Surviving severe personality disorders: a challenge for patients and professionals

GGzE, a mental health care organisation in the south Netherlands, implemented treatment for patients with severe personality disorders and substance use: clinical case management (CCM). CCM is a special healthcare facility for patients whose needs do not match other existing treatment designs. These patients are characterised by unproductive or disturbed relationships and multiple crises that deregulate clinical practice and impede recovery. In the CCM team, patients are treated with the theoretical concepts of relationship management, interpersonal reconstructive therapy, Livesley's stage-wise treatment and integrated dual disorder treatment (IDDT). These theoretical models and methods used within CCM have been described extensively, though there has been no clinical study about its effect within GGzE so far. Professionals working within the CCM team report that behaviour such as acting out is reduced after about one year of treatment, with less interventions from other caretakers or police involvement. To substantiate these claims, a single group pre-test and posttest was conducted to find out whether these patients really experience changes in physical and psychological problems, as well as changes in their personality disorder.The sample consists of patients who started treatment between 2004 and 2009 (pre measurement T=0), (n = 21). At T=0, patients completed the Symptom Checklist (SCL-90) and Personality Characteristics Questionnaire (Vragenlijst Kenmerken Persoonlijkheid, VKP). The outcomes are compared with the results of the same questionnaires that were completed by patients in 2010 (post measurement T=1). The outcomes of the SCL-90 show significant changes for fear, depression, hostility, distrust and interpersonal sensitivity, as well as the total score of psychoneurosis. The VKP shows significant changes for general personality disorder, schizoid personality disorder and borderline personality disorder. More research is needed to find stronger evidence of treatment effects of CCM, using a bigger sample, a control group and more outcome measurements that also include the drug use of patients.