Résumés
Résumé
Objectif Les taux d’abandon en psychothérapie sont reconnus comme étant élevés chez les patients/patientes souffrant de troubles de la personnalité (TP ; variant entre 25 % et 64 % pour le trouble de personnalité limite). Devant ce constat, la Grille de facteurs pronostiques à la psychothérapie (GFPP ; Gamache et coll., 2017) a été développée afin d’identifier précisément les patients/patientes souffrant de TP à haut risque d’abandonner la thérapie à partir de 15 critères, regroupés en 5 facteurs : Narcissisme pathologique, Antisocialité/Psychopathie, Gains secondaires, Faible motivation, Traits du groupe A. Par ailleurs, nous en connaissons relativement peu sur la pertinence des questionnaires autorapportés couramment utilisés auprès de la clientèle dans l’établissement du pronostic de traitement. Ainsi, le but de l’étude est d’évaluer les liens entre de tels questionnaires et les 5 facteurs de la GFPP.
Méthode Un échantillon de 174 personnes avec un TP (dont 56 % avec traits ou TP limite), évaluées au Centre de traitement Le Faubourg Saint-Jean, ont rempli les versions françaises des questionnaires suivants : Borderline Symptom List (BSL-23), Brief Version of the Pathological Narcissism Inventory (B-PNI), Interpersonal Reactivity Index (IRI), Buss-Perry Aggression Questionnaire (BPAQ), Barratt Impulsiveness Scale (BIS-11), Questionnaire de fonctionnement social (QFS), Self and Interpersonal Functioning Scale (SIFS) et Personality Inventory for DSM-5- Faceted Brief Form (PID-5-FBF). La GFPP a été cotée par une équipe de psychologues expérimentés dans le traitement des TP. Des analyses descriptives et de régression entre les questionnaires autorapportés et les 5 facteurs de la GFPP de même que son score total ont été réalisées. Le but de ces analyses est de déterminer quelles variables des questionnaires autorapportés remplis par les personnes référées pour un TP, et principalement un TPL, contribuent le plus fortement à la prédiction statistique des variables de la GFPP cotée par les cliniciens.
Résultats Les sous-échelles qui contribuent significativement au score du facteur Narcissisme pathologique (R2 ajusté = 0,12) sont : Empathie (SIFS), Impulsivité (inversement ; PID-5) et Rage revendicatrice (B-PNI). Les sous-échelles associées au facteur Antisocialité/Psychopathie (R2 ajusté = 0,24) sont Manipulation, Soumission (inversement) et Dureté du PID-5 ainsi que l’échelle Souci empathique de l’IRI. Les échelles contribuant substantiellement au facteur Gains secondaires (R2 ajusté = 0,20) sont Fréquence (QFS), Colère (inversement ; BPAQ), Fantaisie (inversement) et Souci empathique (IRI), Perfectionnisme rigide (inversement) et Croyances inhabituelles (PID-5). Le facteur Faible motivation (R2 ajusté = 0,10) est expliqué significativement par le score total au BSL (inversement) et la sous-échelle Satisfaction (QFS). Finalement, les sous-échelles significativement associées au facteur Traits du groupe A (R2 ajusté = 0,09) sont Intimité (SIFS) et Soumission (inversement ; PID-5).
Conclusion : Certaines échelles des instruments autorapportés montrent des associations modestes, mais significatives avec les résultats obtenus aux facteurs de la GFPP. Ces échelles pourraient donc s’avérer utiles dans la cotation de la GFPP et fournir des informations complémentaires pour l’orientation clinique.
Mots-clés :
- trouble de la personnalité,
- facteurs pronostiques,
- abandon thérapeutique,
- psychothérapie,
- questionnaires autorapportés
Abstract
Objectives Dropout rates in psychotherapy are known to be high in patients with personality disorders (PD; ranging from 25% and 64% for Borderline PD). Faced with this observation, the Treatment Attrition-Retention Scale for Personality Disorders (TARS-PD; Gamache et coll., 2017) was developed to precisely identify patients with PD at high risk of abandoning therapy based on 15 criteria, regrouped in 5 factors: Pathological Narcissism, Antisocial/Psychopathy, Secondary Gain, Low Motivation, and Cluster A Features. However, we have limited knowledge about the relevance of self-reported questionnaires commonly used with PD patients to establish treatment prognosis. Thus, the purpose of this study is to evaluate the link between such questionnaires and the five factors of the TARS-PD.
Method Data was retrospectively retrieved from the clinical files of 174 participants with a PD (including 56% with borderline traits or PD), who were evaluated at the Centre de traitement le Faubourg Saint-Jean and completed the French version of the following questionnaires: Borderline Symptom List (BSL-23), Brief Version of the Pathological Narcissism Inventory (B-PNI), Interpersonal Reactivity Index (IRI), Buss-Perry Aggression Questionnaire (BPAQ), Barratt Impulsiveness Scale (BIS-11), Social Functioning Questionnaire (SFQ), Self and Interpersonal Functioning Scale (SIFS) and Personality Inventory for DSM-5- Faceted Brief Form (PID-5-FBF). The TARS-PD was completed by well-trained psychologists specialized in PD treatment. Descriptive analyses and regression between self-reported questionnaires and the five factors of the TARS-PD as well as its total score were performed to determine which variables from the self-reported questionnaires completed by the individuals contribute most strongly to the statistical prediction of the variables of the TARS-PD rated by the clinicians.
Results The subscales that significantly contribute to the Pathological Narcissism factor (adjusted R2=0,12) are: Empathy (SIFS), Impulsivity (negatively; PID-5), and Entitlement Rage (B-PNI). The subscales associated with the Antisociality/Psychopathy factor (adjusted R2=0,24) are Manipulativeness, Submissiveness (negatively), and Callousness from the PID-5, and Empathic Concern (IRI). The scales contributing substantially to the Secondary gains factor (adjusted R2=0,20) are Frequency (SFQ), Anger (negatively; BPAQ), Fantasy (negatively) and Empathic Concern (IRI), Rigid Perfectionism (negatively) and Unusual Beliefs and Experiences (PID-5). Low motivation (adjusted R2=0,10) is significantly explained by Total BSL score (negatively) and Satisfaction (SFQ) subscale. Finally, the subscales significantly associated to Cluster A features (adjusted R2=0,09) are Intimacy (SIFS) and Submissiveness (negatively, PID-5).
Conclusion Some scales from self-reported questionnaires demonstrated modest but significant associations with TARS-PD factors. Those scales might be useful in the scoring of the TARS-PD and provide additional information for patients’ clinical orientation.
Keywords:
- personality disorder,
- prognosis,
- dropout,
- psychotherapy,
- self-report questionnaires
Parties annexes
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