Predicting Change in Brief Treatment for BPD: The Role of Defensive Functioning and Pervasiveness in Relationship Patterns.

BACKGROUND

Borderline personality disorder (BPD) is marked by unstable relationships and maladaptive defense mechanisms. This study examined whether defensive functioning and the pervasiveness of core conflictual relationship themes (CCRT) predict symptom change following 10-session General Psychiatric Management (GPM) versus Treatment as Usual (TAU) in patients with BPD.

METHOD: Sixty patients with BPD (75% female, mean age 29.6) in a randomized controlled trial completed the Relationship Anecdote Paradigm at pretreatment. Interviews were coded using the Defense Mechanisms Rating Scale-Q-sort and the CCRT method. Symptom severity change was assessed using the Zanarini Rating Scale for BPD as post-pre score differences for total and subscale measures. Multiple linear regressions were used for analysis.

RESULTS

Neither overall defensive functioning (ODF) (b = -1.59, p = 0.36) nor overall CCRT pervasiveness (OCP) (b = 2.10, p = 0.46) predicted change in borderline symptom severity. However, the interaction between OCP and treatment was significant for affective disturbance (b = 13.55, p = 0.03): patients with low OCP ( < 70%) improved more under GPM, while those with high OCP benefited more from TAU. In TAU, low OCP ( < 50%) was associated with worsening affective symptoms.

CONCLUSIONS

Patients with BPD whose relational patterns were less pervasive and who primarily seek relief from affective distress may particularly benefit from GPM. The preliminary findings further suggest that heightened caution may be warranted when providing TAU to patients with low CCRT pervasiveness.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03717818.