Tratamientos psicológicos eficaces para los trastornos de personalidad

  1. Errasti Pérez, José Manuel 1
  2. Quiroga Romero, Ernesto
  1. 1 Universidad de Oviedo
    info

    Universidad de Oviedo

    Oviedo, España

    ROR https://ror.org/006gksa02

Revista:
Psicothema

ISSN: 0214-9915

Año de publicación: 2001

Volumen: 13

Número: 3

Páginas: 393-406

Tipo: Artículo

Otras publicaciones en: Psicothema

Resumen

Se han propuesto muchos tratamientos psicológicos para los trastornos de la personalidad, pero son escasos los estudios sobre su eficacia clínica. Tras la revisión efectuada, parece que al día de hoy no existe ninguna terapia psicológica eficaz, ni para los trastornos de la personalidad en general, ni para los distintos trastornos de la personalidad en particular. No obstante, para el trastorno límite de la personalidad, la terapia dialéctica cognitivo-conductual y la terapia de conducta clásica cuentan con avales empíricos suficientes como para ser consideradas como tratamientos psicológicos probablemente eficaces. Con todo, parece que los clínicos tratan globalmente los trastornos de la personalidad con terapias concretas predefinidas, cuando según Millon, por el contrario, la propia personalidad es la que debe guiar la terapia mediante la combinación de las diversas terapias existentes según las diversas características problemáticas de la personalidad del paciente

