Personality disorder

doi:10.1017/CBO9780511544392.045

43 - Personality disorder

from Part III - Specific treatments

Published online by Cambridge University Press: 12 May 2010

Anthony Bateman and

Mary Zanarini

Edited by

Peter Tyrer and

Kenneth R. Silk

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Anthony Bateman: Affiliation:
Halliwick Unit St Ann's Hospital St Ann's Road London UK
Mary Zanarini: Affiliation:
McLean Hospital Belmont, MA USA
Peter Tyrer: Affiliation:
Imperial College of Science, Technology and Medicine, London
Kenneth R. Silk: Affiliation:
University of Michigan, Ann Arbor

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Summary

Editor's note

The literature on effective treatments of the personality disorders is quite large but evidence remains sparse. There are a number of personality disorders for which there is absolutely no evidence and/or no studies examining possible evidence for efficacy, and these disorders, schizoid, histrionic, narcissistic, obsessive-compulsive and dependent are not covered in this chapter (but mentioned in the following one on other less-established treatments for personality disorder). Many descriptions of treatment for these disorders are really combinations of theory with clinical supposition but very little evidence. The evidence for some psychotherapeutic intervention is strongest for borderline personality disorder (BPD) and the evidence for psychopharmacological interventions is strongest for schizotypal personality disorder (STPD). Even well-designed studies are confounded by Axis I and Axis II co-morbidities, and this limits interpretation of the findings. The reader will note the importance given to the structuring and organization of treatment and might also consult the chapter on complex interventions in evaluating the significance of the findings.

Introduction

The definition of personality disorder (PD) remains controversial. Both the DSM-IV and ICD-10 take a categorical approach to the diagnosis of PD defining different types of personality according to descriptive criteria. Tyrer et al. (1990), however, found little evidence that categories of personality disorder were helpful in determining response to treatment or indeed that they had any predictive value at all. Research orientated methods rely on structured and semi-structured interviewing or self-report screening measures. Although this improves reliability somewhat, the approach remains unsatisfactory (Pilkonis et al., 1995).

Type: Chapter
Information: Cambridge Textbook of Effective Treatments in Psychiatry , pp. 657 - 681

DOI: https://doi.org/10.1017/CBO9780511544392.045 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2008

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References

Alden, L. (1989). Short-term structured treatment for avoidant personality disorder. Journal of Consulting and Clinical Psychology, 57, 756–64.Google Scholar

Alden, L. E. & Capreol, M. J. (1993). Avoidant personality disorder: Interpersonal problems as predictors of treatment response. Behavioural Therapy, 24, 357–76.Google Scholar

Alford, B. & Beck, A. (1997). The Integrative Power of Cognitive Therapy. New York: Guilford Press.

Barber, J. P. & Muenz, L. R. (1996). The role of avoidance and obsessiveness in matching patients to cognitive and interpersonal psychotherapy: empirical findings from the treatment for depression collaborative research program. Journal of Consulting and Clinical Psychology, 64, 951–58.Google Scholar

Barber, J. P., Morse, J. Q., Krakauer, I. D.et al. (1997). Change in obsessive-compulsive and avoidant personality disorders following Time-limited Supportive-expressive therapy. Psychotherapy, 34, 133–43.Google Scholar

Bateman, A. & Fonagy, P. (1999). The effectiveness of partial hospitalization in the treatment of borderline personality disorder – a randomised controlled trial. American Journal of Psychiatry, 156, 1563–9.Google Scholar

Bateman, A. & Fonagy, P. (2000). Effectiveness of psychotherapeutic treatment of personality disorder. British Journal of Psychiatry, 177, 138–43.Google Scholar

Bateman, A. & Fonagy, P. (2001). Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalisation: an 18-month follow-up. American Journal of Psychiatry, 158, 36–42.Google Scholar

Bateman, A. & Fonagy, P. (2003). Health service utilisation costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalisation versus general psychiatric care. American Journal of Psychiatry, 160, 169–171.Google Scholar

Bateman, A. & Fonagy, P. (2004). Psychotherapy for Borderline Personality Disorder: Mentalisation Based Treatment. Oxford: Oxford University Press.

