Paranoia, experiential avoidance, and narcissism as predictors of outcome in residential treatment of borderline personality disorder

Introduction Previous research has suggested that residential treatment may be effective in reducing symptoms in patients with symptoms of borderline personality disorder (BPD). This study examined whether paranoia, experiential avoidance, and narcissistic personality features predicted response to residential treatment in a cohort of female patients with symptoms of borderline personality disorder. Method Participants were 87 women with borderline personality disorder symptoms who participated in multimodal residential treatment incorporating elements of Dialectical Behavioral Therapy, Mentalization Based Therapy, Transference Focused Psychotherapy, and General Psychiatric Management. All participants met definite or probable criteria for borderline personality disorder as assessed by the International Personality Disorder Examination. Participants were evaluated at baseline and at one-month intervals using the Zanarini Rating Scale for Borderline Personality Disorder, Self-Report Version (Zan-BPD, SR), the Paranoid Thoughts Scale (PTS), the Multidimensional Experiential Avoidance Questionnaire (MEAQ), and the Narcissistic Personality Inventory (NPI). The primary outcome measure was change in mean ZAN-BPD scores. Results Mean scores on the ZAN-BPD (11 to 7, p<0.001), the PTS (2.4 to 2, p<0.001), the Distress Tolerance Subscale of the MEAQ (3.4 to 2.8, p<0.001), and NPI (1.4 to 1.3, p=0.04) all decreased over time. Higher baseline mean scores on the Social Reference subscale of the PTS and the Distress Aversion Subscale of the MEAQ were associated with larger and faster declines in mean ZAN-BPD scores. Baseline scores on the Behavioral Avoidance subscale of the MEAQ were associated with slower declines in mean ZAN-BPD scores. Longitudinal declines in the Distress Aversion subscale of the MEAQ and the Social Reference subscale of the PTS were significantly associated with reductions in mean ZAN-BPD scores over time. NPI scores were not significantly associated with changes in ZAN-BPD scores. Conclusion Multimodal residential treatment may be an effective treatment for female patients with borderline personality disorder. Paranoia and experiential avoidance may not be negative prognostic factors in the treatment of such patients and should be considered significant residential treatment targets. Narcissistic personality features may change more slowly and appear to be less influential in residential treatment for borderline personality disorder.