Cambios en la psicopatología del trastorno limítrofe de la personalidad, en los pacientes tratados con psicoterapia psicodinámica (2000)

Summary There are very few studies on the changes in patients with borderline personality disorder (BPD) treated with psychodynamic psychotherapy, around the world, and as far as we know, this is the first report in Mexico on this subject. The main features of this disorder appear at 18 years of age (75% females; 25% males) and are frequent crises characterized by impulsivity (physical figths, substance abuse, suicide or selfmutilating behavior), affective instability (episodes of depression, anxiety and anger) and alterations in identity (sudden changes in values, vocational or laboral goals) that consume a lot of health resources and contribute to many failures in academic and work performance. Its treatment always needs some form of individual or group psychotherapy, with medication at times. In most of the clinical settings this disorder is considered as untractable or to take years to produce beneficial modifications. According to the epidemiological studies of several countries, this disorder appears in 1.1 to 4.6% in the general population, in 10% of the patients in ambulatory mental health centers, in 20% of the hospitalized psychiatric patients and in 30 to 60% of the patients with personality disorders. In a clinical psychiatric population in the Central Military Hospital (Mexico City) the prevalence was 35.7%. This paper reports changes observed in the psychopathology of borderline personality disorder treated by therapists trained in the Kernberg’s manualized psychodynamic psychotherapy, delivered in two weekly 45 minutes sessions, videorecorded and supervised once a week by experts. As for the therapists that participated in the study, four were psychoanalysts with a mean experience of 12 years (D.E. = 1.15) and 10 psychotherapists with a mean experience of 4.67 years (D.E. = 4.23). The experience of both groups of therapists was significately different (U = 7.5, p,.002). Nineteen patients were treated: four males and 15 females who met the DSM IV borderline personality disorder criteria. Measurements of the psychopathology and global functioning were made at the beginning of the treatment, and every 24 sessions during a two years period, using the Clarkin’s Dimensional Scale of the DSM IV Borderline Personality Disorder, and the DSM IV Global Assessment of Functioning. The results were: a) Eleven patients no longer met the DSM IV borderline personality disorder criteria at the 72 nd session measurement, b) there was a positive change in the severity of the psychopathology in all criteria along time, c) the impulsivity criteria disappeared at the 24 th session evaluation; affective instability criteria almost disappeared at the 48 th session evaluation, while identity alterations criteria had only minimal changes even in those patients that remained in treatment for almost two years, d) the gaining in the Global Assessment of Functioning from the beginning to the 72 nd session measurement was 70% and, f) there were no significative differences between the type of therapist and the improvement of the patient in the measurements. These results should be replicated and contrasted with randomized and comparative studies between this type of therapy and supportive psychotherapy, cognitive-behavioral therapy, interpersonal therapy, group therapy and medication in patients of other social classes treated by residents in psychiatry and clinical psychologists before making available this therapy to a wider patients population.