El trastorno de personalidad por evitaciónuna propuesta de tratamiento especializado en la sanidad pública española
- Felix Inchausti
- Javier Prado-Abril
- Sergio Sánchez-Reales
- Raül Vilagrà-Ruiz
- Eduardo Fonseca-Pedrero 1
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1
Universidad de La Rioja
info
ISSN: 1134-7937
Year of publication: 2018
Volume: 24
Issue: 2-3
Pages: 144-153
Type: Article
More publications in: Ansiedad y estrés
Abstract
Avoidant personality disorder is a common, heterogeneous and disabling mental health problem. Despite this, few studies have specifically focused on avoidant personality disorder treatment, and clinical guidelines have not been developed. Therefore, the main purpose of this work is to critically review the available literature on this topic, and propose a specialized treatment for patients with severe avoidant personality disorder in the Spanish National Health System. The Galatea program is an intensive and longer treatment that combines individual therapy based on Mentalization-Based Therapy and Metacognitive Interpersonal Group Therapy. In order to illustrate the treatment, a clinical case treated within the program is presented. Finally, Galatea's healthcare implications in the specialized treatment of severe avoidant personality disorder in the public mental health settings are discussed.
Bibliographic References
- Alden, L., Short-term structured treatment for avoidant personality disorder. Journal of Consulting and Clinical Psychology 57:6 (1989), 756–764.
- American Psychiatric Association [APA] (2000). Diagnostic and statistical manual of mental disorders (4 th ed., text rev.). Washington, DC: APA.
- APA (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington D.C.: APA.
- Bagby, R.M., Parker, J.D., Taylor, G.J., The twenty-item Toronto Alexithymia Scale–I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research 38:1 (1994), 23–32.
- Bamelis, L.L., Evers, S.M., Spinhoven, P., Arntz, A., Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry 171 (2014), 305–322 https://doi.org/10.1176/appi.ajp.2013.12040518.
- Barber, J.P., Morse, J.Q., Krakauer, I.D., Chittams, J., Crits-Christoph, K., Change in obsessive-compulsive and avoidant personality disorders following time-limited supportive-expressive therapy. Psychotherapy: Theory, Research, Practice, Training 34 (1997), 133–143 https://doi.org/10.1037/h0087774.
- Bartak, A., Spreeuwenberg, M.D., Andrea, H., Holleman, L., Rijnierse, P., Rossum, B.V., … Emmelkamp, P.M., Effectiveness of different modalities of psychotherapeutic treatment for patients with cluster C personality disorders: Results of a large prospective multicentre study. Psychotherapy and Psychosomatics 79 (2010), 20–30 https://doi.org/10.1159/000254902.
- Bateman, A.W., Fonagy, P., Mentalization-based treatment of BPD. Journal of Personality Disorders 18:1 (2004), 36–51.
- Bateman, A.W., Fonagy, P., Mentalization-based treatment for Borderline Personality Disorder: A practical guide. 2006, Oxford University Press, New York.
- Bender, D.S., The therapeutic alliance in the treatment of personality disorders. Journal of Psychiatric Practice 11:2 (2005), 73–87.
- Chan, C.C., Bach, P.A., Bedwell, J.S., An integrative approach using third-generation cognitive-behavioral therapies for avoidant personality disorder. Clinical Case Studies 14 (2015), 466–481 https://doi.org/10.1177/1534650115575788.
- Daubney, M., Bateman, A., Mentalization-based therapy (MBT): An overview. Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists 23:2 (2015), 132–135 https://doi.org/10.1177/1039856214566830.
- Derogatis, L.R., SCL-90-R Cuestionario de 90 síntomas - Manual. 2002, TEA ediciones, Madrid.
- Dimaggio, G., D'Urzo, M., Pasinetti, M., Salvatore, G., Lysaker, P.H., Catania, D., Popolo, R., Metacognitive interpersonal therapy for co-occurrent avoidant personality disorder and substance abuse. Journal of Clinical Psychology 71 (2015), 157–166 https://doi.org/10.1002/jclp.22151.
- Dimaggio, G., Montano, A., Popolo, R., Salvatore, G., Metacognitive Interpersonal Therapy for Personality Disorders: A treatment manual. 2015, Routledge, London.
- Eikenaes, I., Gude, T., Hoffart, A., Integrated wilderness therapy for avoidant personality disorder. Nordic Journal of Psychiatry 60 (2006), 275–281 https://doi.org/10.1080/08039480600790093.
