Unstable Personality Disorder Research Articles

Assessment of Suicide Risk in Patients with Depressive Episodes Due to Affective Disorders and Borderline Personality Disorder: A Pilot Comparative Study.

This study assessed suicidal risk in patients suffering from non-psychotic depressive disorders within various clinical and nosological forms (F31-F34 mood disorders and F60.31-emotionally unstable personality disorder). Clinical and psychological features were presented, as well as predictors of suicidal risk in patients of these groups. We performed a comparative analysis of the anxiety and depression level, the level of mental pain, fear of death and the severity of anti-suicidal motives in patients with affective disorders and borderline personality disorder (BPD). Based on the results, 100% of patients in these clinical nosological groups were found to have a high level of suicidal risk. Patients with affective disorders have weak anti-suicidal motives and are not fully aware of the consequences of their own death. Patients with BPD have a higher suicidal risk than patients with affective disorders; they are characterized by less pronounced social orientation, demonstrativeness, self-centeredness, less pronounced levels of anxiety and fear of death.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Mentalization-oriented psychodynamic group therapy for patients with personality disorders: a naturalistic prospective cohort study

Objectives Patients with personality disorders (PDs) are often treated with non-manualized psychodynamic group therapy (PDT) lasting for several years. Non-manualized PDT often combines a variety of therapeutic approaches from different PDT traditions, including mentalization-based therapy. Currently, little is known about the effect of this long-term, costly treatment. This study investigated the extent to which patients with different PDs benefit from mentalization-oriented PDT as it is implemented in clinical practice in terms of symptom severity, interpersonal problems, and general functioning. Methods The design was a naturalistic, prospective cohort study. Seventy-five consecutive PD patients were assessed before treatment with the Symptom Checklist-90 Revised (SCL-90-R) as the primary outcome measure and the Inventory of Interpersonal Problems (IIP) and Global Assessment of Functioning (GAF) as secondary outcome measures. The sample was repeatedly assessed every 12 months for up to 36 months. Paired t-tests were applied to examine the effectiveness of the intervention. Results Among completers (n = 42; 56%), improvement was observed on the SCL-90-R: Global Severity Index (mean change = −0.45 [95% CI = –0.72, −0.19]; Cohen’s d = –0.55), Positive Symptom Distress Index (–0.40 [–0.63, −0.17]; −0.56); Positive Symptoms Total (–10.70 [–17.31, −4.09]; −0.52). Secondary outcomes also improved: IIP-total (mean change = –0.50 [95%CI = –0.74, −0.25]; Cohen’s d = –0.66); GAF-Functioning (8.79 [6.32, 11.27]; 1.15); and GAF-Symptoms (10.67 [8.09, 13.25]; 1.34). Conclusions Completers improved on symptom severity, interpersonal problems, and general functioning, with within-group effect sizes ranging from medium to large. Approximately half the sample dropped out, suggesting that mentalization-oriented PDT spanning several years may be unrealistic for many patients with PD. Significant outcomes There are no clear guidelines for psychological interventions targeting personality disorders (PDs), and currently eclectic and non-manualized psychodynamic approaches lasting for up to 3 years are prevailing in some clinical practices. Although this treatment approach may have an effect on compliant patients, the high drop-out rate indicates that it may not be suitable for a large proportion of PD patients since it requires long-term commitment. Furthermore, it is difficult to identify the content of the non-manualized psychodynamic therapy and what helps the patients. More specific clinical guidelines emphasizing the application of evidence-based treatments or at least manualized treatments are warranted for the treatment of emotionally unstable PDs and other PDs. Limitations The naturalistic study design, without any control group, limits conclusions about mechanisms of action of the intervention. Since the intervention was not manualized, it is unknown exactly which treatment was actually administered, which reduces external validity. The outcomes are based on completer data of a relatively small sample size with high drop-out rate.

