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Prognostic Significance of Personality Disorders in Patients with Major Depressive Disorder

  • Personality Disorders (M Zimmerman, Section Editor)
  • Published:
Current Treatment Options in Psychiatry Aims and scope Submit manuscript

Abstract

Purpose of Review

Update the evidence regarding how co-occurring personality disorders influence treatment outcomes for major depressive disorder and update the evidence regarding treatment options for personality disorders that are co-occurring with major depressive disorder.

Recent Findings

There is evidence that personality disorders can be effectively treated through a variety of psychotherapeutic modalities. Given the substantial evidence that co-occurring personality disorders impede the recovery from major depressive disorder, comprehensively addressing any co-occurring personality disorders is an essential part of an effective treatment plan for patients with major depressive disorder. Personality disorders such as borderline personality disorder, which is commonly co-occurring with major depressive disorder, have several validated treatment options.

Summary

Since publication of past reviews on the topic, there have been multiple additional studies published to advance the discussion of the impact of personality disorders on treatment outcomes in major depression. There is now substantial evidence that personality disorders can negatively affect treatment outcomes in the setting of major depression, which is consistent with the clinical observation that co-occurring personality disorders need to be comprehensively addressed to achieve optimal outcomes for the individual. There also now exists substantial evidence that personality disorders can be effectively treated using several validated psychotherapeutic modalities. It is recommended that a comprehensive assessment, including assessment for co-occurring personality disorders, is implemented in all cases of major depressive disorder that have not been successfully treated. In those cases where a co-occurring personality disorder is identified, specific treatment for the personality disorder should be recommended.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 [published correction appears in Lancet. 2017 Oct 28;390(10106):e38]. Lancet. 2017;390(10100):1211–59.

    Article  Google Scholar 

  2. Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905–17.

    Article  Google Scholar 

  3. Mulder RT. Personality pathology and treatment outcome in major depression: a review. Am J Psychiatry. 2002;159(3):359–71. https://doi.org/10.1176/appi.ajp.159.3.359.

    Article  PubMed  Google Scholar 

  4. De Bolle M, De Fruyt F, Quilty LC, Rolland JP, Decuyper M, Bagby RM. Does personality disorder co-morbidity impact treatment outcome for patients with major depression? A multi-level analysis. J Personal Disord. 2011;25(1):1–15. https://doi.org/10.1521/pedi.2011.25.1.1.

    Article  Google Scholar 

  5. Newton-Howes G, Tyrer P, Johnson T, Mulder R, Kool S, Dekker J, et al. Influence of personality on the outcome of treatment in depression: systematic review and meta-analysis. J Personal Disord. 2014;28(4):577–93. https://doi.org/10.1521/pedi_2013_27_070.

    Article  Google Scholar 

  6. Kavanagh BE, Williams LJ, Berk M, Turner A, Jackson HJ, Mohebbi M, et al. Personality disorder and functioning in major depressive disorder: a nested study within a randomized controlled trial. Braz J Psychiatry. 2020;42(1):14–21. https://doi.org/10.1590/1516-4446-2018-0308.

    Article  PubMed  Google Scholar 

  7. Lee JH, Kung S, Rasmussen KG, Palmer BA. Effectiveness of electroconvulsive therapy in patients with major depressive disorder and comorbid borderline personality disorder. J ECT. 2019;35(1):44–7. https://doi.org/10.1097/YCT.0000000000000533.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Koppers D, Kool M, Van H, Driessen E, Peen J, Dekker J. The effect of comorbid personality disorder on depression outcome after short-term psychotherapy in a randomised clinical trial. B J Psych Open. 2019;5(4):e61. Published 2019 Jul 16. https://doi.org/10.1192/bjo.2019.47.

    Article  Google Scholar 

  9. van Bronswijk SC, Lemmens LHJM, Viechtbauer W, Huibers MJH, Arntz A, Peeters FPML. The impact of personality disorder pathology on the effectiveness of cognitive therapy and interpersonal psychotherapy for major depressive disorder. J Affect Disord. 2018;225:530–8. https://doi.org/10.1016/j.jad.2017.08.043.

