Comprehensive Psychiatry (Nov 2024)
The interplay of personality pathology and treatment outcome in psychosomatic psychotherapy: A longitudinal analysis using latent change score modelling
- Antonie Louise Bierling,
- Stephan Doering,
- Kerstin Weidner,
- Magdalena Pape,
- Henrik Kessler,
- Tobias Hofmann,
- Matthias Rose,
- Katrin Imbierowicz,
- Franziska Geiser,
- Jörg Rademacher,
- Silke Michalek,
- Eva Morawa,
- Yesim Erim,
- Johanna Sophie Schneider,
- Martin Teufel,
- Armin Hartmann,
- Claas Lahmann,
- Eva Milena Johanne Peters,
- Johannes Kruse,
- Dirk von Boetticher,
- Christoph Herrmann-Lingen,
- Mariel Nöhre,
- Martina de Zwaan,
- Ulrike Dinger,
- Hans-Christoph Friederich,
- Alexander Niecke,
- Christian Albus,
- Rüdiger Zwerenz,
- Manfred Beutel,
- Heribert Christian Sattel,
- Peter Henningsen,
- Barbara Stein,
- Christiane Waller,
- Karsten Hake,
- Carsten Spitzer,
- Andreas Stengel,
- Stephan Zipfel,
- Katja Weimer,
- Harald Gündel,
- Stephan Herpertz,
- Ilona Croy
Affiliations
- Antonie Louise Bierling
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307 Dresden, Germany; Department of Clinical Psychology, Institute of Psychology, Friedrich-Schiller University Jena, Am Steiger 3-1, 07743 Jena, Germany; Corresponding author at: Department of Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
- Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307 Dresden, Germany
- Magdalena Pape
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
- Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany; Department of Psychosomatic Medicine and Psychotherapy, Campus Fulda, University of Marburg, Fulda, Germany
- Tobias Hofmann
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Matthias Rose
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Katrin Imbierowicz
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, University of Bonn, Bonn, Germany
- Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, University of Bonn, Bonn, Germany
- Jörg Rademacher
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Silke Michalek
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Johanna Sophie Schneider
- Clinic of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- Martin Teufel
- Clinic of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
- Armin Hartmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Eva Milena Johanne Peters
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University of Giessen, Giessen, Germany
- Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University of Giessen, Giessen, Germany; Department of Psychosomatic Medicine and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
- Dirk von Boetticher
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
- Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
- Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
- Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
- Ulrike Dinger
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Department of General Internal Medicine and Psychosomatics, University Hospital, Heidelberg University, Heidelberg, Germany
- Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital, Heidelberg University, Heidelberg, Germany
- Alexander Niecke
- Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Christian Albus
- Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Heribert Christian Sattel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
- Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
- Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
- Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
- Karsten Hake
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
- Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
- Andreas Stengel
- Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany; German Center for Mental Health, Site Tübingen, Tübingen, Germany; Clinic for Psychosomatic Medicine and Psychotherapy, Klinikum Stuttgart, Stuttgart, Germany
- Stephan Zipfel
- Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany; German Center for Mental Health, Site Tübingen, Tübingen, Germany
- Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
- Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
- Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
- Ilona Croy
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307 Dresden, Germany; Department of Clinical Psychology, Institute of Psychology, Friedrich-Schiller University Jena, Am Steiger 3-1, 07743 Jena, Germany; German Center for Mental Health (DZPG), Site Halle-Jena-Marburg, Germany
- Journal volume & issue
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Vol. 135
p. 152532
Abstract
Introduction: While ample data demonstrate the effectiveness of inpatient psychosomatic treatment, clinical observation and empirical evidence demonstrate that not all patients benefit equally from established therapeutic methods. Especially patients with a comorbid personality disorder often show reduced therapeutic success compared to other patient groups. Due to the heterogeneous and categorical personality assessment, previous studies indicated no uniform direction of this influence. This complicates the derivation of therapeutic recommendations for mental disorders with comorbid personality pathology. Methods: Analyzing n = 2094 patients from German university hospitals enrolled in the prospective “MEPP” study, we tested the dynamic interaction between dimensionally assessed personality functioning and psychopathology of anxiety and depression. Results: Longitudinal structural equation modelling replicated the finding that the severity of symptoms at admission predicts symptom improvement within the same symptom domain. In addition, we here report a significant coupling parameter between the baseline level of personality function and the change in general psychopathology - and vice versa. Discussion and conclusion: These results imply that personality pathology at admission hinders the therapeutic improvement in anxiety and depression, and that improvement of personality pathology is hindered by general psychopathology. Furthermore, the covariance between both domains supports the assumption that personality functioning and general psychopathology cannot be clearly distinguished and adversely influence each other. A dimensional assessment of the personality pathology is therefore recommendable for psychotherapy research and targeted therapeutic treatment.
