The effectiveness of individual schema therapy in older adults with borderline personality disorder: Protocol of a multiple-baseline study.

D.A Khasho,S.M.J Heijnen-Kohl,S.P.J Van Alphen,M.A Ouwens,A.C Videler,A Arntz

doi:10.1016/j.conctc.2019.100330

Abstract

BackgroundThe treatment of borderline personality disorder (BPD) has been examined extensively in adults up to the age of fifty in the past quarter of a century, but there is still a world to discover in treating BPD in older adults. The aim of the study is to investigate the effectiveness of schema therapy in older adults with BPD.Methods/designA multiple baseline design is used in which participants are randomly assigned to baseline length. The primary outcome measure is assessed weekly and consists of the credibility of negative core beliefs. Secondary outcome measures are quality of life, psychological distress, early maladaptive schemas, schema modes, severity of BPD symptoms and meeting the criteria for BPD. Ten older adults (age > 60 years) with BPD are treated with schema therapy, with weekly sessions during one year. This treatment phase is preceded by a baseline phase varying from 4 to 8 weeks. After treatment, there is a 6-month follow-up phase with monthly booster sessions.DiscussionTo our knowledge, this is the first empirical study of the effectiveness of psychotherapeutic treatment for BPD in older adults. Because of the different manifestation of BPD in later life, besides section II DSM-5 criteria, the alternative, dimensional model for personality disorders of DSM-5 is used to assess BPD in older adults.Trial registrationThe Netherlands National Trial Register NTR7107. Registered 11 March 2018.

Highlights

Borderline personality disorder (BPD) is a lifelong pattern of instability in interpersonal relationships, self-image, and affect [1]
The prevalence can be lower, there is still a substantial group of older adults that meet the criteria for borderline personality disorder (BPD), and core features of BPD, especially emotional dysregulation and disturbed interpersonal relationships persist into old age [4]
The aim of the current study is to investigate whether Schema therapy (ST) can be an effective treatment for older adults with BPD

Summary

Introduction

Borderline personality disorder (BPD) is a lifelong pattern of instability in interpersonal relationships, self-image, and affect [1]. The prevalence can be lower, there is still a substantial group of older adults that meet the criteria for BPD, and core features of BPD, especially emotional dysregulation and disturbed interpersonal relationships persist into old age [4]. These BPD features are associated with psychosocial impairment in older adults [5]. The description of BPD-traits in the Diagnostic and Statistical Manual of Mental Disorders [2] might lead to an underestimation of the ‘true’ prevalence of BPD at older age This calls for a broader view on the behavioral expression of borderline pathology in older adults.

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