Bateman, A. & Fonagy, P. (2006). Mentalization Based Treatment: A Practical Guide, Oxford: Oxford University Press.

Beck, A. T., Ward, C. H., Mendelson, M.et al. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–71.Google Scholar

Bender, D. S., Dolan, R. T., Skodol, A. E.et al. (2001). Treatment utilisation by patients with personality disorders. American Journal of Psychiatry, 158, 295–302.Google Scholar

Benedetti, F., Sforzini, L. & Colombo, C. (1998). Low dose clozapine in acute and continuation treatment of severe borderline personality disorder. Journal of Clinical Psychiatry, 59, 103–7.Google Scholar

Blatt, S. J., Stayner, D. A., Auerbach, J. S. & Behrends, R. S. (1996). Change in object and self-representations in long-term, intensive, inpatient treatment of seriously disturbed adolescents and young adults. Psychiatry, 59, 82–107.Google Scholar

Bogenschutz, M. & Nurnberg, H. (2004). Olanzapine versus placebo in the treatment if borderline personality disorder. Journal of Clinical Psychiatry, 65, 104–9.Google Scholar

Bohus, M., Landwehrmeyer, G., Stiglmayr, C.et al. (1999). Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial. Journal of Clinical Psychiatry, 60, 598–603.Google Scholar

Bohus, M., Haaf, B., Simms, T.et al. (2002). Effectiveness of inpatient Dialectical Behavioural Therapy for Borderline Personality Disorder: a controlled trial. In 5th ISSPD European Congress on Personality Disorders – Abstracts, pp. 18. Munich, Germany.

Byford, S., Knapp, M., Greenshields, J.et al. (2003). Cost-effectiveness of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: a decision-making approach. Psychological Medicine, 33, 977–86.Google Scholar

Campbell, M., Fitzpatrick, R., Haines, A.et al. (2000). A framework for the design and evaluation of complex interventions to improve health. British Medical Journal, 321, 694–6.Google Scholar

Chengappa, K., Ebeling, T., Kang, J.et al. (1999). Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder. Journal of Clinical Psychiatry, 60, 477–84.Google Scholar

Chiesa, M. & Fonagy, P. (2003). Psychosocial treatment for severe personality disorder: 36-month follow-up. British Journal of Psychiatry, 183, 356–62.Google Scholar

Chiesa, M., Fonagy, P., Holmes, J.et al. (2002). Health Service use costs by personality disorder following specialist and non-specialist treatment: a comparative study. Journal of Personality Disorders, 16, 160–73.Google Scholar

Chiesa, M., Fonagy, P., Holmes, J.et al. (2004). Residential versus community treatment of personality disorders: a comparative study of three treatment programmes. American Journal of Psychiatry, 161, 1463–70.Google Scholar

Clark, L. A., Vittengl, J., Kraft, D.et al. (2003). Separate personality traits from states to predict depression. Journal of Personality Disorders, 17, 152–72.Google Scholar

Clarkin, J. F. (2002). 5th ISSPD European Congress on Personality Disorders. In Personality Disorders: Neurobiology and Psychotherapy. Munich.

Clarkin, J. F., Foelsch, P., Levy, K.et al. (2001). The development of a psychodynamic treatment for patients with borderline personality disorder: a preliminary study of behavioural change. Journal of Personality Disorders, 15, 487–95.Google Scholar

Clarkin, J. F., Levy, K. N., Lenzenweger, M. F.et al. (2004). The Personality Disorders Institute/Borderline Personality Disorder Research Foundation randomised controlled trial for borderline personality disorder: rationale, methods, and patient characteristics. Journal of Personality Disorders, 18, 52–72.Google Scholar

Coccaro, E., Harvey, P., Kupsaw-Lawrence, E.et al. (1991). Development of neuropharmacologically based behavioural assessments of impulsive aggressive behaviour. Journal of Neuropsychiatry and Clinical Neuroscience, 3 (Suppl.), 44–51.Google Scholar

