Borderline Personality Disorder Symptoms Research Articles

Effects of a residential psychoeducational parenting program on maternal anxiety and fatigue symptoms

ABSTRACT Aims To evaluate the effects of a 5-day residential psychoeducational program on maternal anxiety and fatigue symptoms among women admitted with their unsettled infants and determine the psychological, social and demographic characteristics which are associated with the effect sizes. Methods This is a secondary analysis of routinely collected data from mothers with children aged up to 24 months who were admitted to and completed the residential early parenting psychoeducational program at Masada Private Hospital Early Parenting Centre in Melbourne. Maternal anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale Three-item Anxiety subscale and maternal fatigue symptoms were the Modified Fatigue Assessment Scale at preadmission, predischarge and follow-up 6-weeks post discharge. Results Overall, 1220 admissions were included in analyses. Cohen’s d for reductions in the anxiety symptoms during the program was 0.64 (95% CI 0.59 to 0.70) and from pre-discharge to post-discharge was 0.14 (95% CI 0.09 to 01.9), and for fatigue was 1.21 (95% CI 1.11 to 1.32). Higher borderline personality disorder symptoms and experiencing more stressful life events were associated with lower mean reductions in anxiety and fatigue symptoms. Women with a history of mental health problems had lower anxiety symptom reductions. Women who were older or had younger babies had lower fatigue score reductions. Conclusion This study confirms the effectiveness of a 5-day residential early parenting psychoeducational program provided by a private sector facility in reducing postnatal anxiety and fatigue rapidly, with effects maintained to at least 6-weeks post-discharge.

Reliability and Mental Health Correlates of a Single-Item Measure of Self-Rated Mental Health (SRMH) in the Chinese Context.

The use of single-item measures of self-rated mental health (SRMH) has been increasingly valued in epidemiologic research. However, little is known about the reliability and mental health correlates of SRMH in Chinese populations. This study examined the reliability and mental health correlates of SRMH in three Chinese samples. We analyzed data collected from two convenience samples of Chinese adults from Hong Kong and/or Taiwan (Sample 1: N = 205; Sample 2: N = 377), and a random sample of Taiwan psychiatric inpatients (Sample 3: N = 100). Our results showed that the single-item measure of SRMH had moderate to good test-retest reliability (intraclass correlation [ICC] = 0.75) in Sample 1 and acceptable reliability between the self-report and interviewer-administered versions (ICC = 0.58) in Sample 3. It had a high positive correlation with self-esteem and a moderately high negative correlation with depression. It also had a consistently negative correlation with borderline personality disorder symptoms and post-traumatic stress disorder symptoms. The SRMH score was also associated with psychiatric service usage. These findings contribute to the body of knowledge regarding the use of a single-item measure of SRMH to assess overall self-perceived mental health in Chinese communities.

Comparison of the Effectiveness of Dialectical Behavior Therapy Skills Training (DBT-ST) and Mindfulness-Based Cognitive Therapy (MBCT) on Cognitive Emotion Regulation in Individuals with Symptoms of Borderline Personality Disorder

Objective: Borderline Personality Disorder (BPD) is the most common personality disorder in psychiatric settings and one of the disorders that causes the most harm to individuals. The aim of the present study was to compare the effectiveness of Dialectical Behavior Therapy Skills Training (DBT-ST) and Mindfulness-Based Cognitive Therapy (MBCT) on cognitive emotion regulation in individuals with symptoms of Borderline Personality Disorder. Methods and Materials: This research was a semi-experimental study, utilizing a pre-test, post-test design with a control group and a follow-up period. The statistical population included all clients aged 18 to 45 who referred to counseling centers in the city of Sari during the first half of 2022 and had files. From all these individuals, those willing to cooperate were selected through purposive non-random sampling, resulting in a sample of 45 participants. These individuals were then randomly assigned to three groups (Group 1: Dialectical Behavior Therapy Skills Training, n = 15; Group 2: Mindfulness-Based Cognitive Therapy, n = 15; and Group 3: Control group, n = 15). Data collection was conducted using the Cognitive Emotion Regulation Questionnaire by Garnefski et al. (2001). The Dialectical Behavior Therapy Skills Training group (2003) participated in 12 weekly 90-minute group sessions, and the Mindfulness-Based Cognitive Therapy group (2002) participated in 8 weekly 90-minute group sessions. Data were analyzed using repeated measures ANOVA. Findings: The results indicated that Dialectical Behavior Therapy Skills Training and Mindfulness-Based Cognitive Therapy were effective on cognitive emotion regulation in individuals with symptoms of Borderline Personality Disorder (P = 0.001). There was a significant difference in the effectiveness of Dialectical Behavior Therapy Skills Training and Mindfulness-Based Cognitive Therapy on cognitive emotion regulation between the experimental groups and the control group. Conclusion: Based on the results of this study, it can be concluded that Dialectical Behavior Therapy Skills Training and Mindfulness-Based Cognitive Therapy, through individuals' cognitive coping strategies, can lead to improvements in psychological indicators and enhancement of mental health in individuals with symptoms of Borderline Personality Disorder.