Drumming, singing and ceremony within a psychologically informed planned environment for women on the offender personality disorder pathway

PurposeThe offender personality disorder (OPD) pathway provides services to people with histories of offending and traits of personality disorder (PD) who are at high risk of violent re-offending. The residential provisions have been developed as psychologically informed planned environments (PIPE), in which socially creative activities form an integral part. Ryan et al. (2018) suggest that social and creative activities offer individuals experiences to increase their understanding of themselves and others. The purpose of this study is to complete a service evaluation exploring how people who live on an OPD PIPE in a woman’s prison make sense of their experiences of a drumming, singing and ceremony group, which was offered to them as part of their provision PIPE.Design/methodology/approachSemi-structured interviews were conducted with six service users (between 19 and 42 years old).FindingsThematic analysis identified three themes: emotional regulation, belonging and connectedness and humanising spaces.Research limitations/implicationsThis study used a small sample (n = 6), and all participants were accessing the same OPD provision PIPE. Further, participation was voluntary, and results found may relate to possible biases in a self-selecting sample. The interviewer knew the participants through their clinical work, and despite being informed that participation in this research project would have no bearing on their treatment pathway, some may have participated as a way to demonstrate their compliance with the overall programme. A further limitation relates to the group being evaluated on its own without a comparison group.Practical implicationsThis study has important implications for treatment delivery in prisons, as it demonstrates the therapeutic merit of social creative activities for one of the most complex, high-risk and challenging offender groups. The findings show that the specific combination of the physical act of drumming and the social act of drumming together may create an environment that allows people to heal and overcome both physical and emotional disconnections that have been caused by their trauma.Social implicationsThis study’s findings provide further understanding of the experience of people who have survived trauma.Originality/valueFindings suggest that the group provides therapeutic value, offering an alternative to traditional therapy and targets specific difficulties particularly associated with emotionally unstable and antisocial PDs. We suggest that socially creative activities form an important part of the rehabilitation process of complex, high-risk groups. Future research would benefit from focusing on the extent to which experiential learning through socially creative group participation can impact on lasting behavioural change.

The relationship to caregiving: how psychological therapies can support carers of people with a diagnosis of emotionally unstable (borderline) personality disorder

This article reviews empirical studies of psychological interventions that have been offered to (informal) carers for people with a diagnosis of emotionally unstable (borderline) personality disorder (EUPD). A search of electronic databases, and subsequent reference searching, was performed in October 2019 to identify empirical studies in this area. In total, sixteen articles were included in this review. The quality of each paper was formally reviewed, alongside their findings. Three main theoretical approaches were apparent: mentalization-based treatment (MBT), dialectical behaviour therapy (DBT), and other psycho-education or miscellaneous intervention. Intervention outcome measures included scales for burden, grief, depression, and anxiety, many of which saw improvements, including clinically significant changes. Among high-quality papers, there was no clearly superior approach to interventions for carers. This review emphasised the need for plurality in psychological approaches for supporting carers, and for more work in this developing area of research.

Personality disorder in an Early Intervention Psychosis cohort: Findings from the Social Epidemiology of Psychoses in East Anglia (SEPEA) study.

AimPersonality Disorders (PD) often share clinical and phenomenological overlap with psychotic disorders, especially at onset. However, there is little research on comorbid PD among people experiencing first episode psychosis. We examined the prevalence of PD recording and its sociodemographic and clinical correlates in people accepted to Early Intervention in Psychosis (EIP) services.MethodsParticipants were aged 16–35, accepted into 6 EIP services for suspected psychosis, as part of the Social Epidemiology of Psychoses in East Anglia (SEPEA) study. PD was recorded by clinicians according to ICD-10. Multilevel logistic regression was performed.ResultsOf 798 participants, 76 people (9.5%) received a clinical diagnosis of PD, with emotionally unstable PD (75.0%, N = 57) the most common subtype. In multivariable analysis, risk factors for PD included female sex (odds ratio [OR]: 3.4; 95% CI: 2.0–5.7), absence of psychotic disorder after acceptance to EIP (OR: 3.0; 95% CI: 1.6–5.5), more severe hallucinations (OR: 1.6; 95% CI: 1.2–2.1), and lower parental SES (OR: 1.4; 95% CI: 1.1–1.8). Compared with the white British, black and minority ethnic groups were less likely to receive a PD diagnosis (OR: 0.3; 95% CI: 0.1–0.7). There was no association between PD and neighbourhood-level deprivation or population-density.ConclusionsRecording of a PD diagnosis was three times more common amongst participants later found not to meet threshold criteria for psychotic disorder, implying phenomenological overlap at referral which highlights difficulties encountered in accurate diagnostic assessment, treatment and onward referral. People with PD experienced more individual-level, but not neighbourhood-level social disadvantage in an already disadvantaged sample.

