STEPPS in Correctional Settings

2016 ◽  
pp. 89-99
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Prison System ◽  
Treatment Programs ◽  
Disciplinary Infractions ◽  
The Us ◽  
Potential Problems ◽  
Correctional Systems ◽  
Correctional Settings ◽  
Self Harm

This chapter describes STEPPS in Iowa correctional systems and elsewhere, as well as the US federal prison system. The program was introduced to the Iowa correctional system in 2005; data show that it is effective in reducing symptoms specific to borderline personality disorder. In addition, STEPPS has been shown to boost mood, reduce disciplinary infractions, and reduce self-harm behaviors. The advantages over other BPD treatment programs in prison settings include the relatively short 20-week length of STEPPS, which is very important because offenders have varying sentence lengths and are transferred or released (or receive parole/probation status) without notice. The program is easily learned by therapists strapped for time, since corrections-based therapists have little time for extensive additional training and budgets are tight. The STEPPS manual can be used “as-is” in prisons and community corrections without extensive modifications. Last, the authors describe potential problems of implementing the program in prisons.

Emotion-Oriented Coping Style Predicts Self-Harm in Response to Acute Psychiatric Hospitalization

Crisis ◽  
2020 ◽  
pp. 1-7
Author(s):  
Jacqueline M. Frei ◽  
Vladimir Sazhin ◽  
Melissa Fick ◽  
Keong Yap
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychiatric Hospitalization ◽  
Coping Styles ◽  
Psychiatric Inpatients ◽  
Borderline Personality ◽  
Self Report ◽  
Therapeutic Interventions ◽  
Coping Behaviors ◽  
Self Harm

Abstract. Psychiatric hospitalization can cause significant distress for patients. Research has shown that to cope with the stress, patients sometimes resort to self-harm. Given the paucity of research on self-harm among psychiatric inpatients, a better understanding of transdiagnostic processes as predictors of self-harm during psychiatric hospitalization is needed. The current study examined whether coping styles predicted self-harm after controlling for commonly associated factors, such as age, gender, and borderline personality disorder. Participants were 72 patients (mean age = 39.32 years, SD = 12.29, 64% male) admitted for inpatient treatment at a public psychiatric hospital in Sydney, Australia. Participants completed self-report measures of coping styles and ward-specific coping behaviors, including self-harm, in relation to coping with the stress of acute hospitalization. Results showed that younger age, diagnosis of borderline personality disorder, and higher emotion-oriented coping were associated with self-harm. After controlling for age and borderline personality disorder, higher levels of emotion-oriented coping were found to be a significant predictor of self-harm. Findings were partially consistent with hypotheses; emotion-oriented but not avoidance-oriented coping significantly predicted self-harm. This finding may help to identify and provide psychiatric inpatients who are at risk of self-harm with appropriate therapeutic interventions.

Rumination in Borderline Personality Disorder: Meta-Analysis

2018 ◽  
Author(s):  
Mara J. Richman ◽  
Zsolt Unoka ◽  
Robert Dudas ◽  
Zsolt Demetrovics
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Emotion Dysregulation ◽  
Meta Analysis ◽  
Borderline Personality ◽  
Therapeutic Interventions ◽  
Sample Type ◽  
Moderator Variables ◽  
Analytic Review ◽  
Self Harm

Borderline personality disorder (BPD) is characterized by deficits in emotion regulation and affective liability. Of this domain, ruminative behaviors have been considered a core feature of emotion dysregulation difficulties. Despite this, inconsistencies have existed in the literature regarding which rumination type is most prominent in those with BPD symptoms. Moreover, no meta-analytic review has been performed to date on rumination in BPD. Taking this into consideration, a meta-analysis was performed to assess how BPD symptoms correlate with rumination, while also considering clinical moderator variables (i.e., BPD symptom domain, co-morbidities, GAF score) and demographic moderator variables (i.e., age, gender, sample type, and education level). Analysis of correlation across rumination domains for the entire sample revealed a medium overall correlation between BPD symptoms and rumination. When assessing types of rumination, the largest correlation was among pain rumination followed by anger, depressive, and anxious rumination. Among BPD symptom domain, affective instability had the strongest correlation with increased rumination, followed by unstable relationships, identity disturbance, and self-harm/ impulsivity, respectively. Demographic variables showed no significance. Clinical implications are considered and further therapeutic interventions are discussed in the context of rumination.

