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Effectiveness of psychotherapeutic treatment of personality disorder

Halliwick Psychotherapy Unit, St Ann's Hospital, London

PETER FONAGY, PhD

Psychoanalysis Unit, University College London

Correspondence: Dr A.W. Bateman, Halliwick Psychotherapy Department, Haringey Healthcare NHS Trust, St Ann's Hospital, St Ann's Road, London N15 3TH

Declaration of interest None.

See editorial, pp. 93-94, this issue.

Background Psychiatrists have been criticised for failing to develop adequate treatment for personality disorder. Psychotherapeutic treatments are promising, but their effectiveness is uncertain.

Aims To investigate the evidence for effectiveness of psychotherapeutic treatment for personality disorder.

Method Systematic literature review.

Results There is evidence for the effectiveness of psychotherapy for personality disorder. Problems of case identification, comorbidity, randomisation, specificity of treatment and outcome measurement are inadequately addressed. Authors mainly relied on cohort studies. Evidence neither suggests superiority of one type of therapy over another nor indicates which subgroups of patients should be offered psychotherapy as in-patient, day patient, or out-patient.

Conclusions New research strategies are needed to show that personality change is both measurable and clinically meaningful. Effectiveness studies using randomised controlled designs are required. The literature suggests that effective treatment should be long-term, integrated, theoretically coherent and focused on compliance.

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