Referencias bibliográficas

  • Alden, L. (1989). Short-term structured treatment for avoidant personality disorder. Journal of Consulting Clinical Psychology, 57, 756–64.
  • American Psychiatric Association (APA) (1980). Manual Diagnóstico y Estadístico de los Trastornos Mentales III (DSM-III). Barcelona: Masson.
  • American Psychiatric Association (APA) (1994/1995). Manual Diagnóstico y Estadístico de los Trastornos Mentales IV (DSM-IV). Barcelona: Masson.
  • Aramburu, B. (1996). La terapia dialéctica conductual para el trastorno límite de la personalidad. Psicología Conductual, 4 (1), 123-140.
  • Barber, J.P., Morse, J.Q., Krakauer, I.D., Chittams, J., y Crits-Christoph, K. (1997). Change in obsessive-compulsive and avoidant personality disorders following time-limited supportive-expressive therapy. Psychotherapy, 34 (2), 133-143.
  • Barley, W.D., Buie, S.E., Peterson, E.W., y Hollingsworth, A.S. (1993). Development of an inpatient cognitive-behavioral treatment program for borderline personality disorder. Journal of Personality Disorders, 7 (3), 232-240.
  • Bateman, A., y Fonagy, P. (1999). Effectiveness of partial hospitalization in the treatment of borderline personality disorder: A randomized controlled trial. American Journal of Psychiatry, 156 (10), 1563-1569.
  • Beahrs, J.O., Butler, J.L., Sturges, S.G., y Drummond, D.J. (1992). Strategic self-therapy for personality disorders. Journal of Strategic and Systemic Therapies, 11 (2), 33-52.
  • Beck, A., y Freeman, A. (1992/1995). Terapia cognitiva de los trastornos de la personalidad. Barcelona: Paidós.
  • Benjamin, L.S. (1993). Interpersonal treatment of personality disorders. Nueva York: Guilford Press.
  • Black, D.W., y Noyes, R. (1997). Obssesive compulsive disorder and axis II. International Review of Psychiatry, 9 (1), 111-118.
  • Bloxham, G., Long, C.G., Alderman, N., y Hollin, C.R. (1993). The behavioral treatment of self-starvation and severe self-injury in a patient with borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry, 24 (3), 261-267.
  • Caballo, V.E. (1998). Tratamiento cognitivo-conductual de los trastornos de la personalidad. En V.E. Caballo (Coord.), Manual para el tratamiento cognitivo-conductual de los trastornos psicológicos. Vol. II. Madrid: Siglo XXI.
  • Cacciola, J.S., Rutherford, M.J., Alterman, A.I., Mckay, J.R., y Snider, E.C. (1996). Personality disorders and treatment outcome in methadone maintenance patients. Journal of Nervous and Mental Disease, 184 (4), 234-239.
  • Cappe, R.F., y Alden, L.E. (1986). A comparison of treatment strategies for clients functionally impaired by extreme shyness and social avoidance. Journal of Consulting Clinical Psychology, 54, 796–801.
  • Croake, J.W. (1989). Adlerian treatment of borderline personality disorder. Individual Psychology: Journal of AdlerianTheory, Research and Practice, 45 (4), 473-489.
  • Davidson, K.M., y Tyrer, P. (1996). Cognitive therapy for antisocial and borderline personality disorders. Single case study series. British Journal of Clinical Psychology, 35 (3), 413-429.
  • Dolan, B. (1998). Therapeutic community treatment for severe personality disorders. En T. Millon, y E. Simonsen, (Coords.). Psychopathy: Antisocial, criminal, and violent behavior (pp. 407-430). New York: The Guilford Press.
  • Dorr, D. (1999). Approaching psychotherapy of the personality disorders from the Millon perspective. Journal of Personality Assessment, 72 (3), 407-426.
  • Dreessen, L., y Arntz, A. (1998). The impact of personality disorders on treatment outcome of anxiety disorders: Best evidence synthesis. Behaviour Research and Therapy, 36 (5), 483-504.
  • Echeburúa, E., y Corral, P. (1999). Avances en el tratamiento cognitivo-conductual de los trastornos de la personalidad. Análisis y Modificación de Conducta, 25, 585-614.
  • Fernández Hermida, J. R. y Pérez Álvarez, M. (2001). Separando el grano de la paja en los tratamientos psicológicos, Psicothema, 13, 337-344.
  • Frances, A. y Widiger, T. A. (1988). Treating sel-defeating personality disorder. Hospital and Community Psychiatry, 39 (8), 819-821.
  • Fuentes, J.B. (1994a). Una nota sobre la constitución histórico-cultural de la figura antropológica (específica) del campo psicológico. Revista de Historia de la Psicología, 15 (3-4), 41-48.
  • Fuentes, J.B. (1994b). Introducción del concepto de «conflicto de normas irresuelto personalmente» como figura antropológica (específica) del campo psicológico. Psicothema, 6 (3), 421-446.
  • Gabbard, G.O. (2000). Psychotherapy of personality disorders. Journal of Psychotherapy Practice and Research, 9 (1), 1-6.
  • Gradman, T.J., Thompson, L.W., y Gallager-Thompson, D. (1999). Personality disorders and mental outcome. En E. Rosowsky, y R.C. Abrams, (Coords.), Personality disorders in older adults: Emerging issues in diagnosis and treatment (pp. 69-94). Mahwah, NJ: Lawrence Erlbaum Associates.