Copas, J. B., O'Brien, M., Roberts, J.et al. (1984). Treatment outcome in personality disorders: the effect of social, psychological and behavioural variables. Personality and Individual Differences, 5, 565–73.Google Scholar

Cornelius, J., Soloff, P., Perel, J.et al. (1990). Fluoxetine trial in borderline personality disorder. Psychopharmacology Bulletin, 26, 151–4.Google Scholar

Davidson, K. & Tyrer, P. (1996). Cognitive therapy for antisocial and borderline personality disorders: single case study series. British Journal of Clinical Psychology, 35, 413–29.Google Scholar

Davidson, K., Norrie, J. & Tyrer, P. (2006a). The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial. Journal of Personality Disorders, 20(5), 450–65.Google Scholar

Davidson, K., Tyrer, P., Gumley, A.et al. (2006b). A randomized controlled trial of cognitive behavior therapy for borderline personality disorder: rationale for trial, method, and description of sample. Journal of Personality Disorders, 20, 431–49.Google Scholar

Davidson, K., Scott, J., Schmidt, U.et al. (2004). Therapist competence and clinical outcome in the Prevention of Parasuicide by Manual Assisted Cognitive Behaviour Therapy Trial: the POPMACT study. Psychological Medicine, 34, 855–63.Google Scholar

Davies, S., Campling, P. & Ryan, K. (1999). Therapeutic Community provision at regional and district levels. Psychiatric Bulletin, 23, 79–83.Google Scholar

Derogatis, L. R. (1983). SCL-90R: Administration, Scoring and Procedures – Manual II. Towson, MD: Clinical Psychometric Research Inc.

Dolan, B., Warren, F. & Norton, K. (1997). Change in borderline symptoms one year after therapeutic community treatment for severe personality disorder. British Journal of Psychiatry, 171, 272–9.Google Scholar

Donnelly, J. & Guy, S. (1998). Evaluation of a first stage pilot project to address offending behaviour in a mentally disordered population in Scotland. Psychiatric Care, 5, 106–8.Google Scholar

D'Silva, K., Duggan, C. & Mccarthy, L. (2004). Does treatment really make psychopaths worse? A review of the evidence. Journal of Personality Disorders, 18, 163–77.Google Scholar

Ekselius, L., Tillfors, M., Furmark, T.et al. (2001). Personality Disorder in the general population: DSM-IV and ICD-10 defined prevalence as related to sociodemographic profile. Personality and Individual Differences, 30, 311–20.Google Scholar

Emmelkamp, P. M., Benner, A., Kuipers, A., Feiertag, G. A.Koster, H. C. & Apeldoorn, F. J. (2006). Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder. British Journal of Psychiatry, 189, 60–4.Google Scholar

Evans, K., Tyrer, P., Catalan, J.et al. (1999). Manual-assisted cognitive-behaviour therapy (MACT): a randomised controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological Medicine, 29, 19–25.Google Scholar

Feske, U., Mulsant, B., Pilkonis, P. A.et al. (2004). Clinical outcome of ECT in patients with major depression and comorbid borderline personality disorder. American Journal of Psychiatry, 161, 2073–80.Google Scholar

Feske, U., Perry, K. J., Chambless, D. L.et al. (1996). Avoidant Personality Disorder as a predictor for treatment outcomes among generalised social phobics. Journal of Personality Disorders, 10, 174–84.Google Scholar

Fisher, M. & Bentley, K. (1996). Two group therapy models for clients with a dual diagnosis of substance abuse and personality disorder. Psychiatric Services, 11, 1244–50.Google Scholar

Fonagy, P. & Bateman, A. (2006). Progress in the treatment of borderline personality disorder. British Journal of Psychiatry, 188, 1–3.Google Scholar

