Changes in the psychopathology of borderline personality disorder with psychodynamic psychotherapy

There are very few studies on the changes in patients with borderline perso nality disorder (BPD) treated with psychodynamic psychotherapy, around the world, and as far as we know, this is the first report in Mexico on this su bject. The main features of this disorder appear at 18 years of age (75% fe males; 25% males) and are frequent crises characterized by impulsivity (phy sical figths, substance abuse, suicide or self-mutilating behavior), affect ive instability (episodes of depression, anxiety and anger) and alterations in identity (sudden changes in values, vocational or laboral goals) that c onsume a lot of health resources and contribute to many failures in academi c and work performance. Its treatment always needs some form of individual or group psychotherapy, with medication at times. In most of the clinical s ettings this disorder is considered as untractable or to take years to prod uce beneficial modifications. According to the epidemiological studies of s everal countries, this disorder appears in 1.1 to 4.6% in the general popul ation, in 10% of the patients in ambulatory mental health centers, in 20% o f the hospitalized psychiatric patients and in 30 to 60% of the patients wi th personality disorders. In a clinical psychiatric population in the Centr al Military Hospital (Mexico City) the prevalence was 35.7%. This paper rep orts changes observed in the psychopathology of borderline personality diso rder treated by therapists trained in the Kernberg's manualized psychodynam ic psychotherapy, delivered in two weekly 45 minutes sessions, videorecorde d and supervised once a week by experts. As for the therapists that partici pated in the study, four were psychoanalysts with a mean experience of 12 y ears (D.E. = 1.15) and 10 psychotherapists with a mean experience of 4.67 y ears (D.E. = 4.23). The experience of both groups of therapists was signifi cately different (U = 7.5, p<.002), Nineteen patients were treated: four ma les and 15 females who met the DSM IV borderline personality disorder crite ria. Measurements of the psychopathology and global functioning were made a t 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 Pers onality Disorder, and the DSM IV Global Assessment of Functioning. The resu lts were: a) Eleven patients no longer met the DSM IV borderline personalit y disorder criteria at the 72(nd) session measurement, b) there was a posit ive change in the severity of the psychopathology in all criteria along tim e, c) the impulsivity criteria disappeared at the 24(th) session evaluation ; affective instability criteria almost disappeared at the 48(th) session e valuation, while identity alterations criteria had only minimal changes eve n 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 diff erences between the type of therapist and the improvement of the patient in the measurements. These results should be replicated and contrasted with r andomized and comparative studies between this type of therapy and supporti ve psychotherapy, cognitive-behavioral therapy, interpersonal therapy, grou p therapy and medication in patients of other social classes treated by res idents in psychiatry and clinical psychologists before making available thi s therapy to a wider patients population.