  • Gunderson, J.G., y Gabbard, G.O. (Coords.) (2000). Psychotherapy of personality disorders . Washintong, DC: American Psychiatric Press.
  • Karterud, S., Vaglum, S., Friis, S., Irion, T., Johns, S., y Vaglum, P. (1992). Day hospital therapeutic community treatment for patients with personality disorders. Journal of Nervous Mental Disorders, 180, 238–243.
  • Kern, R.S., Kuehnel, T.G., Teuber, J., y Hayden, J.L. (1997). Multimodal cognitive-behavior therapy for borderline personality disorder with self-injurious behavior. Psychiatric Services, 48 (9), 1.131-1.133.
  • Koerner, K., y Linehan, M.M. (2000). Research on dialectical behavior therapy for patients with borderline personality disorder. Psychiatric Clinics of North America, 23 (1), 151-167.
  • Kush, F.R. (1995). Individualized behavior therapy programs applied to borderline personality disorder: A primer for clinicians. Journal of Contemporary Psychotherapy, 25 (1), 35-47.
  • Leibbrand, R., Hiller, W., y Fichter, M. (1999). Influence of personality disorders on therapy outcome in somatoform disoders at 2-year followup. Journal of Nervous and Mental Disease, 187 (18), 509-512.
  • Lewis, G., y Appleby, L. (1988). Personality disorders: the patients psychiatrist dislike. British Journal of Psychiatry, 153, 44-49.
  • Linehan, M.M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford.
  • Linehan, M.M., Armstrong, H.E., Suarez, A., Allmon, D., y Heard, H.L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1.060–1.064.
  • Linehan, M.M., Heard, H.L., y Armstrong, H.E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Archives of General Psychiatry, 50, 971–974.
  • Marchand, A., Goyer, L.R., Dupuis, G ., y Mainguy, N. (1998). Personality disorders and the outcome of cognitive-behavioural treatment of panic disorder with agoraphobia. Canadian Journal of Behavioural Science, 30 (1), 14-23.
  • Marlowe, D.B., Kirby, K.C., Festinger, D.S., Husband, S.D., y Platt, J.J. (1997). Impact of comorbid personality disorders and personality disorder symptoms on outcomes of behavioral treatment for cocaine dependence. Journal of Nervous and Mental Disease, 185 (8), 483-490.
  • McCallum, M., y Piper, W.E. (1999). Personality disorders and response to group-oriented evening treatment. Group Dynamics, 3 (1), 3-14.
  • Millon, T. (1969/1976). Psicopatología moderna: Un enfoque biosocial de los aprendizajes erróneos y de los disfuncionalismos. Barcelona: Salvat.
  • Millon, T. (1990). Toward a new Personology: an evolutionary model. Nueva York: Wiley-Interscience.
  • Millon, T. (1987). On the genesis and prevalence of the borderline personality disorder: a social learning thesis. Journal of Personality Disorders, 1, 354-372.
  • Millon, T. (1999a). Personality-guided therapy. Nueva York: Wiley-Interscience.
  • Millon, T. (1999b). Reflections on psychosynergy: a model for integrating science, theory, classification, assessment, and therapy. Journal of Personality Assessment, 72, 437-456.
  • Millon, T., y Davis, R. (1995/1998). Trastornos de la personalidad. Más allá del DSM-IV. Barcelona: Masson.
  • Millon, T., y Escovar, L. (1996). La personalidad y los trastornos de la personalidad: una perspectiva ecológica. En V. Caballo, E. Buela-Casal y J. A. Carrobles, Manual de Psicopatología y trastornos psiquiátricos (pp. 3-33). Madrid: Siglo XXI.
  • Millon, T., y Everly, G.S. (1985/1994). La personalidad y sus trastornos. Barcelona: Martínez Roca.
  • Millon, T., Everly, G.S., y Davis, R.D. (1995). ¿Cómo puede facilitarse la integración de la psicoterapia mediante el conocimiento de la psicopatología? Una perspectiva a partir de los trastornos de la personalidad. Clínica y Salud, 6 (2).
  • Monroe-Blum, H., y Marziali, E. (1995). A controlled trial of short-term group treatment for borderline personality disorder. Journal of Personality Disorders, 9 (3), 190-198.
  • Monsen, J., Odland, T., Faugli, A., y Daas, E. (1995). Personality disorders and psychosocial changes after intensive psychotherapy: A prospective follow-up study of an outpatient psychotherapy project, 5 years after end of treatment. Scandinavian Journal of Psychology, 36 (3), 256-268.
  • Myers, W.A. (1999). Personality disorders in older adults: Some issues in psychodynamic treatment. En E. Rosowsky, y R.C. Abrams, (Coords.), Personality disorders in older adults: Emerging issues in diagnosis and treatment (pp. 205-214). Mahwah, NJ: Lawrence Erlbaum Associates.
  • Nehls, N. (1991). Borderline personality disorder and group therapy. Ar chives of Psychiatric Nursing , 5 (3), 137-146.