Validity of the personality disorder diagnosis in the Swedish National Patient Register.

The Swedish National Patient Register (NPR) is an exceptional source of information in clinical epidemiological research. The register is, however, not validated for the diagnosis of personality disorder (PD). We therefore assessed its validity in this patient group, and the group with emotionally unstable PD (EUPD)/borderline personality disorder (BPD). Records from 100 random adult patients (aged 15-65years) diagnosed with any PD in the NPR between 1987 and 2015 were analysed using a protocol based on general diagnostic criteria for PD, as well as specific criteria for EUPD/BPD in both ICD and DSM classification systems. Of the 100 patients, 27 had been given a diagnosis of EUPD, 23 another specific PD and 50 an unspecified PD. Using ICD criteria, 88 of 95 evaluable patients could be confirmed to have a PD, that is an agreement rate of 93%. Using DSM criteria, the agreement was lower (77 patients or 81%). Of 26 evaluable patients with a diagnosis of EUPD/BPD, the diagnosis was confirmed in all cases when using the ICD criteria, but in only 20 when using the DSM criteria. The NPR is a valid source of data for the diagnosis of PD per se and also of EUPD in women.

Training NHS staff to work with people with trauma induced emotional regulation and interpersonal relational difficulties (TIERI)/borderline personality disorder

PurposeImprovement is sorely needed to the National Health Service (NHS) care for people with trauma induced emotional regulation and interpersonal relational difficulties (TIERI), currently labelled as a variant of personality disorder [PD; borderline personalty disorder/emotionally unstable personality disorder (BPD/EUPD)]. This study aims to improve staff training.Design/methodology/approachA mixed-methods evaluation demonstrated the benefits of offering 495 staff three-day trainings with a clinician-designed, unique training package.FindingsStatistically significant improvements were reported in both staff confidence and optimism when dealing with people with a diagnosis of PD (PWDPD) and scores on the Helping Alliance questionnaire. No statistically significant changes in social attitude resulted. Qualitative data shows negative descriptions generated by staff decreased post-training with an increase in positive and neutral descriptions. The responses generated six different themes: resources, client demand, medical model, emotional, human and positive rewards. Differing proportions were found pre and post-training.Research limitations/implicationsThis was a clinical-world evaluation, not a formal research project. Different pairs/combinations of experienced clinicians (predominantly clinical psychologists) acted as trainers. Some minor variation occurred within the training package used and presentation.Practical implicationsGiven the expense of staff time and resources, this evaluation shows the resultant positive changes achieved. TIERI staff about the difficulties experienced by PWDPD and how to negotiate the relational dynamic is essential. Training helps improve staff perception of the people involved, improves staff confidence and promotes better therapeutic alliances (key to providing the relational and trauma work needed). Ongoing supervision is likely needed post-training.Originality/valuePositive changes resulted from a mixed-methods evaluation of three-day trainings by using a specially designed training package.

Incidence and prevalence rates of personality disorders in Denmark—A register study

Background: Personality disorders (PDs) are prevalent in about one in every 10 adults. Prior to the introduction of the ICD-10 in Denmark, the incidence rate for PD (including schizotypal) among psychiatric patients was approximately 12% and the prevalence rate 14%. Aims: The aim of the present clinical epidemiology study is to investigate the use of ICD-10 PD as primary and secondary diagnoses in years 1995, 2000 and 2006, comorbid disorders and their relation to age and gender. Methods: The study includes all adult patients admitted to any psychiatric hospital (inpatients and outpatients) in Denmark. Results: Both incidence and prevalence rates of PD diagnoses decrease over the study period. It is evident that all specific diagnoses significantly decrease or remain stable whereas the unspecified and mixed type significantly increases constituting up to 50% of diagnoses. Emotionally unstable PD stands out as the single most prevalent covering around one third of PD diagnoses. A decrease is found in the prevalence of patients receiving a PD diagnosis as a primary diagnosis, but an increase as a secondary diagnosis (most often as comorbid to depression or anxiety disorder). Differences are found in relation to gender and age. Conclusion: PDs are among the most prevalent disorders; however, rates are decreasing in psychiatric settings. There seem to be a rather huge gap between clinical evaluation and research data on prevalence of PDs. Clinicians need more education and sufficient time for in-depth personality assessment of PDs in all patient groups.

