C Kümesi Kişilik Bozukluklarında Bilişsel Davranışçı Terapinin Etkililiği

Öz

Bireylerin hayatlarını birçok açıdan etkilediği bilinen ve işlevsellikte bozulmalara neden olan kişilik bozukluklarının özelliklerinin iyi bilinmesi ve tedavi yolları hakkında bilgi sahibi olunması önemlidir. Bu yazıda C kümesi kişilik bozukları olarak kategorilendirilen çekingen, bağımlı ve obsesif kompulsif kişilik bozukluğu ile bu bozukluklarda bilişsel davranışçı terapi’nin (BDT) etkililiği hakkında yapılan çalışmaların incelenmesi amaçlanmıştır. İlk olarak kişilik bozukluklarının tanımlanması ve DSM’deki sınıflandırmanın yıllara göre değişimi açıklanmıştır. Daha sonra çalışma için C kümesi bozukluklarının ve BDT’nin seçilme nedenine değinilip C kümesi bozukluklarının ortak özellikleri gözden geçirilmiştir. Devamında bu üç bozukluk ayrı ayrı ele alınmıştır. Bozukluklar hem tanı kriterleri ve genel özellikleri hem de BDT ile ilgili yapılan çalışmalar çerçevesinde incelenmiştir. Son olarak yazının tartışma ve sonuç kısmında ise tarama sonucunda elde edilen bulgulardan bahsedilmiş ve alanyazındaki eksikliklerin giderilmesi, ayrıca yeni bakış açıları kazanılması için yapılabilecekler tartışılmıştır.

Anahtar Kelimeler

• C kümesi kişilik bozuklukları
• BDT ve kişilik bozuklukları
• çekingen kişilik bozukluğu
• bağımlı kişilik bozukluğu
• obsesif kompulsif kişilik bozukluğu

Effectiveness of Cognitive Behavioral Therapy in Cluster C Personality Disorders

Abstract

It is important to have knowledge about characteristics and treatment methods of personality disorders which affect people in many aspects and cause impairments in functionality. In this article, it is aimed to investigate Cluster C personality disorders (which includes avoidant, dependent and obsessive-compulsive personality disorder) and studies conducted about the effectiveness of cognitive behavioral therapy (CBT) in these disorders. Firstly, the definition of personality disorders and evolution of their classification in DSM over the years were explained. Later the reason of choosing Cluster C disorders and CBT for this article was mentioned. Then common characteristics of Cluster C personality disorders was reviewed. Afterwards these three disorders were discussed separately within the frame of their diagnosis criteria, their characteristics and researches conducted about CBT. Finally, in the discussion and conclusion section, findings obtained from these studies and suggestions for both making up the deficiency in the literature and gaining new perspectives were discussed.

Keywords

• cluster C personality disorders
• CBT and personality disorders
• avoidant personality disorder
• dependent personality disorder
• obsessive compulsive personality disorder

Kaynakça

1. Alden L (1989) Short-term structured treatment for avoidant personality disorder. Journal of Consulting and Clinical Psychology, 57(6):756-764. doi: 10.1037/0022-006X.57.6.756
2. Alden LE ve Capreol MJ (1993) Avoidant personality disorder: Interpersonal problems as predictors of treatment response. Behavior Therapy, 24(3):357-376. doi: 10.1016/S0005-7894(05)80211-4
3. American Psychiatric Association (1952) Diagnostic and statistical manual of mental disorders, 1. baskı. Washington, DC, American Psychiatric Association.
4. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4. baskı. Washington, DC, American Psychiatric Association.
5. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5. baskı. Washington, DC, American Psychiatric Publishing.
6. Baljé A, Greeven A, van Giezen A, Korrelboom K, Arntz A ve Spinhoven P (2016). Group schema therapy versus group cognitive behavioral therapy for social anxiety disorder with comorbid avoidant personality disorder: Study protocol for a randomized controlled trial. Trials, 17: 487. doi: 10.1186/s13063-016-1605-9
7. Beck AT, Davis DD ve Freeman A (2004) Cognitive therapy of personality disorders, 2. baskı. NY, Guilford Publications.
8. Bender DS (2005) The therapeutic alliance in the treatment of personality disorders. Journal of Psychiatric Practice, 11(2):73-87. doi: 10.1097/00131746-200503000-00002

