Borderline personality disorder (BPD) is characterized by affective instability, impulsive behaviors, and disturbed interpersonal relationships. A previous study of our group found that combined therapy with interpersonal psychotherapy adapted to BPD (IPT-BPD) and fluoxetine was superior to single pharmacotherapy in BPD patients. The aim of the present study was to examine what clinical factors predicted response to combined therapy in patients evaluated in the previous efficacy study. The subgroup of 27 patients allocated to combined therapy was analyzed. Patients were treated for 32 weeks with fluoxetine 20–40 mg/day plus IPT-BPD. Patients were assessed at baseline and week 32 with an interview for demographic and clinical variables, CGI-S, HDRS, HARS, SOFAS, BPDSI, and SAT-P. Statistical analysis was performed with multiple regression. The difference of CGI-S score between baseline and week 32 (∆CGI-S) was the dependent variable. Factors significantly and independently related to ∆CGI-S were the BPDSI total score and the items abandonment, affective instability, and identity. Patients with more severe BPD psychopathology and with a higher degree of core symptoms such as fear of abandonment, affective instability, and identity disturbance have a better chance to improve with combined therapy with fluoxetine and IPT-BPD.
Borderline personality disorder is a complex and severe mental disorder that is characterized by a pervasive pattern of instability of interpersonal relationships, self-image and emotions, and impulsive behaviors. It affects approximately 1–5% of the general population and as many as 25% of psychiatric outpatients (Gunderson and Ridolfi, 2001, Torgersen et al., 2001, Grant et al., 2008 and Perroud et al., 2010). The long-standing impairment in functioning and personal distress are extensively documented in BPD. Patients affected by this disorder often require high treatment costs through broad use of psychiatric services (National Institute for Mental Health in England, 2003 and Ansell et al., 2007), stemming in part from their instability in affect and interpersonal relationships.
In the last two decades a growing number of studies about psychotherapy of BPD have been performed and several treatment models have shown some evidence of efficacy, including mentalization-based therapy (Bateman and Fonagy, 1999 and Bateman and Fonagy, 2008), dialectical behavior therapy (Linehan, 1993, Linehan et al., 1999, Linehan et al., 2006 and Verheul et al., 2003), cognitive therapy (Davidson et al., 2006), schema-focused therapy (Kellogg and Young, 2006 and Giesen-Bloo et al., 2006), and systems training for emotional predictability and problem solving (STEPPS) (Blum et al., 2002). As for transference focused therapy (Clarkin et al., 2007 and Yeomans et al., 2007), efficacy in BPD patients can be questioned as results of two controlled trials lead to divergent conclusions (Doering et al., 2010 and Giesen-Bloo et al., 2006). A recent addition to these proposals is represented by interpersonal psychotherapy adapted to BPD (IPT-BPD), an intervention specifically designed for BPD patients to deal with problems in interpersonal contexts (Markowitz, 2005, Markowitz et al., 2006 and Bellino et al., 2010).
The standard model of IPT for major depression was modified by Markowitz (2005) to address the peculiar characteristics and the complex psychopathology of patients with BPD. Authors conceptualized BPD as a mood-inflected chronic illness with recurrent outbursts of anger requiring prolonged duration of treatment up to 34 sessions over 8 months, and provided a more flexible setting to handle crises and improve compliance.
This modified version of IPT (IPT-BPD) shows some relevant similarities with other effective psychotherapies, such as a clear treatment framework, attention to affect, focus on treatment relationship, active role of therapist, change-oriented interventions (Weinberg et al., 2011).
Combination of a specific psychotherapy for BPD patients with drug therapy, i.e. serotonergic antidepressants, is common in clinical practice and was recommended as first choice for patients with affective dysregulation and impulsive-behavioral dyscontrol by the American Psychiatric Association treatment guidelines (American Psychiatric Association, 2001; Oldham, 2005). Moreover, there is some evidence that psychotherapy may enhance pharmacotherapy effects (Herpertz et al., 2007, Lieb et al., 2010 and Stoffers et al., 2012).
