy, and one specific approach is Control Mastery Therapy, which emphasizes addressing Pathogenic beliefs (PB). This study aimed to investigate whether there is a relationship between PB and specific personality disorders and whether these beliefs align with the core features specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for that personality disorder.
This study employed a retrospective cross-sectional design and included 319 participants, comprising individuals receiving treatment at the Psychotherapy Clinic at Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University between 2007 and 2023. All participants were assessed and completed the Structured Clinical Interview for DSM-IV Axis II - Personality Disorders Questionnaire (SCID-II-PQ), Pathogenic Beliefs Scale, and Outcome-Inventory (depression). A generalized linear model (binary logistic regression) was employed, and the predictors included personality disorders. The outcome was the pathogenic belief, and covariates encompassed age, sex, education, clinical diagnosis, and depression score. A sensitivity analysis was conducted to examine the effect on the model when outliers of depressive scores were present.
After adjusting for depression, ten personality disorders were found to predict 16 pathogenic beliefs out of the 27 outcomes examined. Notably, histrionic and obsessive-compulsive personality disorders showed no association with specific pathogenic beliefs. Furthermore, certain pathogenic beliefs were predicted by multiple personality disorders, while conversely, some personality disorders were associated with multiple pathogenic beliefs as well. Sensitivity analysis revealed that outliers influenced the relationships between certain disorders and pathogenic beliefs, particularly those with small effect sizes.
The profound impact of pathogenic beliefs intertwined with personality disorders, particularly influenced by childhood trauma and evident in Cluster B and schizotypal disorders, underscores the critical need for targeted psychotherapeutic interventions. Addressing these beliefs directly is key to enhancing treatment efficacy and patient outcomes. Pathogenic belief should be elicited in clinical settings regardless of personality disorder, especially those who experienced depression. Moving forward, rigorous research is imperative to validate and refine therapeutic approaches aimed at reshaping pathogenic beliefs, ensuring they become pivotal in transforming clinical practice and advancing mental health care.
人格障碍是精神病学领域的重要病症，是轴I临床障碍的诱发因素。首选治疗方法是心理治疗，一种特定的方法是控制掌握疗法，该疗法强调处理致病性信念（PB）。本研究旨在调查PB与特定人格障碍之间是否存在关联，以及这些信念是否与《精神障碍诊断与统计手册》（DSM）中针对该人格障碍规定的核心特征相符。
本研究采用回顾性横断面设计，纳入319名参与者，包括2007年至2023年期间在清迈大学医学院玛哈拉吉·那空清迈医院心理治疗诊所接受治疗的个体。所有参与者均接受评估并完成了《DSM-IV轴II人格障碍结构化临床访谈问卷》（SCID-II-PQ）、致病性信念量表和结果量表（抑郁）。采用广义线性模型（二元逻辑回归），预测变量包括人格障碍。结果变量是致病性信念，协变量包括年龄、性别、教育程度、临床诊断和抑郁评分。进行了敏感性分析，以检查存在抑郁评分异常值时对模型的影响。
在对抑郁进行调整后，发现十种人格障碍可预测所检查的27项结果中的16项致病性信念。值得注意的是，表演型和强迫型人格障碍与特定的致病性信念无关联。此外，某些致病性信念由多种人格障碍预测，反之，一些人格障碍也与多种致病性信念相关。敏感性分析表明，异常值影响了某些障碍与致病性信念之间的关系，尤其是那些效应量较小的关系。
致病性信念与人格障碍相互交织产生的深远影响，尤其受到童年创伤的影响，在B类人格障碍和分裂型人格障碍中表现明显，凸显了针对性心理治疗干预的迫切需求。直接处理这些信念是提高治疗效果和患者预后的关键。无论人格障碍如何，尤其是那些经历过抑郁的患者，在临床环境中都应引出致病性信念。展望未来，必须进行严谨的研究以验证和完善旨在重塑致病性信念的治疗方法，确保它们成为改变临床实践和推进精神卫生保健的关键。
