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Psychotherapy Benefits Patients With Cluster B Personality Disorders

psychologist and patient in individual therapyA new study published in the current issue of Psychotherapy and Psychosomatics by a group of Dutch investigators headed by Paul Emmelkamp indicates that personality disturbances can be treated. Type B personality disorders center on those with dramatic or erratic behavior and most commonly diagnosed as Histrionic (Hysterical) Personality disorder [1].

For patients with cluster B personality disorders there is no consensus regarding the optimal treatment setting. The aim of this study was to compare the effectiveness of different psychotherapeutic settings for patients with cluster B personality disorders (i.e. outpatient, day hospital, and inpatient treatment). The study was conducted between March 2003 and June 2008 in 6 mental health care centers in the Netherlands with a sample of 207 patients with a DSM-IV-TR axis II cluster B diagnosis.

Patients were assigned to 3 different settings of psychotherapeutic treatment and effectiveness was assessed at 18 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45), and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomized, the propensity score method was used to control for initial differences.

Patients in all 3 settings improved significantly in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life 18 months after baseline. The inpatient group showed the largest improvements. The comparison of outpatient and inpatient treatment regarding psychiatric symptoms showed a marginally significant result (p = 0.057) in favor of inpatient treatment.

Patients with cluster B personality disorders improved in all investigated treatment settings with a trend towards larger improvements of psychiatric symptoms in the inpatient setting compared to the outpatient setting. Specialized inpatient treatment should be considered as a valuable treatment option for cluster B personality disorders both in research and in clinical practice.

Material adapted from Journal of Psychotherapy and Psychosomatics

[1] Merck Manual. Personality Disorders. Available online here:

Bartak, A., Andrea, H., Spreeuwenberg, M.D., Ziegler, U.M., Dekker, J., Rossum, B.V., Hamers, E.F.M., Scholte, W., Aerts, J., Busschbach, J.J.V., Verheul, R., Stijnen, T., & Emmelkamp, P.M.G. (2011). Effectiveness of Outpatient, Day Hospital, and Inpatient Psychotherapeutic Treatment for Patients with Cluster B Personality Disorders. Psychother Psychosom, 80:28-38

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