scholarly journals Effectiveness and safety of the adjunctive use of an internet-based self-management intervention for borderline personality disorder in addition to care as usual: results from a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e047771
Author(s):  
Jan Philipp Klein ◽  
Andrea Hauer-von Mauschwitz ◽  
Thomas Berger ◽  
Eva Fassbinder ◽  
Johannes Mayer ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Primary Outcome ◽  
Psychiatric Treatment ◽  
Borderline Personality ◽  
Self Management ◽  
Control Group ◽  
Group Effect ◽  
Management Intervention ◽  
Randomised Controlled

ImportanceBorderline personality disorder (BPD) is a severe mental disorder that is often inadequately treated.ObjectiveTo determine if adding a self-management intervention to care as usual (CAU) is effective and safe.DesignRandomised, controlled, rater-blind trial. Duration of treatment and assessments: 12 months.SettingSecondary care, recruited mainly via the internet.ParticipantsPatients with BPD and BPD Severity Index (BPDSI) of at least 15.InterventionsCAU by treating psychiatrist and/or psychotherapist alone or adjunctive use of an internet-based self-management intervention that is based on schema therapy (priovi).Main outcome measureOutcomes were assessed by trained raters. The primary outcome was change in BPDSI. The safety outcome was the number of serious adverse events (SAEs). The primary outcome time point was 12 months after randomisation.ResultsOf 383 participants assessed for eligibility, 204 were included (91.7% female, mean age: 32.4 years; 74% were in psychotherapy and 26% were in psychiatric treatment). The slope of BPDSI change did not differ significantly between groups from baseline to 12 months (F3,248= 1.857, p=0.14). At 12 months, the within-group effect sizes were d=1.38 (95% CI 1.07 to 1.68) for the intervention group and d=1.02 (95% CI 0.73 to 1.31) for the control group. The between-group effect size was d=0.27 (95% CI 0.00 to 0.55) in the intention-to-treat sample and d=0.39 (95% CI 0.09 to 0.68) for those who used the intervention for at least 3 hours (per-protocol sample). We found no significant differences in SAEs.ConclusionsWe have not found a significant effect in favour of the intervention. This might be due to the unexpectedly large effect in the group receiving CAU by a psychiatrist and/or psychotherapist alone.Trial registrationNCT03418142.

scholarly journals Hypothalamic-pituitary-adrenal axis response in borderline personality disorder without post-traumatic features

2007 ◽  
Vol 190 (4) ◽  
pp. 357-358 ◽  
Author(s):  
Jose L. Carrasco ◽  
Marina Díaz-Marsá ◽  
Jose I. Pastrana ◽  
Rosa Molina ◽  
Loreto Brotons ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Feedback Inhibition ◽  
Borderline Personality ◽  
Dexamethasone Suppression Test ◽  
Control Group ◽  
Hypothalamic Pituitary Adrenal ◽  
Suppression Test ◽  
Post Traumatic ◽  
Dexamethasone Suppression

SummaryHypothalamic–pituitary–adrenal (HPA) axis sensitivity was investigated in 32 non-medicated patients with borderline personality disorder without comorbid post-traumatic syndromes and in 18 normal individuals using a modified dexamethasone suppression test (0.25 mg). Enhanced cortisol suppression was found in the patients v. controls (P < 0.05) and the percentage of participant's with non-suppression was smaller in the patient (34%) than in the control group (89%) (P < 0.01). Baseline cortisol levels in the patients were also lower than in the controls (P < 0.05). The 0.25 mg dexamethasone suppression test reveals increased feedback inhibition of the HPA in borderline personality disorder.

Telehealth Treatment of Patients With Borderline Personality Disorder in a Partial Hospital Setting During the COVID-19 Pandemic: Comparative Safety, Patient Satisfaction, and Effectiveness of In-Person Treatment

2021 ◽  
pp. 1-19
Author(s):  
Mark Zimmerman ◽  
Madeline Ward ◽  
Catherine D'Avanzato ◽  
Julianne Wilner Tirpak
Keyword(s):  
Patient Satisfaction ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychiatric Treatment ◽  
Well Being ◽  
Borderline Personality ◽  
Hospital Treatment ◽  
Level Of Care ◽  
Hospital Level ◽  
Partial Hospital

There are no studies of the safety and effectiveness of telehealth psychiatric treatment of partial hospital level of care, in general, and for borderline personality disorder (BPD) in particular. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, the authors compared the effectiveness of their partial hospital treatment program in treating patients with BPD. For both the in-person and telehealth partial hospital level of care, patients with BPD were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups reported a significant improvement in functioning, coping ability, positive mental health, and general well-being. A large effect size of treatment was found in both treatment groups. No patients attempted suicide. Telehealth partial hospital treatment was as effective as in-person treatment in terms of patient satisfaction, symptom reduction, and improved functioning and well-being for patients with BPD.