Frankenburg, F. R. & Zanarini, M. C. (1993). Clozapine treatment in borderline patients: a preliminary study. Comprehensive Psychiatry, 34, 402–405.Google Scholar

Frankenburg, F. R. & Zanarini, M. C. (2002). Divalproex sodium treatment of women with borderline personality disorder and bipolar II disorder: a double blind placebo controlled pilot study. Journal of Clinical Psychiatry, 63, 442–6.Google Scholar

Gabbard, G. O., Lazar, S. G., Hornberger, J.et al. (1997). The economic impact of psychotherapy: a review. American Journal of Psychiatry, 154, 147–55.Google Scholar

Gabbard, G., Coyne, L., Allen, J.et al. (2000). Evaluation of intensive in-patient treatment of patients with severe personality disorders. Psychiatric Services, 51, 893–8.Google Scholar

Giesen-Bloo, J., Dyck, R., Spinhoven, P.et al. (2006). Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63, 649–58.Google Scholar

Gunderson, J. G., Kolb, J. E. & Austin, V. (1981). The diagnostic interview for borderline patients. American Journal of Psychiatry, 138, 896–903.Google Scholar

Haigh, R. (2002). Therapeutic community research: past, present and future. Psychiatric Bulletin, 26, 68–70.Google Scholar

Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.Google Scholar

Hare, R. (1991). The Hare Psychopathy Checklist – Revised. Toronto: Multi-Health Systems.

Hill, J., Harrington, R. C., Fudge, H.et al. (1989). Adult personality functioning assessment (APFA): an investigation-based standardised interview. British Journal of Psychiatry, 161, 24–35.Google Scholar

Hollander, E., Allen, A., Lopez, R.et al. (2001). A preliminary double blind, placebo controlled trial of divalproex sodium in borderline personality disorder. Journal of Clinical Psychiatry, 62, 199–203.Google Scholar

Hughes, G. & Hogue, T. (1997). First-stage evaluation of a treatment programme for personality disordered offenders. Journal of Forensic Psychiatry, 8, 515–27.Google Scholar

Karterud, S., Vaglum, S., Friis, S.et al. (1992). Day hospital therapeutic community treatment for patients with personality disorder: an empirical evaluation of the containment function. The Journal of Nervous and Mental Disease, 180, 238–43.Google Scholar

Karterud, S., Pedersen, G., Bjordal, E.et al. (2003). Day treatment of patients with personality disorders: experiences from a Norwegian treatment research network. Journal of Personality Disorders, 17, 243–62.Google Scholar

Koenigsberg, H. W., Reynolds, D. & Goodman, L. (2003). Risperidone in the treatment of schizotypal personality disorder. Journal of Clinical Psychiatry, 64, 628–34.Google Scholar

Koerner, K. & Linehan, M. M. (1992). Integrative therapy for borderline personality disorder: dialectical behaviour therapy. In Handbook of Psychotherapy Integration, ed. Norcross, J. C. G., pp. 433–59. New York: Basic Books.

Koons, C., Robins, C. & Tweed, J. (2000). Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behavior Therapy, 32, 371–90.Google Scholar

Lees, J., Manning, N. & Rawlings, B. (1999). Therapeutic community effectiveness. A systematic international review of therapeutic community treatment for people with personality disorders and mentally disordered offenders. NHS Centre for Reviews and Dissemination: University of York, CRD Report 17.

Lees, J., Manning, N. & Rawlings, B. (2004). A culture of enquiry: research evidence and the therapeutic community. Psychiatric Quarterly, 75, 279–94.Google Scholar

Leichsenring, F. & Leibing, E. (2003). The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. American Journal of Psychiatry, 160, 1223–32.Google Scholar

Levendusky, P. (2000). Dialectical behavior therapy: so far so soon. Clinical Psychology Science and Practice, 7, 99–100.Google Scholar

Linehan, M. M. (1987). Dialectical behavioural therapy: A cognitive behavioural approach to parasuicide. Journal of Personality Disorders, 1, 328–33.Google Scholar

Linehan, M. M. (1993). The Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press.

