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La sfida dell’integrazione nel trattamento dei disturbi di personalità
Titolo Rivista: QUADERNI DI PSICOTERAPIA COGNITIVA 
Autori/Curatori: Clara Magrin, Elena Prunetti 
Anno di pubblicazione:  2013 Fascicolo: 33  Lingua: Italiano 
Numero pagine:  16 P. 65-80 Dimensione file:  141 KB
DOI:  10.3280/QPC2013-033005
Il DOI è il codice a barre della proprietà intellettuale: per saperne di più:  clicca qui   qui 


In questo articolo si mette in evidenza come il panorama scientifico stia sempre più sottolineando la necessità di proporre modelli integrati di intervento per il trattamento dei disturbi di personalità. L’attenzione è rivolta, soprattutto, al disturbo borderline, l’unico che ha vari studi empirici che dimostrano l’efficacia di trattamenti specialistici. Oggi abbiamo, infatti, a disposizione vari modelli di cura derivanti da scuole di pensiero diverse, tutti con prove di efficacia, ma nessuno di questi ha dati sufficientemente robusti tali da dichiararne una superiorità rispetto agli altri. Nel presente lavoro saranno ripresi i vari trattamenti e le specificità di ciascuno evidenziando l’assenza di un modello onnicomprensivo adatto a tutti i pazienti aventi un disturbo di personalità. La disamina verterà sull’utilità di sviluppare cure efficaci che possano essere flessibili attingendo tecniche da differenti approcci in modo da consentire ai terapeuti di adattare gli interventi sul singolo paziente. In conclusione verrà presentata un’esperienza di integrazione svolta presso un Servizio per il trattamento ospedaliero dei disturbi di personalità con primi risultati di outcome.


Keywords: Trattamenti integrati, borderline, disturbi di personalità.

  1. Barrachina J., Pascual J.C., Ferrer M., Soler J., Rufat M.J., Andión O., Tiana T., Martín-Blanco A., Casas M., Pérez V. (2011). Axis II comorbidity in borderline personality disorder is influenced by sex, age, and clinical severity. Compr. Psychiatry, 52 (6): 725-30., DOI: 10.1016/j.comppsych.2010.11.009.Epu
  2. Bartels N., Crotty T. (1998). A systems approach to treatment: The borderline personality disorder skills training manual. Winfield, IL: EID Treatment Systems.
  3. Bateman A.W., Fonagy P. (2000). Effectiveness of psychotherapeutic treatment of personality disorder. British Journal of Psychiatry, 177: 138-143., DOI: 10.1192/bjp.177.2.13
  4. Bateman A.W., Fonagy P. (2003a). The development of an attachment-based treatment program for Borderline Personality Disorder. Bulletin of the Menninger Clinic, 67: 187-211.
  5. Bateman A.W., Fonagy P. (2003b). Health service utilization costs for Borline Personality Disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care. American Journal of Psychiatry, 160: 169-171.
  6. Bateman A.W., Fonagy P. (2004). Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment. Oxford: Oxford University Press.
  7. Bateman A.W., Fonagy P. (2006). Mentalization Based Treatment for Borderline Personality Disorder: A Practical Guide, Oxford: Oxford University Press.
  8. Bateman A.W., Fonagy P. (2006). Il trattamento basato seulla mentalizzazione. Psicoterapia per il paziente borderline. Milano: Raffaello Cortina.
  9. Bateman A.W., Ryle A., Fonagy P., Kerr I.B. (2007). Psychotherapy for borderline personality disorder: Mentalizationbased therapy and cognitive analytic therapy compared. International Review of Psychiatry, 19: 51-62.
  10. Bateman A., Fonagy P. (2008). 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. American Journal of Psychiatry, 165 (5): 631-8., DOI: 10.1176/appi.ajp.2007.07040636.Epub2008Mar17
  11. Bateman A., Fonagy P. (2009). Randomized controlled trial of outpatient mentalizationbased treatment versus structured clinical management for borderline personality disor-der. American Journal of Psychiatry, 166 (12): 1355-64., DOI: 10.1176/appi.ajp.2009.09040539.Epub2009Oct15
  12. Bateman A.W., Fonagy P. (2010). Guida partica al trattamento basato sulla mentalizzazione. Per il disturbo borderline della personalità. Milano: Raffaello Cortina.
