Paraphilias, Violence and Personality Disorder: Changes in personality functioning as a result of long-term psychoanalytic psychotherapy

Heim, Nikolas; Ahlers, Imke Eliese; Busse, Alexandra and Rost, Felicitas (2019). Paraphilias, Violence and Personality Disorder: Changes in personality functioning as a result of long-term psychoanalytic psychotherapy. In: Society for Psychotherapy Research 5th Joint European & UK Chapters Conference, 19-21 Sep 2019, Krakow, Poland.

URL: https://www.sprconference.com/EU-UK-2019/#:~:text=...

Abstract

Background: Within a psychiatric classification, patients with problematic sexual behaviors are diagnosed as suffering from 'paraphilias' with a focus on overt sexual symptomatology whilst neglecting personality pathology. Patients with a history of violence, on the other hand, have often been recognised as having personality disorder (PD). The aim of this presentation is to highlight that like violent behavior, abnormal sexual behaviors, may also be conceptualised as underlying personality difficulties, and that it is these which become the focus of treatment for both groups of patients, rather than the behaviours themselves.

Method: 168 patients with a DSM-5 diagnosis of a paraphilic disorder and 85 patients with a history of violent offences were referred to the Portman Clinic for long-term, open-ended psychoanalytic psychotherapy. Patients were assessed at intake and at yearly intervals during treatment with the Shedler-Westen Assessment Procedure (SWAP-200), a clinician-rated measure of PD and personality functioning. The two groups of patients were compared in terms of their initial PD diagnoses. Furthermore, multi-level modeling was carried out to investigate and compare changes in trajectories of personality difficulties over a four year treatment period. Results are currently analysed but will be ready to present at the conference. They will be discussed in light of the important implications for future assessment and treatment of both patient groups. The importance to implement clinical meaningful outcome measures that move beyond measuring overt changes in behaviours and symptoms to measuring intrapsychic changes will be highlighted.

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