Linehan, M. & Heard, H. (1993). Impact of treatment accessibility on clinical course of parasuicidal patients: reply. Archives of General Psychiatry, 50, 157–8.Google Scholar

Linehan, M. M., Armstrong, H., Suarez, A.et al. (1991). Cognitive-behavioural treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060–64.Google Scholar

Linehan, M. M., Heard, H. L. & Armstrong, H. E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50, 971–4.Google Scholar

Linehan, M., Dimeff, L., Reynolds, S.et al. (2002). Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13–26.Google Scholar

Linehan, M. M., Comtois, K. A., Murray, A. M.et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–66.Google Scholar

Longabaugh, R., Wirtz, P. W., DiClemente, C. C.et al. (1994). Issues in the development of client-treatment matching hypotheses. Journal of Studies on Alcohol. 12 (Suppl.), 46–59.Google Scholar

Lynch, T. R., Chapman, A. L., Rosenthal, M. Z.et al. (2006). Mechanisms of change in dialectical behavior therapy: theoretical and empirical observations. Journal of Clinical Psychology, 62, 459–80.Google Scholar

Maden, T. & Tyrer, P. (2003). Dangerous and severe personality disorders: a new concept from the United Kingdom. Journal of Personality Disorders, 17, 489–96.Google Scholar

Main, T. (1957). The ailment. British Journal of Medical Psychology, 30, 129–45.Google Scholar

Markovitz, P. J. (1995). Pharmacotherapy of impulsivity, aggression, and related disorders. In Impulsivity and Aggression, ed. Hollander, E. & Stein, D.. Chichester, UK: John Wiley.

Markovitz, P. J. & Wagner, C. (1995). Venlafaxine in the treatment of borderline personality disorder. Psychopharmacology Bulletin, 31, 773–7.Google Scholar

Markovitz, P. J., Calabrese, J., Schulz, S. C.et al. (1991). Fluoxetine in treatment of borderline and schizotypal personality disorders. American Journal of Psychiatry, 148, 1064–7.Google Scholar

Marlowe, M. J., O'Neill-Byrne, K., Lowe-Ponsford, F.et al. (1996). The borderline syndrome index: a validation study using the personality assessment schedule. British Journal of Psychiatry, 168, 72–5.Google Scholar

Marziali, E. & Monroe-Blum, H. (1995). An interpersonal approach to group psychotherapy with borderline personality disorder. Journal of Personality Disorders, 9, 179–89.Google Scholar

Marzillier, J. S., Lambert, C. & Kelett, J. (1976). A controlled evaluation of systematic desensitisation and social skills training for socially inadequate psychiatric patients. Behavioural Research and Therapy, 14, 225–38.Google Scholar

McGlashan, T. H. (1986). Schizotypal personality disorder. Chestnut Lodge follow-up study: long-term follow-up perspectives. Archives of General Psychiatry, 43, 329–34.Google Scholar

Mersch, P. P., Jansen, M. A. & Arntz, A. (1995). Social phobia and personality disorder: severity of complaint and treatment effectiveness. Journal of Personality Disorders, 9, 143–59.Google Scholar

Montgomery, S. & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 135, 382–9.Google Scholar

Nickel, M. K., Muehlbacher, M, Nickel, C.et al. (2006). Aripiprazole in the treatment of patients with borderline personality disorder: a double-blind, placebo-controlled study. American Journal of Psychiatry, 163, 833–8.Google Scholar

Norden, M. J. (1989) Fluoxetine in borderline personality disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 13, 885–93.Google Scholar

Oldham, J., Phillips, K., Gabbard, G.et al. (2001). Practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Association. American Journal of Psychiatry, 158, 1–52.Google Scholar

Overall, J. & Gorham, D. (1962). The brief psychiatric rating scale. Psychological Reports, 10, 799–812.Google Scholar

Perry, J. C., Banon, E. & Ianni, F. (1999). Effectiveness of psychotherapy for personality disorder. American Journal of Psychiatry, 156, 1312–21.Google Scholar