    Article  PubMed  Google Scholar 

  10. • George MP, Garrison GM, Merten Z, Heredia D Jr, Gonzales C, Angstman KB. Impact of personality disorder cluster on depression outcomes within collaborative care management model of care. J Prim Care Commun Health. 2018;9:2150132718776877. https://doi.org/10.1177/2150132718776877Recent study comparing different clusters of PDs.

    Article  Google Scholar 

  11. Ramleth RK, Groholt B, Diep LM, Walby FA, Mehlum L. The impact of borderline personality disorder and sub-threshold borderline personality disorder on the course of self-reported and clinician-rated depression in self-harming adolescents. Borderline Personal Disord Emot Dysregul. 2017;4:22. Published 2017 Oct 31. https://doi.org/10.1186/s40479-017-0073-5.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wiegand HF, Godemann F. Increased treatment complexity for major depressive Disorder for inpatients with comorbid personality disorder [published correction appears in Psychiatr Serv. 2017 Apr 1;68(4):404]. Psychiatr Serv. 2017;68(5):524–7. https://doi.org/10.1176/appi.ps.201600192.

    Article  PubMed  Google Scholar 

  13. Bukh JD, Andersen PK, Kessing LV. Personality and the long-term outcome of first-episode depression: a prospective 5-year follow-up study. J Clin Psychiatry. 2016;77(6):e704–10. https://doi.org/10.4088/JCP.15m09823.

    Article  PubMed  Google Scholar 

  14. Sheets ES, Duncan LE, Bjornsson AS, Craighead LW, Craighead WE. Personality pathology factors predict recurrent major depressive disorder in emerging adults. J Clin Psychol. 2014;70(6):536–45. https://doi.org/10.1002/jclp.22028.

    Article  PubMed  Google Scholar 

  15. Grilo CM, Stout RL, Markowitz JC, Sanislow CA, Ansell EB, Skodol AE, et al. Personality disorders predict relapse after remission from an episode of major depressive disorder: a 6-year prospective study. J Clin Psychiatry. 2010;71(12):1629–35. https://doi.org/10.4088/JCP.08m04200gre.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gunderson JG, Stout RL, Shea MT, Grilo CM, Markowitz JC, Morey LC, et al. Interactions of borderline personality disorder and mood disorders over 10 years. J Clin Psychiatry. 2014;75(8):829–34. https://doi.org/10.4088/JCP.13m08972.

    Article  PubMed  Google Scholar 

  17. Skodol AE, Grilo CM, Keyes KM, Geier T, Grant BF, Hasin DS. Relationship of personality disorders to the course of major depressive disorder in a nationally representative sample. Am J Psychiatry. 2011;168(3):257–64. https://doi.org/10.1176/appi.ajp.2010.10050695.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Skodol AE, Grilo CM, Pagano ME, et al. Effects of personality disorders on functioning and well-being in major depressive disorder. J Psychiatr Pract. 2005;11(6):363–8. https://doi.org/10.1097/00131746-200511000-00002.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Markowitz JC, Skodol AE, Petkova E, Cheng J, Sanislow CA, Grilo CM, et al. Longitudinal effects of personality disorders on psychosocial functioning of patients with major depressive disorder. J Clin Psychiatry. 2007;68(2):186–93. https://doi.org/10.4088/jcp.v68n0202.

    Article  PubMed  Google Scholar 

  20. Iacoviello BM, Alloy LB, Abramson LY, Whitehouse WG, Hogan ME. The role of cluster B and C personality disturbance in the course of depression: a prospective study. J Personal Disord. 2007;21(4):371–83. https://doi.org/10.1521/pedi.2007.21.4.371.

