Treatment compliance and effectiveness in complex PTSD patients with co-morbid personality disorder undergoing stabilizing cognitive behavioral group treatment: a preliminary study.
BACKGROUND
In the empirical and clinical literature, complex posttraumatic stress disorder (PTSD) and personality disorders (PDs) are suggested to be predictive of drop-out or reduced treatment effectiveness in trauma-focused PTSD treatment.


OBJECTIVE
In this study, we aimed to investigate if personality characteristics would predict treatment compliance and effectiveness in stabilizing complex PTSD treatment.


METHODS
In a randomized controlled trial on a 20-week stabilizing group cognitive behavioral treatment (CBT) for child-abuse-related complex PTSD, we included 71 patients of whom 38 were randomized to a psycho-educational and cognitive behavioral stabilizing group treatment. We compared the patients with few PD symptoms (adaptive) (N=14) with the non-adaptive patients (N=24) as revealed by a cluster analysis.


RESULTS
We found that non-adaptive patients compared to the adaptive patients showed very low drop-out rates. Both non-adaptive patients, classified with highly different personality profiles "withdrawn" and "aggressive," were equally compliant. With regard to symptom reduction, we found no significant differences between subtypes. Post-hoc, patients with a PD showed lower drop-out rates and higher effect sizes in terms of complex PTSD severity, especially on domains that affect regulation and interpersonal problems.


CONCLUSIONS
Contrary to our expectations, these preliminary findings indicate that this treatment is well tolerated by patients with a variety of personality pathology. Larger sample sizes are needed to study effectiveness for subgroups of complex PTSD patients.
GGZ inGeest, Amsterdam, The Netherlands ; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands ; EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands ; PsyQ, Parnassiagroep, The Hague, The Netherlands.
Ethy
E
Dorrepaal
Kathleen
K
Thomaes
Johannes H
JH
Smit
Dick J
DJ
Veltman
Adriaan W
AW
Hoogendoorn
Anton J L M
AJ
van Balkom
Nel
N
Draijer
Personality disorders; child abuse; cognitive behavioral treatment; complex PTSD; dissociative subtype; posttraumatic stress disorder; treatment outcome