Pilkonis, P. A., Heape, C. L., Proietti, M. S.et al. (1995). The reliability and validity of two structured interviews for personality disorders. Archives of General Psychiatry, 52, 1029–33.Google Scholar

Pinto, O. & Akiskal, H. (1998). Lamotrigine as a promising approach to borderline personality: an open case series without concurrent DSM-IV major mood disorder. Journal of Affective Disorders, 51, 333–43.Google Scholar

Project Match Research Group (1998). Therapists effects in three treatments for alcohol problems. Psychotherapy Research, 8, 455–74.

Putnam, K. & Silk, K. R. (2005). Emotion dysregulation and the development of borderline personality disorder. Development and Psychopathology, 17, 899–925.Google Scholar

Quale, M. & Moore, E. (1998). Evaluating the impact of structured group work with men in a high security hospital. Criminal Behaviour and Mental Health, 8, 77–92.Google Scholar

Raine, A., Mellingen, K., Liu, J.et al. (2003). Effects of environmental enrichment at ages 3–5 years on schizotypal personality and antisocial behavior at ages 17 and 23. American Journal of Psychiatry, 196, 1627–35.Google Scholar

Renneberg, B., Goldstein, A. J., Phillips, D.et al. (1990). Intensive behavioural group treatment of avoidant personality disorder. Behaviour Therapy, 21, 363–77.Google Scholar

Rice, M. E., Harris, G. T. & Cormier, C. A. (1992). An evaluation of a maximum-security therapeutic community for psychopaths and other mentally disordered offenders. Law and Human Behaviour, 16, 399–412.Google Scholar

Rinne, T., Brink, W., Wouters, L.et al. (2002). SSRI treatment of borderline personality disorder: a randomized, placebo-controlled clinical trial for female patients with borderline personality disorder. American Journal of Psychiatry, 159, 2048–54.Google Scholar

Robins, C. (2003). Dialectical behavior therapy for borderline personality disorder. Psychiatric Annals, 32, 608–16.Google Scholar

Rocca, P., Marchiaro, L., Cocuzza, E.et al. (2002). Treatment of borderline personality disorder with risperidone. Journal of Clinical Psychiatry, 63, 241–4.Google Scholar

Rosser, R., Birch, S., Bond, H.et al. (1987). Five year follow-up of patients treated with in-patient psychotherapy at the Cassel Hospital for Nervous Diseases. Journal of the Royal Society of Medicine, 80, 549–55.Google Scholar

Rutter, D. & Tyrer, P. (2003). The value of therapeutic communities in the treatment of personality disorder: a suitable place for treatment?Journal of Psychiatric Practice, 9, 291–302.Google Scholar

Ryle, A. (2004). The contribution of cognitive analytic therapy to the treatment of borderline personality disorder. Journal of Personality Disorders, 18, 3–35.Google Scholar

Ryle, A. & Golynkina, K. (2000). Effectiveness of time-limited cognitive analytic therapy of borderline personality disorder: factors associated with outcome. British Journal of Medical Psychology, 73, 197–210.Google Scholar

Safran, J. D. & Segal, Z. V. (1990). Interpersonal Process in Cognitive Therapy. New York: Basic Books.

Salzman, C., Wolfson, A., Schatzberg, A.et al. (1995). Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. Journal of Clinical Psychopharmacology, 15, 23–9.Google Scholar

Sara, G., Raven, P. & Mann, A. (1996). A comparison of DSM-IIIR and ICD10 personality disorder criteria in an outpatient population. Psychological Medicine, 26, 151–60.Google Scholar

Saunders, D. (1996). Feminist cognitive behavioral and process-psychodynamic treatment for men who batter: interaction of abuser traits and treatment models. Violence and Victims, 11, 393–414.Google Scholar

Scheel, K. (2000) The empirical basis of dialectical behavior therapy: summary, critique, and implications. Clinical Psychology Science and Practice, 7, 68–86.Google Scholar

Schulz, S., Camlin, K., Berry, S.et al. (1999a). Olanzapine safety and efficacy in patients with borderline personality disorder and comorbid dysthymia. Biological Psychiatry, 46, 1429–35.Google Scholar

Schulz, S. C., Camlin, K. L., Berry, S. A.et al. (1999b). A controlled study of Risperidone for borderline personality disorder. In 7th International Congress on Schizophrenia Research, pp. 296–297. Santa Fe, New Mexico: Schizophrenia Research.

