The Impact of Personality Disorders on Treatment Outcome for Veterans in a Posttraumatic Stress Disorder Residential Treatment Program
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
This study evaluated the effect of comorbid personality disorders on treatment outcome for male and female Veterans with posttraumatic stress disorder (PTSD). One hundred and sixty-six Veterans participated in a PTSD Residential Rehabilitation Program, which included cognitive processing therapy (CPT) provided in a combined individual and group format. Sixty-six percent of participants met criteria at pre-treatment for at least one personality disorder. No difference was found between participants with and without personality disorders on pre-treatment demographic variables, self-reported PTSD symptoms, or clinician-assessed PTSD symptoms. However, differences were found between the groups on self-reported depression symptoms. When controlling for pre-treatment self-reported depression symptoms, results indicated that both groups had significant reductions on PTSD outcome measures, regardless of the presence of a personality disorder. Additionally, a comparable number of participants with and without personality disorders no longer met criteria for PTSD following treatment. Findings suggest that Veterans with personality disorders can benefit from a CPT-based PTSD residential program.
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association. text revision.
- Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corporation.
- Blake, D. D., & Sonnenberg, R. T. (1998). Outcome research on behavioral and cognitive-behavioral treatments for trauma survivors. In V. M. Folette, J. I. Ruzek, & F. R. Abueg (Eds.), Cognitive-behavioral therapies for trauma (pp. 15–47). New York, NY: The Guilford Press.
- Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Charney, D. S., & Keane, T. M. (1990). The clinician-administered PTSD scale-IV. Boston: National Center for PTSD, Behavioral Sciences Division.
- Blanchard, E. B., Hickling, E. J., Taylor, A. E., Forneris, C. A., Loos, W., & Jaccard, J. (1995). Effects of varying scoring rules of the clinician-administered PTSD scale (CAPS) for the diagnosis of posttraumatic stress disorder in motor vehicle accident victims. Behaviour Research and Therapy, 33, 471–475. CrossRef
- Bollinger, A. R., Riggs, D. S., Blake, D. D., & Ruzek, J. I. (2000). Prevalence of personality disorders among combat veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 13, 255–270. CrossRef
- Chard, K. M. (2005). An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73, 965–971. CrossRef
- Chard, K. M., Resick, P. A., Monson, C. M., & Kattar, K. (2009). Cognitive processing therapy therapist group manual: Veteran/military version. Washington, DC: Department of Veteran’s Affairs.
- Clarke, S. B., Rizvi, S. L., & Resick, P. A. (2008). Borderline personality characteristics and treatment outcome in cognitive-behavioral treatments for PTSD in female rape victims. Behavior Therapy, 39, 72–78. CrossRef
- Department of Defense Task Force on Mental Health. (2007). An achievable vision: Report of the department of defense task force on mental health. Falls Church, VA: Defense Health Board.
- Dreessen, L., & Arntz, A. (1998). The impact of personality disorders on treatment outcome of anxiety disorders: Best-evidence synthesis. Behaviour Research and Therapy, 36, 483–504. CrossRef
- Dunn, N. J., Yanasek, E., Schillaci, J., Simotas, S., Rehm, L. P., Souchek, J., et al. (2004). Personality disorders in veterans with posttraumatic stress disorder and depression. Journal of Traumatic Stress, 17, 75–82. CrossRef
- Feeny, N. C., Zoellner, L. A., & Foa, E. B. (2002). Treatment outcome for chronic PTSD among female assault victims with borderline personality characteristics: A preliminary examination. Journal of Personality Disorders, 16, 30–40. CrossRef
- First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). User’s guide for the structured clinical interview for DSM-IV axis II personality disorders (SCID-II). Washington, DC: American Psychiatric Press, Inc.
- Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (2008). Effective treatments for PTSD, Practice guidelines from the international society for traumatic stress studies (2nd ed.). New York: Guilford Press.
- Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. O. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 6, 459–473. CrossRef
- Hembree, E. A., Cahill, S. P., & Foa, E. B. (2004). Impact of personality disorders on treatment outcome for female assault survivors with chronic posttraumatic stress disorder. Journal of Personality Disorders, 18, 117–127. CrossRef
- Keane, T. M., Marshall, A. D., & Taft, C. T. (2006). Posttraumatic stress disorder: Etiology, epidemiology and treatment outcome. Annual Review of Clinical Psychology, 2, 161–197. CrossRef
- Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048–1060. CrossRef
- Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: The Guilford Press.
- Newton-Howes, G., Tyrer, P., & Johnson, T. (2006). Personality disorder and the outcome of depression: A meta-analysis of published studies. British Journal of Psychiatry, 188, 13–20. CrossRef
- Orsillo, S. M., Weathers, F. W., Litz, B. T., Steinberg, H. R., Huska, J. A., & Keane, T. M. (1996). Current and lifetime psychiatric disorders among veterans with war zone-related posttraumatic stress disorder. Journal of Nervous and Mental Disease, 184, 307–313. CrossRef
- Owens, G. P., & Chard, K. M. (2003). Comorbidity and psychiatric diagnoses among women reporting child sexual abuse. Child Abuse and Neglect, 27, 1075–1082. CrossRef
- Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867–879. CrossRef
- Schnurr, P. P., Friedman, M. J., Engel, C. C., Foa, E. B., Shea, M. T., Chow, B. K., et al. (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women: A randomized controlled trial. Journal of the American Medical Association, 297(8), 820–830. CrossRef
- Southwick, S. M., Yehuda, R., & Giller, E. L. (1993). Personality disorders in treatment-seeking combat Veterans with posttraumatic stress disorder. American Journal of Psychiatry, 150, 1020–1023.
- van Minnen, A., Arntz, A., & Keijsers, G. P. J. (2002). Prolonged exposure in patients with chronic PTSD: Predictors of treatment outcome and dropout. Behaviour Research and Therapy, 40, 439–457. CrossRef
- Veterans Health Administration, Department of Defense. (2004). VA/DoD clinical practice guideline for the management of post-traumatic stress. Version 1.0. Washington, DC: Veterans Health Administration, Department of Defense.
- Weathers, F. W., Huska, J. A., & Keane, T. M. (1991). PCL-S for DSM-IV. Boston: National Center for PTSD–Behavioral Science Division.
- Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. Poster presented at the 9th annual meeting of the International Society for Traumatic Stress Studies. San Antonio, TX: International Society for Traumatic Stress Studies.
- Weertman, A., Arntz, A., Schouten, E., & Dreessen, L. (2005). Influences of beliefs and personality disorders on treatment outcome in anxiety disorder patients. Journal of Consulting and Clinical Psychology, 73, 936–944. CrossRef
- Zayfert, C., Becker, C. B., & Gillock, K. L. (2002). Managing obstacles to the utilization of exposure therapy with PTSD patients. In L. Van de Creek & T. L. Jackson (Eds.), Innovations in clinical practice: A source book (pp. 201–222). Sarasota, FL: Professional Resource Press.
- The Impact of Personality Disorders on Treatment Outcome for Veterans in a Posttraumatic Stress Disorder Residential Treatment Program
Cognitive Therapy and Research
Volume 36, Issue 5 , pp 576-584
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Personality disorders
- Treatment outcome
- Author Affiliations
- 1. Ft. Thomas—PTSD and Anxiety Disorders Division, Cincinnati VA Medical Center, 1000 S. Ft. Thomas Avenue, Ft. Thomas, KY, 41075, USA
- 2. Substance Dependence Program, Cincinnati VA Medical Center, 3200 Vine Street, Cincinnati, OH, 45220, USA
- 3. University of Tennessee, Knoxville, TN, USA
- 4. University of Cincinnati, Cincinnati, OH, USA