Clarifying the relation between mother and adolescent borderline personality disorder symptoms: The roles of maternal and adolescent emotion regulation and maladaptive maternal emotion socialization.

Despite evidence for the intergenerational transmission of borderline personality disorder (BPD) pathology from mothers to offspring, the factors underlying the relation between mother and child BPD symptoms remain unclear and little is known about the pathways through which maternal BPD symptoms may relate to BPD symptoms in their offspring. One set of factors that warrants consideration in this regard is mother and child emotion regulation (ER) difficulties. In particular, theory and research suggest an indirect relation between mother and child BPD symptoms through maternal ER difficulties (and related maladaptive emotion socialization strategies) and, subsequently, child ER difficulties. Thus, this study used structural equation modeling to examine a model wherein maternal BPD symptoms relate to offspring BPD symptoms in adolescence through maternal ER difficulties (and maladaptive maternal emotion socialization strategies) and, subsequently, adolescent ER difficulties. A nationwide community sample of 200 mother-adolescent dyads completed an online study. Results provided support for the proposed model, revealing both a direct relation between maternal and adolescent BPD symptoms and two indirect relations through (a) maternal and adolescent ER difficulties and (b) maternal ER difficulties, maternal maladaptive emotion socialization strategies, and adolescent ER difficulties. Results highlight the relevance of both mother and adolescent ER difficulties in the relation between mother and offspring BPD pathology, as well as the potential clinical utility of targeting mother and child ER in interventions aimed at preventing the intergenerational transmission of BPD pathology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effectiveness of an Integrative Psychotherapy Program in Reducing the Symptoms of Borderline Personality Disorder

The Effectiveness of an Integrative Psychotherapy Program in Reducing the Symptoms of Borderline Personality Disorder

Supplemental Material for Associations Between Borderline Personality Disorder Symptoms and Personality Functioning in Adolescents: A Brief Report

Supplemental Material for Associations Between Borderline Personality Disorder Symptoms and Personality Functioning in Adolescents: A Brief Report

Intensive Exposure Therapy for an Individual With History of Self-Harm and Suicidality

Practitioners may hesitate to treat patients with a history of nonsuicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs) using exposure therapy due to concerns that exposures will increase these risk-related behaviors. However, when NSSI/STBs are exacerbated by distress associated with anxiety disorders or obsessive-compulsive disorder (OCD), lack of treatment can worsen disability. This case report describes the treatment of a 14-year-old gender-fluid individual with symptoms of multiple anxiety disorders, OCD, and borderline personality disorder (including emotion dysregulation, chronic suicidality, and NSSI). Treatment involved dialectical behavioral therapy (DBT) for “stage one” of treatment, including maintaining behavioral control over self-harm and suicidal behaviors, followed by intensive exposure and response prevention (ERP) during “stage two” of treatment. Upon discharge, the client had maintained an absence of NSSI/STBs, demonstrated reductions in anxiety and OC symptoms, observed further decreased familial accommodation, and improved daily functioning. In addition, the client’s parents exhibited an improved capacity to regulate their own emotions (before responding to the client), more validating responses, and reduction in familial accommodation. This case report supports the feasibility, efficacy, and safety of exposure therapy for individuals in “stage two” of DBT and highlights the role of exposure as an important emotion regulation strategy to reduce OCD and anxiety symptoms in patients with a history of self-harm and suicidality. Challenges, successes, and future directions are discussed.

Empathic accuracy of romantic partner negative affect is influenced by borderline personality symptoms.