- Eikenaes, I., Hummelen, B., Abrahamsen, G., Andrea, H., Wilberg, T., Personality functioning in patients with avoidant personality disorder and social phobia. Journal of Personality Disorders 27 (2013), 746–763 https://doi.org/10.1521/pedi_2013_27_109.
- Emmelkamp, P.M., Benner, A., Kuipers, A., Feiertag, G.A., Koster, H.C., van Apeldoorn, F.J., Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder. The British Journal of Psychiatry 189 (2006), 60–64 https://doi.org/10.1192/bjp.bp.105.012153.
- First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.B.W., Davies, M., Borus, J., … Rounsaville, B., The Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Part II: Multi-Site test-retest reliability. Journal of Personality Disorders 9:2 (1995), 92–104 https://doi.org/10.1521/pedi.1995.9.2.92.
- Fraley, R.C., Heffernan, M.E., Vicary, A.M., Brumbaugh, C.C., The Experiences in Close Relationships-Relationship Structures questionnaire: A method for assessing attachment orientations across relationships. Psychological Assessment 23:3 (2011), 615–625 https://doi.org/10.1037/a0022898.
- Gilbert, S.E., Gordon, K.C., Interpersonal psychotherapy informed treatment for avoidant personality disorder with subsequent depression. Clinical Case Studies 12 (2013), 111–127 https://doi.org/10.1177/1534650112468611.
- Gordon-King, K., Schweitzer, R.D., Dimaggio, G., Metacognitive interpersonal therapy for personality disorders featuring emotional inhibition: A multiple baseline case series. The Journal of Nervous and Mental Disease., 2018 https://doi.org/10.1097/NMD.0000000000000789.
- Gude, T., Vaglum, P., One-year follow-up of patients with cluster C personality disorders: A prospective study comparing patients with “pure” and comorbid conditions within cluster C, and “pure” C with “pure” cluster A or B conditions. Journal of Personality Disorders 15:3 (2001), 216–228.
- Horowitz, L.M., Rosenberg, S.E., Baer, B.A., Ureno, G., Villasenor, V.S., Inventory of interpersonal problems: Psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology 56:6 (1988), 885–892.
- Huppert, J.D., Strunk, D.R., Ledley, D.R., Davidson, J.R.T., Foa, E.B., Generalized social anxiety disorder and avoidant personality disorder: Structural analysis and treatment outcome. Depression and Anxiety 25:5 (2008), 441–448 https://doi.org/10.1002/da.20349.
- Inchausti, F., García-Poveda, N.V., Ballesteros-Prados, A., Ortuño-Sierra, J., Sánchez-Reales, S., Prado-Abril, J., … Fonseca-Pedrero, E., The effects of metacognition-oriented social skills training on psychosocial outcome in schizophrenia-spectrum disorders: A randomized controlled trial. Schizophrenia Bulletin., 2017 https://doi.org/10.1093/schbul/sbx168.
- Inchausti, F., García-Poveda, N.V., Prado-Abril, J., Ortuño-Sierra, J., Gaínza-Tejedor, I., Metacognition-oriented social skills training (MOSST): Theoretical framework, working methodology and treatment description for patients with schizophrenia. Papeles del Psicologo, 38(3), 2017 https://doi.org/10.23923/pap.psicol2017.2840.
- Karterud, S., Mentalization-Based Group Therapy (MBT-G): A theoretical, clinical and research manual. 2015, Oxford University Press, Oxford.
- Karterud, S., Pedersen, G., Bjordal, E., Brabrand, J., Friis, S., Haaseth, O., … Urnes, O., Day treatment of patients with personality disorders: Experiences from a Norwegian treatment research network. Journal of Personality Disorders 17:3 (2003), 243–262.
- Krueger, R.F., Derringer, J., Markon, K.E., Watson, D., Skodol, A.E., Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychological Medicine 42:9 (2012), 1879–1890 https://doi.org/10.1017/S0033291711002674.
- Kvarstein, E.H., Arnevik, E., Halsteinli, V., Ro, F.G., Karterud, S., Wilberg, T., Health service costs and clinical gains of psychotherapy for personality disorders: A randomized controlled trial of day-hospital-based step-down treatment versus outpatient treatment at a specialist practice. BMC Psychiatry, 13, 2013, 315 https://doi.org/10.1186/1471-244x-13-315.
- Kvarstein, E.H., Karterud, S., Large variations of global functioning over five years in treated patients with personality traits and disorders. Journal of Personality Disorders 26:2 (2012), 141–161 https://doi.org/10.1521/pedi.2012.26.2.141.