    Article  Google Scholar 

  21. Joyce PR, McKenzie JM, Carter JD, et al. Temperament, character and personality disorders as predictors of response to interpersonal psychotherapy and cognitive-behavioural therapy for depression. Br J Psychiatry. 2007;190:503–8. https://doi.org/10.1192/bjp.bp.106.024737.

    Article  PubMed  Google Scholar 

  22. Cyranowski JM, Frank E, Winter E, et al. Personality pathology and outcome in recurrently depressed women over 2 years of maintenance interpersonal psychotherapy. Psychol Med. 2004;34(4):659–69. https://doi.org/10.1017/S0033291703001661.

    Article  CAS  PubMed  Google Scholar 

  23. Kool S, Dekker J, Duijsens IJ, de Jonghe F, Puite B. Efficacy of combined therapy and pharmacotherapy for depressed patients with or without personality disorders. Harv Rev Psychiatry. 2003;11(3):133–41. https://doi.org/10.1080/10673220303950.

    Article  PubMed  Google Scholar 

  24. Viinamäki H, Tanskanen A, Koivumaa-Honkanen H, Haatainen K, Honkalampi K, Antikainen R, et al. Cluster C personality disorder and recovery from major depression: 24-month prospective follow-up. J Personal Disord. 2003;17(4):341–50. https://doi.org/10.1521/pedi.17.4.341.23971.

    Article  Google Scholar 

  25. • Cristea IA, Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry. 2017;74(4):319–28. https://doi.org/10.1001/jamapsychiatry.2016.4287Relatively up to date systematic review and meta-analysis of the efficacy of psychotherapy in treating BPD.

    Article  PubMed  Google Scholar 

  26. Clarkin J, Levy K, Lenzenweger M, et al. Evaluating three treatments for borderline Personality Disorder: A multiwave study. Am J Psychiatry. 2007;164:922–8.

    Article  Google Scholar 

  27. Giesen-Bloo J, van Dyck R, Spinhoven P, van Tilburg W, Dirksen C, van Asselt T, et al. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry. 2006;63(6):649–58. https://doi.org/10.1001/archpsyc.63.6.649.

    Article  PubMed  Google Scholar 

  28. Linehan M, Korslund K, Harned M, et al. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry. 2015;72:475–82.

    Article  Google Scholar 

  29. Daubney M, Bateman A. Mentalization-based therapy (MBT): an overview. Australas Psychiatry. 2015;23:132–5.

    Article  Google Scholar 

  30. • Vogt KS, Norman P. Is mentalization-based therapy effective in treating the symptoms of borderline personality disorder? A systematic review. Psychol Psychother. 2019;92(4):441–64. https://doi.org/10.1111/papt.12194Recent systematic review of MBT for treating BPD.

    Article  PubMed  Google Scholar 

  31. Gunderson J, Masland S, Choi-Kain L. Good psychiatric management: a review. Curr Opin Psychol. 2018;21:127–31. https://doi.org/10.1016/j.copsyc.2017.12.006.

    Article  PubMed  Google Scholar 

  32. Links PS, Shah R, Eynan R. Psychotherapy for borderline personality disorder: progress and remaining challenges. Curr Psychiatry Rep. 2017;19(3):16. https://doi.org/10.1007/s11920-017-0766-x.

    Article  PubMed  Google Scholar 

  33. • Solberg JJ, Deyo-Svendsen ME, Nylander KR, Bruhl EJ, Heredia D Jr, Angstman KB. Collaborative care management associated with improved depression outcomes in patients with personality disorders, compared to usual primary care. J Prim Care Community Health. 2018;9:2150132718773266. https://doi.org/10.1177/2150132718773266Recent study examining how an improved system of care can lead to better outcomes when treating co-occurring PDs and MDD.

    Article  PubMed  PubMed Central  Google Scholar 

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Young, M. Prognostic Significance of Personality Disorders in Patients with Major Depressive Disorder. Curr Treat Options Psych 7, 559–569 (2020). https://doi.org/10.1007/s40501-020-00227-7

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