The present study sought to examine the relation between borderline personality disorder (BPD) symptoms and empathic accuracy while improving on prior methodologies by using daily affect assessment in romantic partners. BPD symptoms were assessed in both members of 81 community couples who also reported on their own and their partner's negative and positive affect daily for 3 weeks. Data were analyzed using the Truth and Bias Model of Judgment, which allows the source of empathic accuracy to be parsed into partner affect (truth) and own affect (bias). Results provided evidence that individuals with higher BPD symptoms exhibited increased empathic accuracy for a partner's negative affect, particularly when partners also had higher BPD symptoms. The source of this accuracy stemmed more from bias forces than truth forces, indicating that participants' own affective states lead to more accurate judgments of partner affective state. The results suggest that this bias reduced the general tendency among participants to underestimate partner negative affect, thus leading to higher empathic accuracy. Overall, our results extend and provide support for previous research indicating that BPD symptoms are associated with heightened, not diminished, empathic accuracy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Клинические особенности пограничного личностного расстройства у подростков

Aim. Identification of the features of primary and comorbid signs of borderline personality disorder (BPD) in teenagers. Design. Open-label cohort study. Materials and methods. A pilot clinical evaluation was performed for a full cohort of teenagers admitted to psychiatric in-patient clinic in 2021–2022, the condition of which corresponded to the International Classification of Diseases, revision 11, BPD criteria. The study included 74 teenagers aged 11–17 years old, of which 72 were females. The mean age was 16.6 years old. Results. All 74 patients had comorbid disorders; complex comorbidities were observed in 31 (41.9%) patients. Forty-seven (63.5%) patients had a history of bullying. Anxiety and post-stress disorders preceded clinical manifestations of the BPD symptoms in 64 (86.5%) cases. Self-harm and attempted suicide were recorded in 58 (78.4%) patients; problems with self-identification, including gender preferences, were observed in 56 (75.7%) patients, problems with interpersonal relationships — in 64 (86.5%) patients, and dissociative symptoms — in 41 (55.4%) patients. Multiple personality disorder identification as “we”, “multiple personalities”) was observed in 12 (16.2%) cases. Clinically significant signs of various eating disorders were diagnosed in 16 (21.6%) patients. After being treated in an in-patient clinic, 65 (87.8%) teenagers demonstrated significant improvement. Most challenging was the management of patients with substantial dissociative symptoms, persistent “gender identity disorder” and trends to use abnormal psychological defence mechanisms. Conclusion. Interim data show that manifestation of symptoms and comorbidities, as well as a short-term response to therapy in teenagers differ from those in adults with BPD, favouring BPD with adolescent onset as a relatively separate sub-type and justifying a dimensional approach for the search and optimisation of early therapeutic interventions in teenagers with BPD. Keywords: borderline personality disorder, teenagers, comorbidity, psychiatric disorders, International Classification of Diseases, revision 11 (ICD-11).

The biosocial correlates and predictors of emotion dysregulation in autistic adults compared to borderline personality disorder and nonclinical controls

BackgroundEmotion dysregulation (ED) is a core symptom of borderline personality disorder (BPD), whose aetiology has been attributed to biosocial factors. In autism spectrum condition (ASC), although ED is prevalent and is associated with decreased well-being (e.g. self-harm, suicidality), it has been understudied, especially in adults. It is therefore crucial to further understand ED in autistic adults to improve its treatment. Our study investigates ED, its behavioural correlates (e.g. self-harm, suicidality) and biosocial predictors in autistic adults relative to BPD and nonclinical controls (NC).MethodsA total of 724 participants (ASC = 154; BPD = 111; NC = 459) completed 11 self-reported questionnaires assessing ED, ASC and BPD traits, co-occurring disorders, alexithymia, emotional vulnerability and invalidating experiences (e.g. bullying, autistic camouflaging). The occurrence of ED behavioural correlates (i.e. self-harm, history of suicide attempts, and psychiatric hospitalizations) was collected. In addition, between-groups analyses, linear regressions and machine learning (ML) models were used to identify ED predictors in each group.ResultsED and its behavioural correlates were higher in ASC compared to NC, but milder than in BPD. While gender did not predict ED scores, autistic women had increased risk factors to ED, including sexual abuse and camouflaging. Interestingly, BPD traits, emotional vulnerability and alexithymia strongly predicted ED scores across the groups. Using ML models, sensory sensitivity and autistic camouflaging were associated with ED in ASC, and ADHD symptoms with ED in BPD.LimitationsASC and BPD diagnoses were self-reported, which did not allow us to check their accuracy. Additionally, we did not explore the transactional and the moderating/mediating relationships between the different variables. Moreover, our research is cross-sectional and cannot draw conclusions regarding the direction and causality of relationships between ED and other clinical dimensions.ConclusionsED and its behavioural correlates are heightened in BPD compared to ASC and nonclinical controls. In the ASC group, there were no gender differences in ED, despite the heightened exposure of autistic women to ED risk factors. BPD traits, emotional vulnerability, and alexithymia are core to ED regardless of diagnosis. Although less central, sensory sensitivity and autistic camouflaging seem to be specific predictors of ED in autistic adults.

