Psychotherapy prognostic factors for personality disorders (PD) treatment: The role of self-reported questionnaires
Objectives Dropout rates in psychotherapy are known to be high in patients with personality disorders (PD; ranging from 25% and 64% for Borderline PD). Faced with this observation, the Treatment Attrition-Retention Scale for Personality Disorders (TARS-PD; Gamache et coll., 2017) was developed to precisely identify patients with PD at high risk of abandoning therapy based on 15 criteria, regrouped in 5 factors: Pathological Narcissism, Antisocial/Psychopathy, Secondary Gain, Low Motivation, and Cluster A Features. However, we have limited knowledge about the relevance of self-reported questionnaires commonly used with PD patients to establish treatment prognosis. Thus, the purpose of this study is to evaluate the link between such questionnaires and the five factors of the TARS-PD. Method Data was retrospectively retrieved from the clinical files of 174 participants with a PD (including 56% with borderline traits or PD), who were evaluated at the Centre de traitement le Faubourg Saint-Jean and completed the French version of the following questionnaires: Borderline Symptom List (BSL-23), Brief Version of the Pathological Narcissism Inventory (B-PNI), Interpersonal Reactivity Index (IRI), Buss-Perry Aggression Questionnaire (BPAQ), Barratt Impulsiveness Scale (BIS-11), Social Functioning Questionnaire (SFQ), Self and Interpersonal Functioning Scale (SIFS) and Personality Inventory for DSM-5- Faceted Brief Form (PID-5-FBF). The TARS-PD was completed by well-trained psychologists specialized in PD treatment. Descriptive analyses and regression between self-reported questionnaires and the five factors of the TARS-PD as well as its total score were performed to determine which variables from the self-reported questionnaires completed by the individuals contribute most strongly to the statistical prediction of the variables of the TARS-PD rated by the clinicians. Results The subscales that significantly contribute to the Pathological Narcissism factor (adjusted R 2=0,12) are: Empathy (SIFS), Impulsivity (negatively; PID-5), and Entitlement Rage (B-PNI). The subscales associated with the Antisociality/Psychopathy factor (adjusted R 2=0,24) are Manipulativeness, Submissiveness (negatively), and Callousness from the PID-5, and Empathic Concern (IRI). The scales contributing substantially to the Secondary gains factor (adjusted R 2=0,20) are Frequency (SFQ), Anger (negatively; BPAQ), Fantasy (negatively) and Empathic Concern (IRI), Rigid Perfectionism (negatively) and Unusual Beliefs and Experiences (PID-5). Low motivation (adjusted R 2=0,10) is significantly explained by Total BSL score (negatively) and Satisfaction (SFQ) subscale. Finally, the subscales significantly associated to Cluster A features (adjusted R 2=0,09) are Intimacy (SIFS) and Submissiveness (negatively, PID-5). Conclusion Some scales from self-reported questionnaires demonstrated modest but significant associations with TARS-PD factors. Those scales might be useful in the scoring of the TARS-PD and provide additional information for patients’ clinical orientation.