  • Nehls, N. (1992). Group therapy for people with borderline personality disorder: Interventions associated with positive outcomes. Issues in Mental Health Nursing, 13 (3), 255-269.
  • Nurnberg, H.G., Raskin, M., Levine, P.E., y Pollack, E. (1989). Borderline personality disorder as a negative prognostic factor in anxiety disorders. Journal of Personality Disorders, 3 (3), 205-216.
  • O’Leary, K.M., Turner, E.R., Gardner, D.L., y Cowdry, R.W. (1991). Homogeneous group therapy of borderline personality disorder. Group, 15 (1), 56-64.
  • Organización Mundial de la Salud (OMS) (1994). CIE 10. Trastornos mentales y del comportamiento. Criterios diagnósticos de investigación. Madrid: Meditor.
  • Pérez Álvarez, M. (1996). Tratamientos psicológicos. Madrid: Universitas.
  • Perry, J.C., Banon, E., y Ianni, F. (1999). Effectiveness of psychotherapy for personality disorders. American-Journal-of-Psychiatry, 156 (9), 1.312-1.321.
  • Perry, J.C., y Bond, M. (2000). Empirical studies of psychotherapy for personality disorders. En J.G. Gunderson y G.O. Gabbard (Coords.), Psy chotherapy of personality disorders. Washinton, DC: American Psychiatric Press.
  • Perry, J.C., y Flannery, R.B. (1982). Passive-aggressive personality disorder. Treatment implications of a clinical typology. Journal of Nervous and Mental Disease, 170 (3), 164-173.
  • Piper, W.E., Rosie, J.S., Azim, H.F., y Joyce, A.S. (1993). A randomized trial of psychiatric day treatment for patients with affective and personality disorders. Hospital and Community Psychiatry, 44 (8), 757-763.
  • Piper, W.E., Rosie, J.S., Joyce, A.S., y Hassan, F.A. (1996). Time limited day treatment for personality disorders: integration of research and practice in a group program. Washington (DC): American Psychological Association Press.
  • Pollack, J., Winston, A., McCullough, L., Fiegenheimer, W., y Winston, B. (1990). Efficacy of brief adaptational psychotherapy. Journal of Personality Disorders, 4, 244–250.
  • Pretzer, J. (1998). Cognitive-behavioral approaches to the treatment of personality disorders. En C. Perris y P.D. McGorry (Coords.), Cognitive psychotherapy of psychotic and personality disorders: Handbook of theory and practice (pp. 269-291). Chichester, England: John Wiley & Sons.
  • Proeve, M. (1995). A multimodal therapy approach to treatment of borderline personality disorder: A case study. Psychological Reports, 76 (2), 587-592.
  • Quiroga, E. (2000). Entrevista a Theodore Millon. Análisis y Modificación de Conducta, 26 (105), 5-28.
  • Reich, J.H., y Green, A.I. (1991). Effect of personality disorders on outcome of treatment. Journal of Nervous and Mental Disease, 179 (2), 74- 82.
  • Renneberg, B., Goldstein, A.J., Phillips, D., y Chambless, D. (1990). Intensive behavioral group treatment of avoidant personality disorder. Behavior Therapy, 21 (3), 363-377.
  • Retzlaff, P.D. (Coord.) (1995). Tactical psychotherapy of the personality disorders: Toward morphologic based approach. Boston: Allyn & Bacon.
  • Retzlaff, P.D. (1997). The MCMI as a treatment planning tool. En T. Millon (Coord.), The Millon inventories: clinical and personality assessment (pp. 217-244) Nueva York: The Guilford Press.
  • Robin, M.W., y DiGiuseppe, R. (1993). Rational-emotive therapy with an avoidant personality. En K.T. Kuehlwein, y H. Rosen, Cognitive therapies in action: Evolving innovative practice (pp. 143-159). San Francisco, CA: Jossey-Bass Inc, Publishers.
  • Roca, M. y Bernardo, M. (1998). Epidemiología. En M. Bernardo y M. Roca (Coords.), Trastornos de la personalidad: Evaluación y Tratamiento. Perspectiva psicobiológica (pp. 1-17). Barcelona: Masson.
  • Ruiz, M. A. (1998). Tratamiento cognitivo de los trastornos de ansiedad y de personalidad. En M.A. Vallejo (Coord.), Avances en la técnicas de modificación de conducta. Madrid: Fundación Universidad-Empresa.
  • Ryle, A. (1996). Cognitive analytic therapy: Theory and practice and its application to the treatment of a personality-disordered patient. Journal of Psychotherapy Integration, 6 (2), 139-172.
  • Ryle, A., y Beard, H. (1993). The integrative effect of reformulation: Cognitive analytic therapy with a patient with borderline personality disorder. British Journal of Medical Psychology, 66 (3), 249-258.
  • Saito, T. (1992). Systemic family therapy of a junior high student with school refusal and suspected borderline personality disorder. Japanese Journal of Family Psychology, 6 (2), 81-94.
  • Safran, J.D., y Mcmain, S. (1992). Cognitive-interpersonal approach to the treatment of personality disorders. Journal of Cognitive Psychothe rapy, 6, 59-68.
  • Sanislow, C.A., y McGlashan, T.H. (1998). Treatment outcome of personality disorders. Canadian Journal of Psychiatry, 43 (3), 237-250.