  13. Beck A.T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Hoeber.
  14. Beck A.T., Rush A.J., Shaw B.F., Emery G. (1979). Cognitive Therapy of Depression. New York: Guilford Press.
  15. Beck A.T., Freeman A., Davis D. & Associates (2004). Cognitive therapy of personality disorders (2nd ed.) New York: Guilford Press.
  16. Benjamin L.S. (2003). Interpersonal reconstructive therapy: An integrative, personalitybased treatment for complex cases. New York: Guilford Press.
  17. Biskin R.S., Paris J. (2013). Comorbidities in Borderline Personality Disorder http://www.psychiatrictimes.com/articles/comorbidities-borderline-personality-disorder Blum N., Bartels N., St. John D. et al. (2002). STEPPS: Systems Training for Emotional Predictability and Problem Solvinggroup treatment for borderline personality disorder. Coralville, IA: Blum’s Books.
  18. Blum N., Pfohl B., St. John D., Monahan P., Black D.W. (2002). STEPPS: A cognitive-behavioral systems-based group treatment for outpatients with borderline personality disorder: A preliminary report. Comprehensive Psychiatry, 43: 301-310.
  19. Blum N., John D., Pfohl B., Stuart S., McCormick B., Allen J., Arndt S., Black D. (2008). Systems Training for Emotional Predictability and Problem Solving (STEPPS) for Outpatients With Borderline Personality Disorder: A Randomized Controlled Trial and 1-Year Follow-Up. Am. J. Psychiatry, 165: 468-478. 10.1176/appi.ajp.2007.07071079
  20. Bohus M., Haaf B., Simms T., Limberger M.F., Schmahl C., Unckel C., Lieb K., Linehan M.M. (2004). Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behav. Res. Ther., 42: 487-499.
  21. Bowden-Jones O., Iqbal M.Z., Tyrer P., Seivewright N., Cooper S., Judd A., Weaver T., Cosmic study team (2004). Prevalence of personality disorder in alcohol and drug services and associated comorbidity. Addiction, 99 (10): 1306-14.
  22. Castonguay L., Beutler L. (2006). Principles of therapeutic change: a task force on partecipants, relationships, and techniques factors. Journal of Clinical Psychology, 62 (6): 631-638., DOI: 10.1002/jclp.2025
  23. Clarkin J.F., Yeomans F.E., Kernberg O.F. (1999). Psychotherapy for Borderline Personality. New York: Wiley.
  24. Clarkin J.F., Yeomans F.E., Kernberg O.F. (2000). Psicoterapia della personalità borderline. Milano: Raffaello Cortina.
  25. Clarkin J.F., Foelsch P.A., Levy K.N., Hull J.W., Delaney J.C., Kernberg O.F. (2001). The development of a psychodynamic treatment for pa tients with borderline personality disorder: A preliminary study of behavioral change. Journal of Personality Disorders, 15: 487-495.
  26. Clarkin J.F., Levy K.N., Lenzenweger M.F., Kernberg O.F. (2004). The personality disorders institute/borderline personality disorder research foundation radomized control trial for borderline personality disorder: Rationale, methods, and patient characteristics. Journal of Personality Disorders, 18: 52-72.
  27. Clarkin J.F., Levy K.N., Lenzenweger M.F., Kernberg O.F. (2007). Evaluating three treatments for borderline personality disorder: A multiwave study. American Journal of Psychiatry, 164: 922-928. Clarkin J.F. (2012). An integrated approach to psychotherapy techniques for patients with personality disorder. Journal of Personality Disorders, 26 (1): 43-62.
  28. Cloninger C.R. (2000). Apractical way to diagnosis personality disorder: a proposal. Journal of Personality Disorders, 14 (2): 99-108.
  29. Cramer V., Torgersen S., Kringlen E. (2006). Personality disorders and quality of life: A population study. Comprehensive Psychiatry, 47: 178-184.