- Kvarstein, E.H., Karterud, S., Large variation of severity and longitudinal change of symptom distress among patients with personality disorders. Personality and Mental Health 7:4 (2013), 265–276 https://doi.org/10.1002/pmh.1226.
- Lecrubier, Y., Sheehan, D.V., Weiller, E., Amorim, P., Bonora, I., Harnett Sheehan, K., … Dunbar, G.C., The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: Reliability and validity according to the CIDI. European Psychiatry 12:5 (1997), 224–231 https://doi.org/10.1016/S0924-9338(97)83296-8.
- Leichsenring, F., Leibing, E., Cognitive–behavioural therapy for avoidant personality disorder. The British Journal of Psychiatry, 190(1), 2007, 80 LP-80 [consultado 5 Abr 2017]. Obtenido de: http://bjp.rcpsych.org/content/190/1/80.1.Abstract.
- Martin-Blanco, A., Ancochea, A., Soler, J., Elices, M., Carmona, C., Pascual, J.C., Changes over the last 15 years in the psychopharmacological management of persons with borderline personality disorder. Acta Psychiatrica Scandinavica 136:3 (2017), 323–331 https://doi.org/10.1111/acps.12767.
- Moroni, F., Procacci, M., Pellecchia, G., Semerari, A., Nicolo, G., Carcione, A., … Colle, L., Mindreading dysfunction in avoidant personality disorder compared with other personality disorders. The Journal of Nervous and Mental Disease 204:10 (2016), 752–757 https://doi.org/10.1097/NMD.0000000000000536.
- Nararro-Haro, M.V., Hoffman, H.G., Garcia-Palacios, A., Sampaio, M., Alhalabi, W., Hall, K., Linehan, M., The use of virtual reality to facilitate mindfulness skills training in dialectical behavioral therapy for borderline personality disorder: A case study. Frontiers in Psychology, 7, 2016, 1573 https://doi.org/10.3389/fpsyg.2016.01573.
- Ogrodniczuk, J.S., Piper, W.E., Joyce, A.S., Effect of alexithymia on the process and outcome of psychotherapy: A programmatic review. Psychiatry Research 190:1 (2011), 43–48 https://doi.org/10.1016/j.psychres.2010.04.026.
- Pascual, J.C., Palomares, N., Ibanez, A., Portella, M.J., Arza, R., Reyes, R., … Carrasco, J.L., Efficacy of cognitive rehabilitation on psychosocial functioning in Borderline Personality Disorder: A randomized controlled trial. BMC Psychiatry, 15, 2015, 255 https://doi.org/10.1186/s12888-015-0640-5.
- Pellecchia, G., Moroni, F., Colle, L., Semerari, A., Carcione, A., Fera, T., … Procacci, M., Avoidant personality disorder and social phobia: Does mindreading make the difference?. Comprehensive Psychiatry 80 (2018), 163–169 https://doi.org/10.1016/j.comppsych.2017.09.011.
- Popolo, R., MacBeth, A., Canfora, F., Rebecchi, D., Toselli, C., Salvatore, G., Dimaggio, G., Metacognitive Interpersonal Therapy in group (MIT-G) for young adults with personality disorders: A pilot randomized controlled trial. Psychology and Psychotherapy., 2018 https://doi.org/10.1111/papt.12182.
- Pos, A.E., Emotion focused therapy for avoidant personality disorder: Pragmatic considerations for working with experientially avoidant clients. Journal of Contemporary Psychotherapy 44 (2014), 127–139 https://doi.org/10.1007/s10879-013-9256-6 LB - Pos2014.
- Prado-Abril, J., Sánchez-Reales, S., Inchausti, F., En busca de nuestra mejor versión: pericia y excelencia en Psicología Clínica. Ansiedad Y Estrés 23:2 (2017), 110–117 https://doi.org/10.1016/j.anyes.2017.06.001.
- Renneberg, B., Goldstein, A.J., Phillips, D., Chambless, D.L., Intensive behavioral group treatment of avoidant personality disorder. Behavior Therapy 21 (1990), 363–377 https://doi.org/10.1016/S0005-7894(05)80337-5.
- Robinson, A.H., Safer, D.L., Moderators of dialectical behavior therapy for binge eating disorder: Results from a randomized controlled trial. The International Journal of Eating Disorders 45:4 (2012), 597–602 https://doi.org/10.1002/eat.20932.
- Rossouw, T.I., The use of mentalization-based treatment for adolescents (MBT-A) with a young woman with mixed personality disorder and tendencies to self-harm. Journal of Clinical Psychology 71:2 (2015), 178–187 https://doi.org/10.1002/jclp.22153.
