Psychotherapeutic treatment concepts of personality disorders in patients with childhood traumatization

The psychotherapeutic treatment of personality disorders in patients with childhood traumatization is still a major challenge. The broad range of clinical problems includes disturbed emotion regulation, reduced mentalization function, impaired integration of personality, maladaptive patterns of behavior and a high degree of comorbidity. A variety of treatment concepts of psychodynamic, cognitive-behavioral, and other origin have been developed to treat this patient population. The aim of this paper is to identifiy those concepts whose effectiveness has been sufficienty demonstrated by controlled studies. The concepts will be briefly described and evaluated with regard to their utility in focusing specific clinical problem areas. While a variety of treatment approaches has been developed for this condition, only a limited number of concepts of cognitive-behavioral and psychodynamic origin show up with sufficient evidence in terms of controlled studies. Among the cognitive-behaviorally oriented concepts are: Dialectical-behavioral Psychotherapy (Linehan), Affect Management Training (e.g. Cloitre), and Schema Therapy (Young). The psychodynamic concepts with evidence of effectiveness are: Tranference-focused Psychotherapy (Kernberg/Clarkin), Psychodynamic-interactional and Structure-related Psychotherapy (Heigi-Evers & Heigl, Rudolf), Mentalization-based Treatment (Bateman & Fonagy), and Psychodynamically Oriented Trauma Therapy (Reddemann, Sachsse). However, a critical discussion of these concepts reveals that, because of the heterogeneity of the patient population, none of these concepts is able to cover all types of clinical problems presented by the patients.