title: Effectiveness of Psychotherapy in Personality Disorders Not Otherwise Specified: A Comparison of Different Treatment Modalities.
abstract: OBJECTIVE
  Although personality disorder not otherwise specified (PDNOS) is highly prevalent and associated with a high burden of disease, only a few treatment studies in this patient group exist. This study is the first to investigate the effectiveness of different modalities of psychotherapy in patients with PDNOS, i.e., short-term (up to 6 months) and long-term (more than 6 months) outpatient, day hospital, and inpatient psychotherapy.
  
  
  METHODS
  A total of 205 patients with PDNOS were assigned to one of six treatment modalities. Effectiveness was assessed over 60 months after baseline. The primary outcome measure was symptom severity, and the secondary outcome measures included psychosocial functioning and quality of life. The study design was quasi-experimental, and the multiple propensity score was used to control for initial differences between treatment groups.
  
  
  RESULTS
  All treatment modalities showed positive outcomes, especially in terms of improvements of symptom severity and social role functioning. At 12-month follow-up, after adjustment for initial differences between the treatment groups, short-term outpatient psychotherapy and short-term inpatient psychotherapy showed most improvement and generally outperformed the other modalities concerning symptom severity. At 60 months after baseline, effectiveness remained but observed differences between modalities mostly diminished.
  
  
  CONCLUSIONS
  Patients with PDNOS benefit from psychotherapy both at short-term and long-term follow-up. Short-term outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness.
  
  
  CONCLUSIONS
  The effectiveness of different modalities of psychotherapy in patients with PDNOS (i.e., short-term vs long-term; outpatient versus day hospital versus inpatient psychotherapy) has not yet been compared. Different modalities of psychotherapy are effective for patients with PDNOS, and positive effects remain after 5 years. In patients with PDNOS short-term (less than 6 months) outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the four other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness.
authors.affiliation: Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands.|Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Eva K
authors.initials: EK
authors.lastname: Horn
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.|Bos en Lommer Private Practice, Amsterdam, The Netherlands.
authors.forename: Anna
authors.initials: A
authors.lastname: Bartak
authors.affiliation: Center of Psychotherapy Pro Persona, Lunteren, The Netherlands.
authors.forename: Anke M M A
authors.initials: AM
authors.lastname: Meerman
authors.affiliation: Altrecht, Zeist, The Netherlands.
authors.forename: Bert V
authors.initials: BV
authors.lastname: Rossum
authors.affiliation: Zaans Medical Center, Zaandam, The Netherlands.
authors.forename: Uli M
authors.initials: UM
authors.lastname: Ziegler
authors.affiliation: GGZ WNB, Bergen op Zoom, The Netherlands.|Private Practice, Bergen op Zoom, The Netherlands.
authors.forename: Moniek
authors.initials: M
authors.lastname: Thunnissen
authors.affiliation: Arkin, Amsterdam, The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Soons
authors.affiliation: GGZ Breburg, Tilburg, The Netherlands.|Tranzo Scientific Centre for Care and Welfare, Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
authors.forename: Helene
authors.initials: H
authors.lastname: Andrea
authors.affiliation: De Viersprong, Netherlands Institute for Personality Disorders, Halsteren, The Netherlands.
authors.forename: Elisabeth F M
authors.initials: EF
authors.lastname: Hamers
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.|The Center for Social and Humanities Research, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Paul M G
authors.initials: PM
authors.lastname: Emmelkamp
authors.affiliation: Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.affiliation: Viersprong Institute for Studies on Personality Disorders (VISPD), Bergen op Zoom, The Netherlands.|Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Jan J V
authors.initials: JJ
authors.lastname: Busschbach
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.|De Viersprong, Netherlands Institute for Personality Disorders, Halsteren, The Netherlands.
authors.forename: Roel
authors.initials: R
authors.lastname: Verheul
mesh_terms: D000328:Adult; D003631:Day Care, Medical / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D009426:Netherlands; D010045:Outpatients / Q000523:psychology / Q000706:statistics & numerical data; D010554:Personality Disorders / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Long-term Treatment Effectiveness; Mixed Personality Disorder; Personality Disorder Not Otherwise Specified; Personality Disorders; Psychotherapy