Brain-derived neurotrophic factor as a suicide factor in mental disorders.

Brain-derived neurotrophic factor (BDNF) plays a critical role in brain plasticity processes and serum levels have been demonstrated to be altered in patients with different mental disorder including suicidal behaviour. The objective of this study was to examine the association between serum BDNF levels as a possible peripheral indicator of suicide behaviour in subjects suffering from depression, personality disorders (PDs) and adjustment disorders (ADs) with or without suicide attempt. The research included 172 randomly selected individuals suffering from recurrent depressive disorder (RDD; F 33.2), emotionally unstable PD (F 60.3) and AD (F 43.2), with or without attempted suicide according to the criteria of the ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) and 60 phenotypically health control subjects. In the group of patients, 73% subjects took some form of psychopharmacotherapy. Serum BDNF levels were measured by enzyme linked immunosorbent assay. Subjects with PD and AD with suicide attempts had significantly lower serum BDNF levels than those without suicide attempts. In groups of subjects with PD and AD, those taking psychopharmacotherapy had higher serum BDNF levels. In the group of subjects with RDD, there were no differences with respect to suicide attempts or psychopharmacotherapy. Logistical regression analysis was indicated that psychopharmacotherapy and serum BDNF levels statistically correlated with suicide attempts. The lower levels of BDNF in subjects suffering from PD and AD with suicide attempts, suggest that the serum BDNF level is a potential marker of suicidal behaviour, independent of mental disorders.

Naturalistic study on ICD-10 personality disorders

Objective. To study the frequency, socio-demography and comorbidity of ICD-10 personality disorders (PD), especially of emotionally unstable PD, in psychiatric inpatients. To test the subdivision of emotionally unstable PD in impulsive and borderline subtypes. Methods. Data on all psychiatric hospital stays in the Canton of Zurich in the years 1998–2002, routinely collected at the time of each patient's hospitalization, were analysed. Results. PD was diagnosed in 10.2% of all inpatients, and the proportion of emotionally unstable PD diagnosis was 54.5%. There are considerable differences between impulsive and borderline personality disorders with respect to sex, age, employment status and comorbidity. Conclusion. Emotionally unstable PD is the most frequent PD in clinical settings. Its differentiation into impulsive and borderline subtypes is justified.

The subaffective-character spectrum subtyping distinction in primary early-onset dysthymia: a clinical and family study

In 1983, Akiskal proposed that primary early-onset dysthymia should be divided into two subtypes: subaffective dysthymia, which is a subsyndromal form of major mood disorder; and character spectrum disorder, which is a form of personality disorder with secondary dysphoria. The present study attempted to validate this distinction. Akiskal's (1983) criteria were applied to a sample of 97 early-onset dysthymic outpatients, yielding groups of 41 subaffective and 56 character spectrum patients. Patients were evaluated using structured interviews for Axis I and II disorders, family history of psychopathology, and the early home environment, and a comprehensive battery of questionnaires. In addition, direct and family history interviews were conducted with their first-degree relatives. There was mixed support for Akiskal's typology. Consistent with the model, subaffectives exhibited higher rates of major depression, depressive symptoms, and a number of depressive personality and cognitive features. In addition, there was a higher rate of alcoholism among the relatives of character spectrum patients. However, contrary to Akiskal's model, the groups did not differ on gender, unstable personality disorders, family history of mood disorders, or the early home environment.

“Unstable” Personality Disorders: Prognostic Implications for Major Depression

Sixty-nine depressed inpatients assessed for DSM-III personality disorders (PDs) were followed up after 4 years. Patients with unstable PDs (USPD; borderline, narcissistic, histrionic, and antisocial PDs) were compared with all other depressives. Considering patients of all ages, USPD was unrelated to course and weakly related to suicidal behavior. In post hoc analyses, patients were divided into “younger” (aged 18—25) and “older” (over 25). USPD but not other PDs predicted more episodes of depression, more manipulative suicidal behavior, and more medically serious suicide attempts among older depressives. USPD was unrelated to prognosis among younger depressives. This may be because many young USPDs will reach higher levels of adaptive functioning over several years, whereas USPDs still requiring hospitalization beyond their mid-20s tend to have more intractable character pathology with poorer long-term prognosis.