9. Bieling PJ, Beck AT ve Brown GK (2000) The sociotropy–autonomy scale: Structure and implications. Cognitive Therapy and Research, 24(6): 763-780. doi: 10.1023/A:1005599714224
10. Borge FM, Hoffart A, Sexton H, Martinsen E, Gude T, Hedley LM ve ark. (2010) Pre‐treatment predictors and in‐treatment factors associated with change in avoidant and dependent personality disorder traits among patients with social phobia. Clinical Psychology & Psychotherapy, 17(2): 87-99. doi: 10.1002/cpp.640
11. Bornstein RF (2004) Integrating cognitive and existential treatment strategies in psychotherapy with dependent patients. Journal of Contemporary Psychotherapy, 34(4): 293-309. doi: 10.1007/s10879-004-2525-7
12. Bornstein, RF (2005) The dependent patient: A practitioner's guide. Washington, DC, American Psychological Association.
13. Bornstein RF (2006) A Freudian construct lost and reclaimed: The psychodynamics of personality pathology. Psychoanalytic Psychology, 23(2):339-353. doi:10.1037/0736-9735.23.2.339
14. Bornstein RF (2007) Dependent personality disorder: Effective time-limited therapy. Current Psychiatry, 6(1): 37-45. https://www.mdedge.com/psychiatry adresinden erişildi.
15. Chioqueta AP ve Stiles TC (2004) Assessing suicide risk in cluster C personality disorders. Crisis, 25(3): 128-133. doi: 10.1027/0227-5910.25.3.128
16. Corruble E, Ginestet D ve Guelfi JD (1996) Comorbidity of personality disorders and unipolar major depression: A review. Journal of Affective Disorders, 37(2-3):157-170. doi: 10.1016/0165-0327(95)00091-7
17. Cummings JA, Hayes AM, Cardaciotto L ve Newman CF (2012) The dynamics of self-esteem in cognitive therapy for avoidant and obsessive–compulsive personality disorders: An adaptive role of self-esteem variability? Cognitive therapy and research, 36(4): 272-281. doi: 10.1007/s10608-011-9375-x
18. Deltito JA ve Stam M (1989) Psychopharmacological treatment of avoidant personality disorder. Comprehensive psychiatry, 30(6):498-504. doi: 10.1016/0010-440X(89)90079-5
19. Disney KL (2013) Dependent personality disorder: A critical review. Clinical Psychology Review, 33(8):1184-1196. doi: 10.1016/j.cpr.2013.10.001
20. Emmelkamp PM, Benner A, Kuipers A, Feiertag GA, Koster HC ve van Apeldoorn FJ (2006) Comparison of brief dynamic and cognitive–behavioural therapies in avoidant personality disorder. The British Journal of Psychiatry, 189(1):60-64. doi: 10.1192/bjp.bp.105.012153
21. Enero C, Soler A, Ramos I, Cardona S, Guillamat R ve Valles V (2013) Distress level and treatment outcome in obsessive-compulsive personality disorder (OCPD) [Özet]. European Psychiatry, 28:1. doi: 10.1016/S0924-9338(13)77373-5
22. Faith C (2009) Dependent personality disorder: A review of etiology and treatment. Graduate Journal of Counseling Psychology, 1(2):66-75. https://epublications.marquette.edu/gjcp/ adresinden erişildi.
23. Farabaugh A, Fava M, Mischoulon D, Sklarsky K, Petersen T ve Alpert J (2005) Relationships between major depressive disorder and comorbid anxiety and personality disorders. Comprehensive Psychiatry, 46(4):266-271. doi: 10.1016/j.comppsych.2004.10.005
24. Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ ve ark. (2004) Prevalence, correlates, and disability of personality disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions [Özet]. The Journal of Clinical Psychiatry, 65(7):948. doi: 10.4088/JCP.v65n0711
25. Hardy GE, Barkham M, Shapiro DA, Stiles WB, Rees A ve Reynolds S (1995) Impact of Cluster C personality disorders on outcomes of contrasting brief psychotherapies for depression. Journal of Consulting and Clinical Psychology, 63(6):997. doi: 10.1037/0022-006X.63.6.997
26. Herzog DB, Keller MB, Lavori PW, Kenny GM, ve Sacks NR (1992) The prevalence of personality disorders in 210 women with eating disorders. The Journal of Clinical Psychiatry, 53(5):147–152. https://www.ncbi.nlm.nih.gov/pubmed/1592839 adresinden erişildi.
27. Hofmann SG (2007) Treating avoidant personality disorder: The case of Paul. Journal of Cognitive Psychotherapy, 21(4):346-352. doi: 10.1891/088983907782638770
28. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT ve Fang A (2012) The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5):427-440. doi: 10.1007/s10608-012-9476-1
29. Hyman SM ve Schneider BA (2004) The short-term treatment of a long-term interpersonal avoidance. Clinical Case Studies, 3(4):313-332. doi: 10.1177/1534650103259644
30. Jungquist CR, O’Brien C, Matteson-Rusby S, Smith MT, Pigeon WR, Xia ve ark. (2010) The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain. Sleep Medicine, 11(3):302-309. doi: 10.1016/j.sleep.2009.05.018
31. Kernberg OF (1985) Borderline conditions and pathological narcissism. Oxford, Rowman & Littlefield.