When Trust Does Not Come Easily: Negative Emotional Information Unduly Influences Trustworthiness Appraisals for Individuals With Borderline Personality Features

2020 ◽  
Vol 34 (3) ◽  
pp. 394-409 ◽  
Author(s):  
Sara R. Masland ◽  
Jill M. Hooley
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Control Group ◽  
Undue Influence ◽  
Emotional Information ◽  
Consistent Finding ◽  
Emotional Context ◽  
State Dependent ◽  
Personality Features

Individuals with borderline personality disorder and subclinical borderline features perceive others as untrustworthy (e.g., Fertuck, Grinband, & Stanley, 2013). Trust difficulties may be influenced by emotional state and are formally articulated in the diagnostic criteria for the disorder as temporary state-dependent paranoia. The current study examines the influence of emotional information on trustworthiness appraisals. Seventy-seven community adults, ranging in age from 18 to 70 (M = 31.53, SD = 14.01), with three or more borderline personality disorder symptoms (n = 30) or two or fewer symptoms (n = 47), completed an affective priming paradigm. They were exposed to negative, neutral, or positive information before rating the trustworthiness of unfamiliar faces. Individuals with borderline pathology made more untrusting appraisals regardless of prime, and they were more greatly influenced by negative primes relative to the control group. Findings suggest that biased trustworthiness appraisal is a replicable and consistent finding for individuals with borderline pathology, and that emotional context, even if unrelated to the appraisal at hand, has undue influence.

scholarly journals Day hospital versus intensive out-patient mentalisation-based treatment for borderline personality disorder: multicentre randomised clinical trial

2019 ◽  
Vol 216 (2) ◽  
pp. 79-84 ◽  
Author(s):  
Maaike L. Smits ◽  
Dine J. Feenstra ◽  
Hester V. Eeren ◽  
Dawn L. Bales ◽  
Elisabeth M. P. Laurenssen ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Borderline Personality ◽  
Treatment Intensity ◽  
Day Hospital ◽  
Secondary Outcomes

BackgroundTwo types of mentalisation-based treatment (MBT) have been developed and empirically evaluated for borderline personality disorder (BPD): day hospital MBT (MBT-DH) and intensive out-patient MBT (MBT-IOP). No trial has yet compared their efficacy.AimsTo compare the efficacy of MBT-DH and MBT-IOP 18 months after start of treatment. MBT-DH was hypothesised to be superior to MBT-IOP because of its higher treatment intensity.MethodIn a multicentre randomised controlled trial (Nederlands Trial Register: NTR2292) conducted at three sites in the Netherlands, patients with BPD were randomly assigned to MBT-DH (n = 70) or MBT-IOP (n = 44). The primary outcome was symptom severity (Brief Symptom Inventory). Secondary outcome measures included borderline symptomatology, personality functioning, interpersonal functioning, quality of life and self-harm. Patients were assessed every 6 months from baseline to 18 months after start of treatment. Data were analysed using multilevel modelling based on intention-to-treat principles.ResultsSignificant improvements were found on all outcome measures, with moderate to very large effect sizes for both groups. MBT-DH was not superior to MBT-IOP on the primary outcome measure, but MBT-DH showed a clear tendency towards superiority on secondary outcomes.ConclusionsAlthough MBT-DH was not superior to MBT-IOP on the primary outcome measure despite its greater treatment intensity, MBT-DH showed a tendency to be more effective on secondary outcomes, particularly in terms of relational functioning. Patients receiving MBT-DH and MBT-IOP, thus, seem to follow different trajectories of change, which may have important implications for clinical decision-making. Longer-term follow-up and cost-effectiveness considerations may ultimately determine the optimal intensity of specialised treatments such as MBT for patients with BPD.

A retrospective chart review: adolescents with borderline personality disorder, borderline personality traits, and controls

2016 ◽  
Vol 30 (2) ◽  
Author(s):  
Ellen N. Jopling ◽  
Sarosh Khalid-Khan ◽  
Shivani F. Chandrakumar ◽  
Shira C. Segal
Keyword(s):  
Mental Health ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mortality Rate ◽  
Chart Review ◽  
Adult Population ◽  
Retrospective Chart Review ◽  
Borderline Personality ◽  
Control Group ◽  
Disruptive Disorders

Abstract With an estimated lifetime prevalence as high as 5.9% in the general population, borderline personality disorder (BPD) is a psychiatric disorder characterized by marked impulsivity as well as difficulties in interpersonal relationships, self-image, and affects. The burden on the health care system is immense with BPD patients accounting for 10%–20% of the patients in mental health outpatient facilities and 15%–40% in mental health inpatient facilities. Further, while 75%–80% of BPD patients attempt to commit suicide, 10% succeed; this mortality rate exceeds even that of anorexia nervosa which, with a weighted mortality rate of 5.1%, has often been considered to have the highest mortality rate of any mental disorder. In order to provide treatment and to implement preventative measures, a risk profile as well as clinical features must be identified within the adolescent population. This is presently crucial, as the current criteria for BPD are not developmentally focused, and as a result, criteria initially developed for the adult population are being applied in diagnoses of adolescents. A population of adolescents (n=80) between 16 and 19 years of age meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria either for BPD traits (n=46) or for BPD (n=36) were included in a retrospective chart review; a control group consisting of n=30 mood and anxiety control subjects were included to allow for further comparisons. Complex significant differences were discovered between the three groups in the following areas: history of sexual abuse, suicidal ideation, internalizing/externalizing symptoms, interpersonal difficulties, impulsivity, pre-perinatal stress, bullying, substance abuse, anxiety disorders, disruptive disorders, and finally, learning disorders.