Schwarz, D. & Lellouch, J. (1967). Explanatory and pragmatic attitudes in therapeutic trials. Journal of Chronic Diseases, 20, 637–48.Google Scholar

Shearin, E. & Linehan, M. M. (1992). Patient–therapist ratings and relationship to progress in dialectical behaviour therapy for borderline personality disorder. Behaviour Therapy, 23, 730–41.Google Scholar

Siever, L. J. & Davis, K. L. (1991). A psychobiological perspective on the personality disorders. American Journal of Psychiatry, 148, 1647–58.Google Scholar

Siever, L. J., Torgersen, S., Gunderson, J. G.et al. (2002). The borderline diagnosis III: identifying endophenotypes for genetic studies. Biological Psychiatry, 51, 964–8.Google Scholar

Slade, M. & Priebe, S. (2001). Are randomised controlled trials the only gold that glitters?British Journal of Psychiatry, 179, 286–7.Google Scholar

Stein, D., Simeon, D., Frenkel, M.et al. (1995). An open trial of valproate in borderline personality disorder. Journal of Clinical Psychiatry, 56, 506–10.Google Scholar

Stone, M. (1993). Long-term outcome in personality disorders. British Journal of Psychiatry, 162, 299–313.Google Scholar

Stravynski, A., Marks, I. & Yule, W. (1982). Social skills problems in neurotic outpatients: social skills training with and without cognitive modification. Archives of General Psychiatry, 39, 1378–85.Google Scholar

Stravynski, A., Belisle, M., Marcoulier, M.et al. (1994). The treatment of avoidant personality disorder by social skills training in the clinic or in real-life settings. Canadian Journal of Psychiatry, 39, 377–83.Google Scholar

Swenson, C. (2000). How can we account for DBT's widespread popularity. Clinical Psychology: Science and Practice, 7, 87–91.Google Scholar

Tucker, L., Bauer, S. F., Wagner, et al. (1987). Long-term hospital treatment of borderline patients: a descriptive outcome study. American Journal of Psychiatry, 144, 1443–1448.Google Scholar

Turkat, I. D. & Maisto, S. A. (1985). Personality disorders: application of the experimental method to the formulation of personality disorders. In Clinical Outcome of Psychological Disorders, ed. Barlow, D. H.. New York: Guilford Press.

Turner, R. (2000a). Naturalistic evaluation of dialectical behaviour therapy-orientated treatment for borderline personality disorder. Cognitive and Behavioural Practice, 7, 413–19.Google Scholar

Turner, R. (2000b). Understanding dialectical behaviour therapy. Clinical Psychology Science and Practice, 7, 95–8.Google Scholar

Tyrer, P. (2002). Practice guideline for the treatment of borderline personality disorder: a bridge too far. Journal of Personality Disorders, 16, 113–18.Google Scholar

Tyrer, P., Seivewright, N., Ferguson, B.et al. (1990). The Nottingham Study of Neurotic Disorder: relationship between personality status and symptoms. Psychological Medicine, 20, 423–31.Google Scholar

Tyrer, P., Jones, V. & Thompson, S. (2003). Service variation in baseline variables and prediction of risk in a randomised controlled trial of psychological treatment in repeated parasuicide: the POPMACT study. International Journal of Social Psychiatry, 49, 58–69.Google Scholar

Tyrer, P., Tom, B., Byford, S.et al. (2004). Differential effects of manual assisted cognitive behaviour therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study. Journal of Personality Disorders, 18, 102–16.Google Scholar

