Terapia transdiagnóstica y transteórica para el trastorno de personalidad

This paper argues that evidence of limited efficacy of specialized therapies for personality disorder points to the need for trans-diagnostic and trans-theoretical treatment models. Current therapies largely adopt a diagnosis-specific and therapeutic schools approach to therapy development; each major school of thought tends to develop its own treatment model for specific diagnoses. The relevance of a diagnosis specific approach to treatment is challenged given the well-established problems with current diagnoses and growing recognition that the general features of personality disorder and severity are more useful in understanding prognosis than specific diagnoses. These developments point to the use of a trans-diagnostic treatment model. Similarly, a schools approach to treatment is questioned given the failure to demonstrate differences in efficacy across therapeutic models and evidence that these therapies do not yield better outcomes that supportive therapy or general clinical care. These finding point to the need for a more integrated approach. Implementation of trans-diagnostic and trans-theoretical treatment requires a more detailed assessment of personality pathology than is provided by current diagnoses in order to identify impairments that form the targets for change and a scheme for organizing therapy and coordinating the implementation of an eclectic array of interventions. The article outlines a practical way to conceptualize assessment for treatment purposes and a framework for organising and delivering therapy.Este artículo sostiene que la evidencia de la limitada eficacia de las terapias especializadas en el trastorno de personalidad apunta a la necesidad de modelos de tratamiento transdiagnósticos y transteóricos. Las terapias actuales adoptan para el desarrollo de la terapia, en gran medida, un enfoque de escuela terapéutica y diagnóstico específico; cada corriente de pensamiento principal tiende a desarrollar su propio modelo de tratamiento para diagnósticos específicos. La relevancia de un enfoque de diagnóstico específico para el tratamiento se ve cuestionada dados los problemas consolidados reflejados en los diagnósticos actuales y el creciente reconocimiento de que las características generales del trastorno de personalidad y su gravedad son más provechosas para comprender el pronóstico que los diagnósticos específicos. Estos avances sugieren el empleo de un modelo de tratamiento transdiagnóstico. De forma similar, se cuestiona el enfoque de las escuelas de tratamiento, ya que no se han demostrado diferencias en la eficacia entre los modelos terapéuticos, ni la evidencia de que estas terapias arrojen mejores resultados que la terapia de apoyo o la atención médica general. Estos hallazgos indican la necesidad de un enfoque más integrado. La implementación del tratamiento transdiagnóstico y transteórico requiere una valoración más detallada sobre la patología de la personalidad, que la proporcionada por los diagnósticos actuales, para identificar las deficiencias que conforman los objetivos de cambio, y un esquema para organizar la terapia y coordinar la aplicación de una matriz ecléctica de intervenciones. El artículo describe una forma práctica de conceptualizar la valoración con fines de tratamiento y un marco para organizar y administrar la terapia

Sensation seeking scales and traits delineating personality disorders in a sample of Chinese students

Scores on the Zuckerman Sensation Seeking Scales (SSS) are consistently elevated in samples of psychopathic patients or prisoners suggesting that sensation seeking is an aspect of antisocial personality disorder. This was investigated in a sample of 171 Chinese university students (102 women and 69 men) who also completed the Dimensional Assessment of Personality Pathology - Basic Questionnaire (DAPP) which assesses four broad domains of personality dysfunction. Factor Analysis clearly identified five-factors, four of which were labeled as "Emotional Dysregulation", "Dissocial", "Bored" and "Inhibition", similar to those detected in the previous studies. Contrary to expectations, except the Boredom Susceptibility was loaded on the factor "Bored" in women, the four SSS subscales were loaded on a fifth factor in both gender samples, suggesting that the SSS does not clearly measure an important feature of personality disorder.Scores on the Zuckerman Sensation Seeking Scales (SSS) are consistently elevated in samples of psychopathic patients or prisoners suggesting that sensation seeking is an aspect of antisocial personality disorder. This was investigated in a sample of 171 Chinese university students (102 women and 69 men) who also completed the Dimensional Assessment of Personality Pathology - Basic Questionnaire (DAPP) which assesses four broad domains of personality dysfunction. Factor Analysis clearly identified five-factors, four of which were labeled as "Emotional Dysregulation", "Dissocial", "Bored" and "Inhibition", similar to those detected in the previous studies. Contrary to expectations, except the Boredom Susceptibility was loaded on the factor "Bored" in women, the four SSS subscales were loaded on a fifth factor in both gender samples, suggesting that the SSS does not clearly measure an important feature of personality disorder. (c) 2006 Elsevier Ltd. All rights reserved