scholarly journals Mentalizing Based on External Features in Borderline Personality Disorder Compared With Healthy Controls: The Role of Attachment Dimensions and Childhood Trauma

2019 ◽  
Vol 33 (6) ◽  
pp. 736-750 ◽  
Author(s):  
Martijn Van Heel ◽  
Patrick Luyten ◽  
Celine De Meulemeester ◽  
Dominique Vanwalleghem ◽  
Rudi Vermote ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Childhood Trauma ◽  
Mental States ◽  
Borderline Personality ◽  
Control Group ◽  
Healthy Controls ◽  
Avoidant Attachment ◽  
The Mind ◽  
Attachment Dimensions

Extant research suggests that borderline personality disorder (BPD) is associated with impairments in mentalizing, that is, comprehending behavior in terms of underlying mental states. However, the precise nature of these impairments remains unclear. The literature is mixed concerning mental-izing based on external features of others, and specifically facial emotion recognition (FER) in BPD patients. This study investigated FER differences in 79 BPD patients and 79 matched healthy controls using the Reading the Mind in the Eyes Test (RMET). The authors also investigated attachment dimensions and childhood trauma in relation to mentalizing based on external features. Results showed that BPD patients performed worse on positive and negative emotions. Furthermore, avoidant attachment was negatively related to FER for neutral emotions, particularly in the control group. Trauma was negatively related to FER at trend level, particularly in BPD patients. The implications for this understanding of mentalizing based on external features in BPD are discussed.

scholarly journals Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial

2010 ◽  
Vol 196 (5) ◽  
pp. 389-395 ◽  
Author(s):  
Stephan Doering ◽  
Susanne Hörz ◽  
Michael Rentrop ◽  
Melitta Fischer-Kern ◽  
Peter Schuster ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Randomised Controlled Trial ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Controlled Trial ◽  
Borderline Personality ◽  
Patient Treatment ◽  
Significant Group ◽  
Randomised Controlled ◽  
Transference Focused Psychotherapy

BackgroundTransference-focused psychotherapy is a manualised treatment for borderline personality disorder.AimsTo compare transference-focused psychotherapy with treatment by experienced community psychotherapists.MethodIn a randomised controlled trial (NCT00714311) 104 female out-patients were treated for 1 year with either transference-focused psychotherapy or by an experienced community psychotherapist.ResultsSignificantly fewer participants dropped out of the transference-focused psychotherapy group (38.5% v. 67.3%) and also significantly fewer attempted suicide (d = 0.8, P = 0.009). Transference-focused psychotherapy was significantly superior in the domains of borderline symptomatology (d = 1.6, P = 0.001), psychosocial functioning (d = 1.0, P = 0.002), personality organisation (d = 1.0, P = 0.001) and psychiatric in-patient admissions (d = 0.5, P = 0.001). Both groups improved significantly in the domains of depression and anxiety and the transference-focused psychotherapy group in general psychopathology, all without significant group differences (d = 0.3–0.5). Self-harming behaviour did not change in either group.ConclusionsTransference-focused psychotherapy is more efficacious than treatment by experienced community psychotherapists in the domains of borderline symptomatology, psychosocial functioning, and personality organisation. Moreover, there is preliminary evidence for a superiority in the reduction of suicidality and need for psychiatric in-patient treatment.

Facial emotional expression in reaction to social exclusion in borderline personality disorder

2011 ◽  
Vol 41 (9) ◽  
pp. 1929-1938 ◽  
Author(s):  
K. Staebler ◽  
B. Renneberg ◽  
M. Stopsack ◽  
P. Fiedler ◽  
M. Weiler ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Social Exclusion ◽  
Social Contexts ◽  
Emotional Reactions ◽  
Borderline Personality ◽  
Emotional Expressions ◽  
Control Group ◽  
Coding System ◽  
Emotional Facial Expressions

BackgroundDisturbances in social interaction are a defining feature of patients with borderline personality disorder (BPD). In this study, facial emotional expressions, which are crucial for adaptive interactions in social contexts, were assessed in patients with BPD in response to social exclusion.MethodWe examined facial emotional reactions of 35 patients with BPD and 33 healthy controls when playing Cyberball, a virtual ball-tossing game that reliably induces social exclusion. Besides self-reported emotional responses, facial emotional expressions were analyzed by applying the Emotional Facial Action Coding System (EMFACS).ResultsPatients with BPD showed a biased perception of participation. They more readily reported feeling excluded compared to controls even when they were included. In BPD, social exclusion led to an increase in self-reported other-focused negative emotions. Overall, EMFACS analyses revealed that BPD patients reacted with fewer positive expressions and with significantly more mixed emotional expressions (two emotional facial expressions at the same time) compared to the healthy control group when excluded.ConclusionsBesides a negative bias for perceived social participation, ambiguous facial emotional expressions may play an important role in the disturbed relatedness in patients with BPD.

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