  • Shea, M.T., Pilkonis, P.A., Beckham, E., y Collins, J.F. (1990). Personality disorders and treatment outcome in the NIMH Treatment of Depression Collaborative Research Program. American Journal of Psychiatry, 147 (6), 711-718.
  • Shearin, E.N., y Linehan, M.M. (1992). Patient-therapist ratings and relationship to progress in dialectical behavior therapy for borderline personality disorder. Behavior Therapy, 23, 730–741.
  • Shearin, E.N. y Linehan, M.M. (1994). Dialectical behavior therapy for borderline personality disorder: Theoretical and empirical foundations. Acta Psychiatrica Scandinavica, 89, 61-68.
  • Simpson, E.B., Pistorello, J., Begin, A., Costello, E., Levinson, J., Mulberry, S., Pearlstein, T., Rosen, K., y Stevens, M. (1998). Use of dialectical behavior therapy in a partial hospital program for women with borderline personality disorder. Psychiatric Services, 49 (5), 669-673.
  • Smith, T.E., Deutsch, A., Schwartz, F., y Terkelson, K. G. (1993). The role of personality in the treatment of schizofrenic and schizoaffective disorder inpatients: A pilot study. Bulletin of the Menninger Clinic, 57 (1), 88-89.
  • Soler, P.A., y Gascón, J. (1999). Recomendaciones terapéuticas en los trastornos mentales. 2ª edición. Barcelona: Masson (Comité de consenso de Catalunya en terapéutica de los trastornos mentales) (Capítulo X: «Trastornos de la personalidad y del comportamiento del adulto», pp. 187-208).
  • Springer, T., Lohr, N.E., Buchtel, H.A., y Silk, K.R. (1995). A preliminary report of short-term cognitive-behavioral group therapy for inpatients with personality disorders. Journal of Psychotherapy Practice and Research, 5 (1), 57-71.
  • Stevenson, J., y Meares, R. (1992). An outcome study of psychotherapy for patients with borderline personality disorder. American Journal of Psychiatry, 149, 358-362.
  • Stravynski, A., Belisle, M., Marcouiller, M., Lavallee, Y.J., y Elie, R. (1994). The treatment of avoidant personality disorder by social skills training in the clinic or in real-life setting. Canadian Journal of Psy chiatry, 39 (8), 377-383.
  • Stravynski, A., Grey, S., y Elie, R. (1987). An outline of the therapeutic process in social skills training with socially dysfunctional patients. Journal of Consulting Clinical Psychology, 56, 224-228.
  • Stravynski, A., Marks, I., y Yule, W. (1982). Social skills problems in neurotic outpatients: social skills training with and without cognitive modification. Archives of General Psychiatry, 39, 1378-1385.
  • Tamai, K., Takeichi, M., y Tashiro, N. (1991). Morita therapy for treating borderline personality disorder: The utility of treatment structuredness and limit-setting. International Bulletin of Morita Therapy, 4 (1-2), 32-41.
  • Waltz, J., y Linehan, M.M. (1999). Functional analysis of borderline personality disorder behavioral criterion patterns: Links to treatment. En J. Derksen, y C. Maffei, (Coords.). Treatment of personality disorders, (pp. 183-206). New York: Kluwer Academic/Plenum Publishers.
  • Wessler, R.L. (1993a). Enfoques cognitivos para los trastornos de personalidad. Psicología Conductual, 1, 35-50.
  • Wessler, R.L. (1993b). Cognitive appraisal therapy and disorders of personality. En K.T. Kuehlwein, y H. Rosen, Cognitive therapies in action: Evolving innovative practice, (pp. 240-267). San Francisco: JosseyBass, Inc.
  • Wilberg, T., Friis, S., Karterud, S., Mehlum, L., Urnes, O., y Vaglum, P. (1998). Outpatient group psychotherapy: A variable continuation treatment for patients with borderline personality disorder treated in a day hospital? A 3-year follow-up study. Nordic Journal of Psychiatry, 52 (3), 213-221.
  • Wilberg, T., Karterud, S., Urnes, O., Pedersen, G., y Friis, S. (1998). Outcomes of poorly functioning patients with personality disorders in a day treatment program. Psychiatric Services, 49 (11), 1462-1467.
  • Wilberg, T., Urnes, O., Friis, S., Irion, T., Pedersen, G., y Karterud, S. (1999). One-year followup of day treatment for poorly functioning patients with personality disorders. Psychiatric Services, 50 (10), 1326-1330.
  • Winston, A., Laikin, M., Pollack J., Samstag, L.W., McCullough, L.,y Muran, J.C. (1994). Short-term psychotherapy of personality disorders. American Journal of Psychiatry, 151, 190–194.
  • Winston, A., Pollack, J ., McCullough, L., Flegenheimer, W., Kestenbaum, R., y Trujillo, M. (1991). Brief psychotherapy of personality disorders. Journal of Nervous Mental Disorders, 179, 188–193.
  • Young, J.E. (1990). Cognitive therapy for personality disorders: A schemafocused approach. Sarasota, FL: Professional Resource Exchange.
  • Young, J., y Behary, W. (1998). Schema-focused therapy for personality disorders. En N. Tarrier, y A. Wells (Coords.), Treating complex cases: The cognitive behavioural therapy approach (pp. 340-376). Chichester, England: John Wiley & Sons Ltd.