Childhood maltreatment, dissociation and borderline personality disorder: Preliminary data on the mediational role of mentalizing in complex post-traumatic stress disorder.

Treatments for borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) are less effective for patients with co-occurring symptoms of both disorders, who are considered to have complex PTSD (cPTSD), compared with patients with either condition alone. Evidence suggests that co-occurrence of symptoms indicates greater impairment in mentalizing. This study examines evidence for targeting mentalizing when treating individuals with co-occurring symptoms, irrespective of their exposure to developmental trauma and, for the first time, investigates the mediational role of mentalizing in the associations between BPD symptomatology and cPTSD. We identified in a routine clinical service a group of patients with BPD, with or without co-occurring symptoms of PTSD. We hypothesized that patients with co-occurring symptoms and a history of childhood maltreatment will show more severe clinical profiles and greater mentalizing problems, which in turn lead to symptoms consistent with cPTSD. Clinical profiles of 72 patients with BPD (43 with and 29 without co-occurring symptoms of PTSD; mean age in both groups 28 years, 79% and 83% female, respectively) were identified using the Structured Clinical Interview for DSM-IV Axis II Disorders. Patients completed self-report measures of BPD and PTSD symptoms, well-being, dissociation and reflective functioning. Childhood trauma histories were evaluated. Compared with patients with BPD-only, those with co-occurring BPD and PTSD showed greater severity in terms of BPD and dissociative symptoms, met a broader range of BPD diagnostic criteria, had a greater sense of personal worthlessness and self-evaluated their well-being as considerably diminished. This group was also more inclined to recall increased instances of childhood sexual abuse. In a mediation analysis, mentalizing acted as a partial mediator for the relationship between BPD severity and cPTSD, as well as between dissociative symptoms and cPTSD. Interestingly, mentalizing did not mediate the relationship between childhood sexual abuse and cPTSD. Overall, the correlational findings are consistent with an intended focus on mentalizing to treat cPTSD symptoms in individuals who also meet criteria for a diagnosis of BPD.

Experiences of consumers, carers and clinicians during borderline personality disorder presentations to the emergency department-An integrative review.

People with a borderline personality disorder (BPD) diagnosis or symptoms may experience emotional crises which necessitate use of the emergency department (ED). No existing reviews focus specifically on experiences of consumersa, carersb and clinicians in relation to ED presentations by people diagnosed with BPD. The aim of this study was to synthesise knowledge on consumer, carer and clinician experiences of BPD in the ED. An integrative review methodology was chosen as it best captures the complexity of varied perspectives and emergent phenomena from diverse literature sources. EMBASE, CINAHL, PsycInfo and Medline were searched for papers published before 16 February 2022. Nine papers met the inclusion criteria (five qualitative, one quantitative, one mixed methods and two letters to the editor). Key themes were barriers to timely and adequate care, and stigmatising attitudes and practices towards people diagnosed with BPD. Negative attitudes were perceived to perpetuate harmful outcomes and further ED visits. Predominantly negative ED experiences were expressed by clinicians, consumers and carers. Further work is needed in ED models of care and staff education to improve the experience of care for consumers, carers and clinicians alike. Opportunities for change will exist through co-designed innovation, education, advocacy and leadership.