- Salazar, J., Marti, V., Soriano, S., Beltran, M., Adam, A., Validity of the Spanish version of the Inventory of Interpersonal Problems and its use for screening personality disorders in clinical practice. Journal of Personality Disorders 24:4 (2010), 499–515 https://doi.org/10.1521/pedi.2010.24.4.499.
- Seemuller, F., Meier, S., Obermeier, M., Musil, R., Bauer, M., Adli, M., … Moller, H.-J., Three-Year long-term outcome of 458 naturalistically treated inpatients with major depressive episode: Severe relapse rates and risk factors. European Archives of Psychiatry and Clinical Neuroscience 264:7 (2014), 567–575 https://doi.org/10.1007/s00406-014-0495-7.
- Simonsen, S., Heinskou, T., Sorensen, P., Folke, S., Lau, M.E., Personality disorders: Patient characteristics and level of outpatient treatment service. Nordic Journal of Psychiatry 71:5 (2017), 325–331 https://doi.org/10.1080/08039488.2017.1284262.
- Stevens, C.L., Muran, J.C., Safran, J.D., Gorman, B.S., Winston, A., Levels and patterns of the therapeutic alliance in brief psychotherapy. American Journal of Psychotherapy 61:2 (2007), 109–129.
- Stravynski, A., Lesage, A., Marcouiller, M., Elie, R., A test of the therapeutic mechanism in social skills training with avoidant personality disorder. The Journal of Nervous and Mental Disease 177 (1989), 739–744.
- Svartberg, M., Stiles, T.C., Seltzer, M.H., Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. American Journal of Psychiatry 161 (2004), 810–817 https://doi.org/10.1176/appi.ajp.161.5.810.
- Thylstrup, B., Simonsen, S., Nemery, C., Simonsen, E., Noll, J.F., Myatt, M.W., Hesse, M., Assessment of personality-related levels of functioning: a pilot study of clinical assessment of the DSM-5 level of personality functioning based on a semi-structured interview. BMC Psychiatry, 16, 2016, 298 https://doi.org/10.1186/s12888-016-1011-6.
- Torgersen, S., The nature (and nurture) of personality disorders. Scandinavian Journal of Psychology 50:6 (2009), 624–632 https://doi.org/10.1111/j.1467-9450.2009.00788.x.
- Tracey, T.J., Kokotovic, A.M., Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology 1:3 (1989), 207–210 https://doi.org/10.1037/1040-3590.1.3.207.
- Tufekcioglu, S., Muran, J.C., Safran, J.D., Winston, A., Personality disorder and early therapeutic alliance in two time-limited therapies. Psychotherapy Research: Journal of the Society for Psychotherapy Research 23:6 (2013), 646–657 https://doi.org/10.1080/10503307.2013.843803.
- Verheul, R., Andrea, H., Berghout, C.C., Dolan, C., Busschbach, J.J.V., van der Kroft, P.J.A., … Fonagy, P., Severity Indices of Personality Problems (SIPP-118): Development, factor structure, reliability, and validity. Psychological Assessment 20:1 (2008), 23–34 https://doi.org/10.1037/1040-3590.20.1.23.
- Vrabel, K.R., Ro, O., Martinsen, E.W., Hoffart, A., Rosenvinge, J.H., Five-year prospective study of personality disorders in adults with longstanding eating disorders. The International Journal of Eating Disorders 43:1 (2010), 22–28 https://doi.org/10.1002/eat.20662.
- Watson, D., Friend, R., Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology 33 (1969), 448–457.
- Weinbrecht, A., Schulze, L., Boettcher, J., Renneberg, B., Avoidant personality disorder: A current review. Current Psychiatry Reports, 18(3), 2016, 29 https://doi.org/10.1007/s11920-016-0665-6.
- Wilberg, T., Karterud, S., Pedersen, G., Urnes, O., The impact of avoidant personality disorder on psychosocial impairment is substantial. Nordic Journal of Psychiatry 63 (2009), 390–396 https://doi.org/10.1080/08039480902831322.
- Wilberg, T., Karterud, S., Pedersen, G., Urnes, O., Irion, T., Brabrand, J., … Stubbhaug, B., Outpatient group psychotherapy following day treatment for patients with personality disorders. Journal of Personality Disorders 17:6 (2003), 510–521.
- Zimmermann, P., Alliger-Horn, C., Kowalski, J.T., Plate, S., Wallner, F., Wolff, E., Ströhle, A., Treatment of avoidant personality traits in a German armed forces inpatient psychiatric setting. Military Medicine 178 (2013), 213–217 https://doi.org/10.7205/MILMED-D-12-00261.