  30. Critchfield K.L., Clarkin J.F., Levy K.N., Kernberg O.F. (2007). Organization of co-occurring Axis II features in borderline personality disorder. The British Journal of Clinical Psychology/The British Psychological Society, 47 (Pt 2): 185-200. Epub 2007 Sep 7.
  31. Critchfield K.L., Benjamin L.S. (2006). Integration of therapeutic factors in treating personality disorders. In: Castonguay L.G., Beutler L.E., editors, Principles of therapeutic change that work. New York: Oxford University Press, pp. 253-271.
  32. De Groot E.R., Verheul R., Trijsburg W. (2008). An integrative perspective on psychotherapeutic treatments for borderline personality disorder. Jounal of Personality Disorders, 22 (4): 332-352.
  33. Didonna F., editor (2008). Clinical Handbook of Mindfulness. New York: Springer.
  34. Dimaggio G., Semerari A., a cura di (2003). I disturbi di personalità. Modelli e trattamento. Stati mentali, metarappresentazione, cicli interpersonali. Roma-Bari: Laterza.
  35. Dimaggio G., Semerari A., Carcione A., Nicolò G., Procacci M. (2007). Psychotherapy of Personality Disorders: Metacognition, States of Mind and Interpersonal Cycles. London: Routledge.
  36. Dimaggio G., Salvatore G., Fiore D., Carcione A., Nicolò G., Semerari A. (2012). General Principles for Treating Personality Disorder with a prominent Inhibitedness Trait: Towards an Operationalizing Integrated Technique. Journal of personality Disorders. 26 (1): 63-83.
  37. Doering S., Hörz S., Rentrop M., Fischer-Kern M., Schuster P., Benecke C., Buchheim A., Martius P., Buchheim P. (2010). Transference-Focused Psychotherapy vs. treatment by community psychotherapists for borderline personality disorder: A randomised controlled trial. British Journal of Psychiatry, 196: 389-395., DOI: 10.1192/bjp.bp.109.07017
  38. Ellis A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stewart.
  39. Farrell J.M., Shaw I.A., Webber M.A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry., DOI: 10.1016/j.jbtep.2009.01.00
  40. Fernadez-Alvarez H., Clarkin J., del Carmen Salgueiro M., Critchfield K.L. (2006). Participant factors in treating personality disorders. In: Castonguay L.G., Beutler L.E., Principles of therapeutic change that work. New York: Oxford University Press.
  41. Fonagy P., Bateman A. (2006). Progress in the treatment of borderline personality disorder. Br. J. Psychiatry, 188: 1-3.
  42. Giesen-Bloo J., Van Dyck R., Spinhoven P., Van Tilburg W., Dirksen C., Van Asselt T. et al. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs. transference-focused psychotherapy. Archives of General Psychiatry, 63: 649-658., DOI: 10.1001/archpsyc.63.6.64
  43. Grant B.F., Chou S.P., Goldstein R.B., Huang B., Stinson F.S., Saha T.D., Smith S.M., Dawson D.A., Pulay A.J., Pickering R.P., Ruan W.J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Clin. Psychiatry, 69 (4): 533-45. Gunderson J.G., Stout R.L., McGlashan T.H., Shea M.T., Morey L.C., Grilo C.M., Zanarini M.C., Yen S., Markovitz J.C., Sanislow C., Ansell E., Pinto A., Skodol A.E. (2011). Tenyear course of borderline personality disorder: psychopathology and function from the collaborative longitudinal personality disorders study. Arch. Gen. Psychiatry, 68: 827-837.
  44. Jørgensen C.R., Freund C., Bøye R., Jordet H., Andersen D., Kjølbye M. (2013) Outcome of mentalization-based and supportive psychotherapy in patients with borderline personality disorder: a randomized trial. Acta Psychiatr. Scand., 127 (4): 305-17., DOI: 10.1111/j.1600-0447.2012.01923.x.Epub2012Aug17
  45. Leichsenring F., Leibing E. (2003). The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. Am. J. Psychiatry, 160 (7): 1223-32.
  46. Lieb K., Zanarini M.C., Schmahl C., Linehan M.M., Bohus M. (2004). Borderline personality disorder. Lancet, 364 (9432): 453-61.