ICD-11 complex posttraumatic stress disorder and subclasses of borderline personality disorder in a South Korean adult population with childhood abuse experiences: a latent class analysis

BackgroundComplex posttraumatic stress disorder (CPTSD) and borderline personality disorder (BPD), which are distinctive diagnoses, share the common risk factor of childhood abuse experiences. However, additional evidence is needed to determine which factors contribute to the manifestation of different symptoms.MethodParticipants were 499 South Korean early and midlife adults with primarily college level education who reported experiences of childhood abuse. They were enrolled from an online panel using a stratified sampling considering gender, age, and residence information. A latent class analysis (LCA) was conducted to identify the patterns of CPTSD and BPD symptoms. We adopted a three-step LCA to compare types of childhood abuse, invalidating environments, attachment styles, and pathological personality traits among different classes.ResultsThe LCA revealed four classes. Class 1 showed the highest scores in all symptoms and risk factors. Class 2 was distinguished from Class 3 by the externalizing versus internalizing associated pathological personality traits. Class 3 experienced high emotional neglect in addition to other types of abuse and it also showed an additional avoidant attachment style. Class 4 showed low symptomatology.ConclusionClass 1 was named as a CPTSD and BPD “comorbid” class, Class 2 as an “externalizing BPD” class, Class 3 as an “avoidant BPD” class, and Class 4 as a “low symptom” class. Childhood abuse may heighten the risk for high comorbidity of CPTSD and BPD as well as externalizing-internalizing subgroups of BPD. Beyond the identification of CPTSD and BPD, assessing attachment styles and pathological personality traits based on dimensional approaches would benefit the tailoring of effective treatment.

Online psychoeducation and digital assessments as a first step of treatment for borderline personality disorder: A protocol for a pilot randomized controlled trial

Background Treatment trials for borderline personality disorder (BPD) have consistently demonstrated that approaches that are diagnostically tailored are superior to those which are not. Currently, gold standard treatments for BPD are highly intensive, lengthy, and specialized, leading to a critical gap between the supply and demand of effective, evidence-based treatment for patients who receive a diagnosis of BPD. Psychoeducation, which is a common component of most treatments known to be effective, is a low-cost, low-burden intervention proven to relieve symptoms. The present study builds on psychoeducation research, assessing online video prescriptions as a means of disseminating information patients need to know about their diagnosis and care. Methods This article presents the study protocol for a safety, feasibility, and preliminary efficacy trial of psychoeducational video prescriptions and online assessment with feedback for newly diagnosed individuals with BPD. We aim to recruit 100 adults recently diagnosed with BPD to be randomly assigned to receive videos about BPD or videos about non-BPD mental health topics that are matched in length in the first step of the study. All participants will complete daily surveys about their emotions, interpersonal interactions, and behaviors, as well as self-report assessments and cognitive tests at 4 different time points. Half of the participants in the intervention group will receive feedback on their symptom ratings and cognitive test performance to assess whether there is incremental value in tailoring this online set of interventions with individualized feedback unique to each participant. This study aims to assess the effects of BPD-focused psychoeducational videos with and without personalized feedback, on BPD and depressive symptom severity as well as core mechanisms of the disorder such as loneliness, rejection sensitivity, cognitive control difficulties, and self-clarity. Results will inform efforts to progress to a larger, more definitive trial. Trial registration Clinical trials registration: The protocol is registered with ClinicalTrials.gov NCT05358925.

Systems Training for Emotional Predictability and Problem Solving for older adults with borderline personality disorder symptoms

Objective:Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a 20-week group treatment program for patients with borderline personality disorders (BPD). STEPPS is an evidence-based treatment to reduce BPD symptoms. However, the mean age of patients studied thus far is 33 years. Studies evaluating STEPPS in older adults are lacking. Aim of this study was to investigate the feasibility of STEPPS in older adults with BPD symptoms.Method:A naturalistic, pre- vs post-treatment pilot study design. Twenty-four patients (mean age 64 years) completed the Dutch version of the STEPPS program. Primary outcome was BPD symptoms and secondary outcome was psychological distress and maladaptive personality functioning.Preliminary results of the ongoing study:The STEPPS pilot in older adults demonstrated a significant decrease in BPD symptoms (Cohen’s d = 1.6), improved self-control of emotions and impulses (r = 0.58), and improved identity integration (Cohen’s d = 0.5). No significant differences were found for psychological distress.Conclusion:STEPPS is feasible for older adults with BPD symptoms. The treatment program led to a decreased in BPD symptoms and improvement of emotion regulation skills in older adults.Future perspectives:To further improve the feasibility of STEPSS in older adults a Delphi study was performed with seven experts in the field. The results of this Delphi study will additionally be discussed in this presentation. Most important recommendations were the addition of age-specific topics to the STEPPS program, e.g., changing social roles, life review, and/or physical limitations.