32. Lazare A (1971) The hysterical character in psychoanalytic theory. Archives of General Psychiatry, 25(2):131-137. doi:10.1001/archpsyc.1971.01750140035007
33. Lucas R (1992) The psychotic personality: A psychoanalytic theory and its application in clinical practice. Psychoanalytic Psychotherapy, 6(1):73-79. doi: 10.1080/02668739200700321
34. Masroor U ve Gul S (2012) Schema focused CBT intervention of dependent personality disorder: A case study [Özet]. Pakistan Journal of Clinical Psychology, 11(1):43. https://rj.icpuok.edu.pk/index.php/pjcp adresinden erişildi.
35. McCann J ve Biaggio MK (1989) Narcissistic personality features and self-reported anger. Psychological Reports, 64(1):55-58. doi: 10.2466/pr0.1989.64.1.55
36. National Collaborating Centre for Mental Health (2004) Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and related eating disorders. https://www.ncbi.nlm.nih.gov/books/NBK49304/ adresinden erişildi.
37. Ng RM (2005) Cognitive therapy for obsessive-compulsive personality disorder--a pilot study in Hong Kong Chinese patients. Hong Kong Journal of Psychiatry, 15(2):50-54. https://www.easap.asia/ adresinden erişildi.
38. Nordahl, HM ve Stiles TC (2000) The specificity of cognitive personality dimensions in cluster C personality disorders. Behavioural and Cognitive Psychotherapy, 28(3):235-246. doi:10.1017/S1352465800003040
39. Nordahl HM, Vogel PA, Morken G, Stiles TC, Sandvik P ve Wells A (2016) Paroxetine, cognitive therapy or their combination in the treatment of social anxiety disorder with and without avoidant personality disorder: A randomized clinical trial. Psychotherapy and Psychosomatics, 85(6):346-356. doi: 10.1159/000447013
40. Overholser JC ve Fine MA (1994) Cognitive-behavioral treatment of excessive interpersonal dependency: A four-stage psychotherapy model. Journal of Cognitive Psychotherapy, 8(1):55-70. doi: 10.1891/0889-8391.8.1.55
41. Pincus AL ve Gurtman MB (1995) The three faces of interpersonal dependency: Structural analyses of self-report dependency measures. Journal of Personality and Social Psychology, 69(4):744-758. doi: 10.1037/0022-3514.69.4.744
42. Pincus AL ve Wilson KR (2001) Interpersonal variability in dependent personality. Journal of Personality, 69(2):223-251. doi: 10.1111/1467-6494.00143 Raja M ve Azzoni A (2007) The impact of obsessive-compulsive personality disorder on the suicidal risk of patients with mood disorders. Psychopathology, 40(3):184-190. doi:10.1159/000100366
43. Sato T ve McCann D (2007) Sociotropy–autonomy and interpersonal problems. Depression and Anxiety, 24(3):153-162. doi: 10.1002/da.20230
44. Seligman L ve Reichenberg LW (2007) Selecting effective treatments: A comprehensive, systematic guide to treating mental disorders, 3. baskı. San Fransisco, CA, John Wiley & Sons.
45. Shea MT, Stout R, Gunderson J, Morey LC, Grilo CM, McGlashan, T ve ark. (2002) Short-term diagnostic stability of schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. American Journal of Psychiatry, 159(12):2036-2041. doi: 10.1176/appi.ajp.159.12.2036
46. Simonelli A ve Parolin M (2017) Dependent personality disorder. Encyclopedia of personality and individual differences (Ed. V Zeigler-Hill ve TK Shackelford) içinde. doi: 10.1007/978-3-319-28099-8_578-1
47. Skodol AE, Gunderson JG, McGlashan TH, Dyck IR, Stout RL, Bender DS ve ark. (2002) Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. American Journal of Psychiatry, 159(2):276-283. doi: 10.1176/appi.ajp.159.2.276
48. Solomonov N, Kuprian N, Zilcha-Mano S, Muran JC ve Barber JP (2020) Comparing the interpersonal profiles of obsessive-compulsive personality disorder and avoidant personality disorder: Are there homogeneous profiles or interpersonal subtypes? Personality Disorders: Theory, Research, and Treatment. Çevrimiçi Yayın. doi: 10.1037/per0000391
49. Strauss JL, Hayes AM, Johnson SL, Newman CF, Brown GK, Barber JP ve ark. (2006) Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. Journal of Consulting and Clinical Psychology, 74(2):337-345. doi: 10.1037/0022-006X.74.2.337
50. Svartberg M, Stiles TC ve Seltzer MH (2005) Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. Focus, 161(3):407-416. doi: 10.1176/foc.3.3.407
51. Torgersen S, Kringlen E ve Cramer V (2001) The prevalence of personality disorders in a community sample. Archives of General Psychiatry, 58(6):590-596. doi: 10.1001/archpsyc.58.6.590
52. Villemarette-Pittman NR, Stanford MS, Greve KW, Houston RJ ve Mathias CW (2004) Obsessive—compulsive personality disorder and behavioral disinhibition. The Journal of Psychology, 138(1):5-22. doi: 10.3200/JRLP.138.1.5-22
53. Weertman A, Arntz A, de Jong PJ ve Rinck M (2008) Implicit self- and other-associations in obsessive-compulsive personality disorder traits. Cognition and Emotion, 22(7):1253-1275. doi: 10.1080/13546780701739790