Differential Treatment Response of Subtypes of Patients With Borderline Personality Organization, as Assessed With Theory-Driven Profiles of the Dutch Short Form of the MMPI: A Naturalistic Follow-Up Study

Abstract

We investigated the validity of different subtypes of borderline personality organization (BPO) as assessed by theory-driven profiles of the Minnesota Multiphasic Personality Disorder (MMPI; Hathaway & McKinley, 1943) Dutch Short Form (DSFM; Eurelings-Bontekoe, Onnink, Williams, & Snellen, 2008) in a naturalistic follow-up study among 2,062 psychiatric outpatients who received 6 months of ambulatory treatment. Patients were assessed at intake (T1) and 6 months later (T2). At T2, both patients and therapists rated the level of improvement, using the Global Assessment of Improvement. Patients with the high-level BPO profile showed the largest increase in well-being and the largest decrease in severity of symptomatology, whereas severity of symptomatology and well-being of patients with psychotic BPO profiles did not change over time. Agreement between patients and therapists about improvement was good for the internalizing immature BPO and high-level BPO patients, but poor for the externalizing low-level BPO and narcissistic patients.

Notes

It should be noted that the DSFM Somatization and Extraversion subscales are not included in the structural assessment model. Although these two scales are always used in the profile interpretation of the individual patient to refine the clinical picture, they are not used for structural diagnosis. Within the theory-driven profile interpretation, the DSFM Somatization subscale is considered to assess bodily awareness and as such to be an important general affect and emotion regulator, independent of structural pathology. Low scores on Somatization could be a complicating factor, irrespective of structural diagnosis, suggesting low or absent awareness of physical sensations, which can be considered the first level of emotional awareness, according to the alexithymia model of Lane, Quinlan, Schwartz, Walker, and Zeilin (1990). Extraversion is considered to be a (normal) temperamental trait and not a marker of structural personality pathology. This is in agreement with Kernberg and Caligor (2005), who argued that the Introversion /Extraversion dimension is a temperamental disposition influencing the type of personality disorder (internalizing or externalizing) but not the severity of structural personality pathology.