A Comprehensive Literature Review of Borderline Personality Disorder: Unraveling Complexity From Diagnosis to Treatment.

Borderline personality disorder (BPD) is a severe mental illness marked by unpredictable feelings, behaviors, and relationships. Symptoms like emotional instability, impulsivity, and poor social connections are the basis for diagnostic criteria. A noteworthy discovery highlights the clinical overlap between BPD and several psychotic disorders by arguing that BPD and psychotic symptoms raise the risk of psychopathology. According to neuroimaging evidence, structural and functional brain changes, notably in regions controlling affective regulation and impulse control, are seen in BPD patients. Adolf Stern, a psychoanalyst, used the word "borderline" in 1938 to describe patients who exhibited increased symptoms during therapy and displayed masochistic tendencies. Modern BPD research has highlighted the complexity of symptoms like boredom, a former diagnostic criterion associated with feelings of emptiness. Though there are still unanswered problems regarding its precise, practical components, the treatment technique known as Schema therapy (ST) has shown promise in treating BPD. It's interesting to note that BPD displays complex relationships with other illnesses; for instance, some neurochemical pathways coincide with those in bulimia nervosa, pointing to a deeper level of interconnection. Concerning diagnosis, BPD's defining symptoms include, among others, the fear of abandonment, identity disruption, and recurrent suicidal conduct. The range of treatment options includes pharmacological interventions and psychotherapies like dialectical behavior therapy (DBT). Even though antidepressants like selective serotonin reuptake inhibitors (SSRIs) are routinely prescribed, research on their efficacy is ongoing, underlining the significance of thorough treatment planning. In conclusion, BPD continues to be a complex condition that calls for early detection, especially considering that it usually manifests in adolescence. While many patients report symptom relief, lingering problems still exist, emphasizing the value of comprehensive and personalized treatment strategies.

Within-patient association between emotion regulation and outcome in prolonged exposure for posttraumatic stress disorder.

Difficulties with emotion regulation (ER) are a risk factor for the development and maintenance of posttraumatic stress disorder (PTSD). Less is known about temporal relations between ER and PTSD symptom change during treatment, including whether ER may represent a more potent change ingredient for some patients relative to others. This study examined the association between within-patient changes in ER and next-session PTSD symptom change and whether this association was more pronounced for patients with poorer baseline ER, more severe depression, or higher borderline personality disorder symptoms. Data derived from a randomized controlled trial (NCT01600456) in which 149 adults with PTSD received up to 10 sessions of prolonged exposure (PE) or PE + sertraline. Patients rated difficulties with ER and PTSD symptoms repeatedly during treatment. Moderators were assessed at baseline. Cross-lagged, dynamic structural equation models revealed that ER improvements were associated with next-session reductions in PTSD (standardized effect = 0.13). PTSD symptom reduction was also associated with next-session ER improvement (standardized effect = 0.34). Moderator analyses revealed that the within-person ER-PTSD symptoms association was stronger for patients with higher baseline depression (standardized effect = 0.39). Reductions in PTSD symptoms may facilitate ER improvements during PE and PE augmented with sertraline rather than improvements in ER producing changes in PTSD symptoms. For patients with higher severity co-occurring depression, ER may represent a more active change ingredient. PE therapists could therefore consider placing particular emphasis on improving ER capabilities when working with this subgroup of patients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Life experienced as worth living and beyond: a qualitative study of the pathways to recovery and flourishing amongst individuals treated for borderline personality disorder