  47. Linehan M.M., Armstrong H.E., Suarez A., Allmon D., Heard H.L. (1991). Cognitive-Behavioural Treatment of chronically Parasuidal Borderline Patient. Archives of General Psychiatry, 50: 971-974.
  48. Linehan M.M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.
  49. Linehan M.M. (1993). Skills Training Manual For Treatment of Borderline Personality Disorder. New York: Guilford Press.
  50. Linehan M.M., Heard H.L., Armstrong H.E. (1993). Naturalistic follow up of a behavioral treatment for chronically parasuicidal borderline patients. Arch. Gen. Psychiatry, 50: 971-974.
  51. Linehan M.M. (1995). Understanding Borderline Personality Disorder:The Dialectic Approach program manual. New York: Guilford Press.
  52. Linehan M.M., Dimeff L.A., Reynolds S.K., Comtois K.A., Welch S.S., Heagerty P., Kivlahan D.R. (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 Alcohol Depend., 67: 13-26.
  53. Linehan M.M., Comtois K.A., Murray A.M., Brown M.Z., Gallop R.J., Heard H.L., Korslund K.E., Tutek D.A., Reynolds S.K., Lindenboim N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch. Gen. Psychiatry, 63: 757-766.
  54. Linehan M.M. (2011). I gruppi di skills training. Il trattamento cognitivo comportamentale del disturbo borderline: il modello dialettico. Milano: Raffaello Cortina.
  55. Liotti G. (2004). The inner schema of borderline states and its correction during psychotherapy: A cognitive-evolutionary approach. In: Gilbert P., editor, Evolutionary theory and cognitive psychotherapy. New York: Springer, pp. 137-160.
  56. Liotti G., Monticelli F. (2008). I sistemi motivazionali nel dialogo clinico. Milano: Raffaello Cortina.
  57. Liotti G., Gilbert P. (2011). Mentalizing, motivation, and social mentalities: Theoretical considerations and implications for psychotherapy. Psychology & Psychotherapy: Theory, Research and Practice, 84: 9-25., DOI: 10.1348/147608310X52009
  58. Livesley W.J. (2003). Practical management of personality disorder. New York: Guilford
  59. Press. Livesley W.J. (2004). Changing ideas about the treatment of borderline personality disorder. Journal of Contemporary Psychotherapy, 34: 185-192.
  60. Livesley W.J. (2005). Principles and strategies for treating personality disorder. Canadian Journal of Psychiatry, 50: 442-450.
  61. Livesley W.J. (2007). An integrated approach to the treatment of personality disorder. Journal of Mental Health, 16: 131-148.
  62. Livesley W.J. (2012). Integrated treatment: a conceptual framework for evidence based approach to the treatment of personality disorder. Journal of Personality Disorders, 26 (1): 17-42.
  63. McMain S.F., Links P.S., Gnam W.H., Guimond T., Cardish R.J., Korman L., Streiner D.L. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. Am. J. Psychiatry, 166: 1365-1374., DOI: 10.1176/appi.ajp.2009.09010039.Epub2009Sep15
  64. Mc Main S.F., Guimond T., Streiner D., Cardish R., Links P. (2012). Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: clinical outcome and functioning over a 2 year follow-up. Am. J. Psychiatry, 169: 650-661., DOI: 10.1176/appi.ajp.2012.1109141
  65. Nadort M., Arntz A., Smit J., Giesen-Bloo J., Eikelenbooma M., Spinhoven P., vanAsselt T., Wensing M., vanDyck R. (2009). Implementation of outpatient schema therapy for borderline personality Disorder with versus without crisis support by the therapist outside office hours: A randomized trial. Behaviour Research and Therapy, 9-13., DOI: 10.1186/1471-244X-9-6
  66. Ogden P., Minton K., Pain C. (2006). Trauma and the Body: A Sensorimotor Approach to Psychotherapy. New York: Norton.