Evaluation of a novel risk assessment method for self-harm associated with Borderline Personality Disorder

2017 ◽  
Vol 25 (5) ◽  
pp. 460-465 ◽  
Author(s):  
Sathya Rao ◽  
Jillian H Broadbear ◽  
Katherine Thompson ◽  
Anna Correia ◽  
Martin Preston ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Case Vignette ◽  
Management Options ◽  
Specific Risk ◽  
Self Harm ◽  
Chronic Risk

Objectives: Borderline personality disorder (BPD) is associated with frequent self-harm and suicidal behaviours. This study compared physician-assessed self-harm risk and intervention choice according to a (i) standard risk assessment and (ii) BPD-specific risk assessment methods. Methods: Forty-five junior and senior mental health physicians were assigned to standard or BPD-specific risk training groups. The assessment utilized a BPD case vignette containing four scenarios describing high/low lethality self-harm and chronic/new patterns of self-harm behaviour. Participants chose from among four interventions, each corresponding to a risk category. Results: Standard and BPD-specific groups were alike in their assessment of self-harm risk. Divergence occurred on intervention choice for assessments of low lethality, chronic risk ( p<.01) and high lethality, chronic risk ( p<.005). Overall, psychiatrists were more likely than their junior colleagues to correctly assess risk and management options. Conclusions: Although standard and BPD-specific methods are well aligned for assessing self harm-associated risk, BPD-specific training raised awareness of BPD-appropriate interventions, particularly in the context of chronic patterns of self-harm behaviour. Wider dissemination of BPD-specific risk training may enhance the confidence of mental health clinicians in identifying the nature of self-harm risk as well as the most clinically appropriate interventions for clients with BPD.

Part 2: Borderline Personality Disorder and Its Clinical Management

2017 ◽  
Author(s):  
Robert Biskin ◽  
Joel Paris
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Behavior Therapy ◽  
Dialectical Behavior Therapy ◽  
Service Use ◽  
Age Groups ◽  
Borderline Personality ◽  
Stepped Care ◽  
Care Models ◽  
Self Harm

The treatment of patients with borderline personality disorder (BPD) has changed significantly over the past 25 years. The previous therapeutic pessimism about BPD treatment outcomes has become more optimistic with the development of a variety of specialized psychotherapies that have been shown to reduce self-harm, suicidality, and health service use as well as improve overall psychopathology. Dialectical behavior therapy was the first evidence-supported treatment, but it has been joined by mentalization-based psychotherapy and a variety of other treatments. Several common factors, including structured treatment approach, are likely important in the effectiveness of these treatments compared with unstructured comparators. Pharmacotherapy serves a more limited role in the treatment of BPD due to many methodological issues in the research and a lack of replication of studies. Judicious and rational use of pharmacotherapy is discussed, as well as suggestions for improving accessibility to specialized psychotherapies through the development of stepped care models. Improving access to care for patients with BPD, throughout all age groups, remains an important next step. This review contains 2 figures, 1 table, and 47 references. Key words: borderline personality disorder, dialectical behavior therapy, mentalization-based treatment, personality disorder, pharmacotherapy, psychotherapy, self-harm

Aggressive behavior and self-harm in Borderline Personality Disorder: The role of impulsivity and emotion dysregulation in a sample of outpatients

2017 ◽  
Vol 249 ◽  
pp. 321-326 ◽  
Author(s):  
Laura Terzi ◽  
Francesca Martino ◽  
Domenico Berardi ◽  
Biancamaria Bortolotti ◽  
Anna Sasdelli ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Aggressive Behavior ◽  
Emotion Dysregulation ◽  
Borderline Personality ◽  
Self Harm

Forensic Issues in Borderline Personality Disorder

2017 ◽  
Author(s):  
Alexander L. Chapman ◽  
André Ivanoff
Keyword(s):  
Mental Health ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Behavioral Problems ◽  
Mental Health Treatment ◽  
Clinical Care ◽  
Borderline Personality ◽  
Comprehensive Treatment ◽  
Psychopharmacological Treatment ◽  
Correctional Settings

Borderline personality disorder (BPD) is a severe, complex, and costly disorder requiring comprehensive treatment. Correctional settings commonly include mental health treatment and on-site mental health clinicians providing psychosocial and psychopharmacological treatment; however, the mandate of prison settings in particular often conflicts directly with providing clinical care to those with complex mental health needs. The necessary emphasis on security, safety, and, in some cases, retribution, can create invalidating environments that both elicit and reinforce the serious behavioral problems often observed among those with BPD, such as self-injury and suicidal behavior. When effective treatments are available, considerable challenges emerge with regard to the training and preparation of clinical staff to treat and line staff to manage inmates with BPD. This chapter discusses these and other issues and provides suggestions for continued work to better understand and treat individuals with BPD in forensic settings.

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