BackgroundDialectical Behaviour Therapy (DBT) is recognized as a leading evidence-based treatment, effective in reducing symptoms of borderline personality disorder (BPD), as well as co-occurring clinical syndromes. However, symptom remission may not be the same as a life experienced as worth living. The purpose of the study was to understand, from the perspective of individuals with lived experience, the concepts of recovery, life experienced as worth living and flourishing after treatment for BPD, and to describe the pathways to wellness after symptom remission.MethodsSemi-structured interviews were conducted with nine adult women previously diagnosed with BPD, co-occurring clinical syndromes and severe self-harm behaviour who self-identified as recovered for a minimum of two years, recruited from a network for individuals with lived experience. The average duration of recovery was 5.7 years with a range from 2 to 10 + years. Data were analysed using thematic analysis.ResultsFour main themes and 14 subthemes were generated from our analyses. Main themes indicated that loved ones helped recovery and to create a life worth living, that participants identified as recovered and as healthy and beyond, and that becoming well is a long process associated in part with reclaiming a healthy identity. Participants defined recovery as separate but related to a life worth living, which in turn was separate but related to being healthy and having lives they described as being beyond health and well-being. The wellness process was described as lengthy and non-linear, including setbacks that with time no longer derailed daily life. A proposed theoretical model depicting the wellness process over time from symptom remission to the experience of a life beyond health and wellness is presented.ConclusionsThis qualitative study contributes knowledge of what a life experienced as worth living means, as well as how wellness progressed into flourishing for some participants within a sample of individuals with lived experience. Our findings may inform treatment development that targets more than symptom reduction, which in turn may shorten trajectories from symptom remission to health, wellness, and flourishing.

Short-Term versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder: A Randomized Clinical Trial (MBT-RCT)

Introduction: Borderline personality disorder (BPD) is a severe and prevalent psychiatric disorder. Mentalization-based therapy (MBT) is an evidence-based intervention for BPD, and several countries offer treatment programs for BPD lasting for years, which is resource demanding. No previous trial has compared short-term with long-term MBT. Objective: The aim of the study was to assess the efficacy and safety of short-term versus long-term MBT for outpatients with BPD. Methods: Adult outpatients (≥18 years) with subthreshold or diagnosed BPD were randomly assigned (1:1) to short-term MBT (5 months) or long-term MBT (14 months). The primary outcome was BPD symptoms assessed with the Zanarini Rating Scale for Borderline Personality Disorder. Secondary outcomes were functional impairment, quality of life, global functioning, and severe self-harm. All outcomes were primarily assessed at 16 months after randomization. This trial was prospectively registered at <ext-link ext-link-type="uri" xlink:href="http://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, NCT03677037. Results: Between October 4, 2018, and December 3, 2020, we randomly assigned 166 participants to short-term MBT (n = 84) or long-term MBT (n = 82). Regression analyses showed no evidence of a difference when assessing BPD symptoms (MD 0.99; 95% CI: −1.06 to 3.03; p = 0.341), level of functioning (MD 1.44; 95% CI: −1.43 to 4.32; p = 0.321), quality of life (MD −0.91; 95% CI: −4.62 to 2.79; p = 0.626), global functioning (MD −2.25; 95% CI: −6.70 to 2.20; p = 0.318), or severe self-harm (RR 1.37; 95% CI: 0.70–2.84; p = 0.335). More participants in the long-term MBT group had a serious adverse event compared with short-term MBT (RR 1.63; 95% CI: 0.94–3.07; p = 0.088), primarily driven by a difference in psychiatric hospitalizations (RR 2.03; 95% CI: 0.99–5.09; p = 0.056). Conclusion: Long-term MBT did not lead to lower levels of BPD symptoms, nor did it influence any of the secondary outcomes compared with short-term MBT.

Self-Reported Gonadal Pubertal Timing Predicts Adolescent Borderline Personality Symptoms: Two Extended Replications With Prospective and Cross-Sectional Data.

The current study investigated the understudied relationship between pubertal timing and borderline personality disorder (BPD) symptoms in males and females. We conducted hierarchical linear regressions in a longitudinal Cohort 1 (N = 117) and a cross-sectional Cohort 2 (N = 127). Cohort 1: Pubertal timing was self-reported at age 10; BPD symptoms and covariates were assessed between ages 13 and 19. Cohort 2: All assessments were between ages 8 and 12. Covariates: race, age, internalizing and externalizing symptoms, and income-to-needs ratio. Sex differences were examined post hoc. In Cohort 1, early gonadal timing was associated with more BPD symptoms in females (beta = .46, p = .002), and late gonadal timing was associated with more BPD symptoms in males (beta = -.23, p = .035). In Cohort 2, early gonadal timing was associated with more BPD symptoms (beta = .21, p = .033) without sex moderation. Results indicate that early gonadal development could be a risk indicator for the emergence of BPD in adolescence, particularly in females, which could inform causal mechanisms and intervention targets.