  67. Paris J., Chenard-Poirier M.P., Biskin R. (2013). Antisocial and borderline personality disorders revisited. Compr. Psychiatry, 54 (4): 321-5., DOI: 10.1016/j.comppsych.2012.10.006.Epub2012Nov28
  68. Prunetti E., Bosio V., Bateni M., Liotti G. (2012). Three-week inpatient Cognitive Evolutionary Therapy (CET) for patients with personality disorders: Evidence of effectiveness in symptoms reduction and improved treatment adherence. Psychology and Psychotherapy: Theory, Research and Practice, 86 (3): 262-279., DOI: 10.1111/j.2044-8341.2011.02060.
  69. Ridolfi M.E. (2006). Linee guida per i familiari: Programma di Gruppo Multifamiliare McLean Hospital (trad. it.: Gunderson J., Berkowitz C.), New England Personality Disorder Association, (617): 855-2680.
  70. 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., DOI: 10.1348/00071120016042
  71. Ryle A., Kerr I.B. (2002). Introducing cognitive analytic therapy: Principles and practice. Chichester: John Wiley & Sons.
  72. Roth A., Fonagy P. (2005). What Works for Whom? Second edition. London: Guilford Press.
  73. Safran J.D., Muran J.C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York: Guilford Press.
  74. Scheel K.R. (2000). The empirical basis of dialectical behavior therapy: Summary critique, and implications. Clinical Psychology: Science and Practice, 7: 68-86., DOI: 10.1093/clipsy.7.1.6
  75. Smith T.L., Barrett M.S., Benjamin L.S., Barber J.P. (2006). Relationship factors in treating personality disorders. In: Castonguay L.G., Beutler L.E., editors, Principles of therapeutic change that work. New York: Oxford University Press, pp. 219-238.
  76. Sollberger D., Walter M. (2010). Psychotherapy of borderline personality disorder: similarities and differences in evidence-based disorder-specific treatment approaches. Fortschritte der Neurologie-Psychiatrie, 78 (12): 698-708.
  77. Stoffers J.M., Völlm B.A., Rücker G., Timmer A., Huband N., Lieb K. (2012). Psychological therapies for people with borderline personality disorder (Review). The Cochrane Collaboration and published in The Cochrane Library, Issue 2.
  78. van Asselt A.D., Dirksen C.D., Arntz A., Giesen-Bloo J.H., van Dyck R., Spinhoven P., van Tilburg W., Kremers I.P., Nadort M., Severens J.L. (2008). Out-patient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy. Br. J. Psychiatry, 192(6):450-7., DOI: 10.1192/bjp.bp.106.03359
  79. Verheul R., van den Bosch L.M.C., Koeter M.W.J., De Ridder M.A.J., Stijnen T., van den
  80. Brink W. (2003). A12-month randomized clinical trial of dialectical behavior therapy for women with borderline personality disorder in Netherlands. British Journal of Psychiatry, 182: 135-140.
  81. Yeomans F.E., Clarkin J.F., Kernberg O.F. (2002). A primer of transference focused psychotherapy for the borderline patient. New York: Jason Aronson.
  82. Yeomans F.E. (2007). Questions Concerning the Randomized Trial of Schema-Focused Therapy vs. Transference-Focused Psychotherapy. Arch. Gen. Psychiatry, 64: 609-10.
  83. Young J.E. (1999). Cognitive therapy for personality disorders: A schema-focused approach (3rd ed.). Sarasota, FL: Pro-fessional Resource Press.
  84. Young J.E. (2002). Schema-focused therapy. In: Simos G., editor, Cognitive behaviour therapy: A guide for the practising clinician. Sussex: Brunner-Routledge, pp. 201-222.
  85. Young J.E., Klosko J.S., Weishaar M.E. (2003). Schema Therapy: A Practitioner’s Guide. New York: Guilford Press.
  86. Young J.E., Klosko J.S., Weishaar M.E. (2007). Schema Therapy. La terapia cognitiva-comportamentale integrata per i disturbi della personalità. Firenze: Eclipsi.
  87. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, fourth edition (text revision). Washington, DC: Author.

Clara Magrin, Elena Prunetti, in "QUADERNI DI PSICOTERAPIA COGNITIVA" 33/2013, pp. 65-80, DOI:10.3280/QPC2013-033005

   

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