Vaglum, P., Friis, S., Irion, T.et al. (1990). Treatment response of severe and nonsevere personality disorders in a therapeutic community day unit. Journal of Personality Disorders, 4, 161–72.Google Scholar

Velzen, C. J. M., Emmelkamp, P. M. G. & Scholing, A. (1997). The impact of personality disorders on behavioural treatment outcome for social phobia. Behaviour Research and Therapy, 35, 889–900.Google Scholar

Verheul, R.Bosch, L. M., Koeter, M. W.et al. (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. British Journal of Psychiatry, 182, 135–40.Google Scholar

Wilberg, T., Friis, S., Karterud, S.et al. (1998). Outpatient group psychotherapy: a valuable continuation treatment for patients with borderline personality disorder treated in a day hospital? A 3-year follow-up study. Nordic Journal of Psychiatry, 52, 213–22.Google Scholar

Wilcox, J. (1995). Divalproex sodium as a treatment for borderline personality disorder. Annals of Clinical Psychiatry, 7, 33–7.Google Scholar

Winston, A., Pollack, J., McCullough, L.et al. (1991). Brief psychotherapy of personality disorders. Journal of Nervous and Mental Disease, 179, 188–93.Google Scholar

Winston, A., Laikin, M., Pollack, J.et al. (1994). Short-term dynamic psychotherapy of personality disorders. American Journal of Psychiatry, 15, 190–4.Google Scholar

Woody, G. E., McLellan, T., Luborsky, L.et al. (1985). Sociopathy and psychotherapy outcome. Archives of General Psychiatry, 179, 188–93.Google Scholar

Young, J. E. (1990). Cognitive Therapy for Personality Disorders: A Schema-focused Approach. Sarasota, Florida: Professional Resource Exchange.

Young, R., Biggs, J., Ziegler, V.et al. (1978). A rating scale for mania: reliability, validity, and sensitivity. British Journal of Psychiatry, 133, 429–35.Google Scholar

Zanarini, M. C. & Frankenburg, F. R. (1997). Pathways to the development of borderline personality disorder. Journal of Personality Disorders, 11, 93–104.Google Scholar

Zanarini, M. C. & Frankenburg, F. R. (2001). Olanzapine treatment of borderline patients: a double-blind, placebo-controlled study. Journal of Clinical Psychiatry.Google Scholar

Zanarini, M. C. & Frankenburg, F. R. (2003). Omega-3 fatty acid treatment of women with borderline personality disorder. American Journal of Psychiatry, 160, 167–9.Google Scholar

Zanarini, M. C., Gunderson, J., Frankenburg, F. R.et al. (1989). The revised Diagnostic Interview for Borderlines: discriminating BPD from other Axis II disorders. Journal of Personality Disorders, 3, 10–18.Google Scholar

Zanarini, M. C., Frankenburg, F. R., Dubo, E.et al. (1998). Axis 1 comorbidity of borderline personality disorder. American Journal of Psychiatry, 155, 1733–9.Google Scholar

Zanarini, M. C., Frankenburg, F. R., Khera, G. S.et al. (2001). Treatment histories of borderline patients. Comprehensive Psychiatry, 42, 144–50.Google Scholar

Zanarini, M. C., Frankenburg, F. R., Hennen, J.et al. (2003a). The Longitudinal Course of Borderline Psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. American Journal of Psychiatry, 160, 274–83.Google Scholar

Zanarini, M. C., Vujanovic, A. A., Parachini, E. A.et al. (2003b). Zanarini rating scale for borderline personality disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology. Journal of Personality Disorders, 17, 233–42.Google Scholar

Zanarini, M. C., Frankenburg, F. R., Hennen, J.et al. (2004a). Axis 1 comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. American Journal of Psychiatry, 161, 2108–14.Google Scholar

Zanarini, M. C., Frankenburg, F. R., Hennen, J.et al. (2004b). Mental Health Service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years. Journal of Clinical Psychiatry, 65, 28–36.Google Scholar