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Hayes A, Courey L, Kells M, Hyndman D, Dempsey M, Murphy M. Caregivers of individuals with borderline personality disorder: The relationship between leading caregiver interventions and psychological distress/positive mental well-being. FAMILY PROCESS 2024. [PMID: 39091082 DOI: 10.1111/famp.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 04/15/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
Burden and psychological distress are higher in informal caregivers (ICs) of people with severe emotional and behavior dysregulation who have been given a diagnosis of borderline personality disorder (BPD) compared with non-caregivers. The current cross-sectional study examines the difference in outcomes of ICs of people with BPD who have received the intervention Family Connections (FC) and who also led interventions for other caregivers (caregiver-leaders) compared with those who have attended FC but not led caregiver interventions (non-leader-FC participants). The sample for this research is from a larger study (Hayes et al., 2023, Borderline Personality Disorder and Emotion Dysregulation, 10, 31). Data for 347 participants who self-reported receiving FC and completed the McLean Screening Instrument for BPD-Carer Version, the Brief COPE, the Multidimensional Scale of Perceived Social Support, the Kessler Psychological Distress scale, the WHO-5 Well-being Index, and the Coronavirus Anxiety Scale were analyzed. The results found that being a caregiver-leader was associated with higher positive mental well-being and lower psychological distress compared with non-leader-FC participants. Being a caregiver-leader was also associated with significantly greater use of the coping strategy of positive reframing and lower use of behavioral disengagement and self-blame than non-leader-FC participants. The study provides preliminary evidence that for those who have received FC, becoming an intervention leader is associated with better outcomes than caregivers who do not become leaders and provides support for caregiver-led rollout of FC across services.
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Affiliation(s)
- Aoife Hayes
- School of Applied Psychology, University College Cork, Cork, Ireland
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - Lynn Courey
- The Sashbear Foundation, Toronto, Ontario, Canada
| | - Mary Kells
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | | | - Maria Dempsey
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
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Wilner JG, Ronzio B, Gillen C, Aguirre B. Self-Hatred: The Unaddressed Symptom of Borderline Personality Disorder. J Pers Disord 2024; 38:157-170. [PMID: 38592908 DOI: 10.1521/pedi.2024.38.2.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Individuals with borderline personality disorder (BPD) often report chronic, severe self-hatred. It is frequently experienced as immutable, seen as a barrier to recovery, and is associated with risk for self-injury and suicide attempts. Yet self-hatred remains a poorly understood, underdiagnosed, and undertreated presentation of BPD. In this concept article and review, we describe the nature of self-hatred in BPD and related disorders, propose a theory as to the development of self-hatred in BPD, review the assessments of and interventions for self-hatred, and consider next steps in the research, assessment, and treatment of self-hatred in BPD. Through increased awareness, understanding, and measures of self-hatred in BPD, new treatment paradigms can be developed to ensure more comprehensive recovery.
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Affiliation(s)
- Julianne G Wilner
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Blake Ronzio
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Carly Gillen
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
| | - Blaise Aguirre
- From Division of Child and Adolescent Psychiatry, McLean Hospital/Harvard Medical School, Belmont, Massachusetts
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Ekdahl S, Carlson E, Idvall E, Perseius KI. Need of support for significant others to persons with borderline personality disorder-A Swedish focus group study. Scand J Caring Sci 2024; 38:240-248. [PMID: 37846882 DOI: 10.1111/scs.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/08/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Being a significant other (SO) to a person with borderline personality disorder (BPD) affect their health. High incidence of substance use disorder, post-traumatic stress disorder, stress, fear, anxiety, depression, family burden and grief are common. Some specific therapies for BPD, have included support to SOs, however resources are scarce and to participate in the support it assumes that the person with BPD is included in these therapies. Although the SO support has been shown to be helpful, they all have a similar structure, and only a small exclusive group of SOs have access to the support. AIM The aim was to describe experiences and need of support for significant others to persons with borderline personality disorder from the perspective of themselves and of health care workers. METHODS Data was collected via two focus groups. One with five SOs to persons with BPD, one with five health care workers. Two interview sessions in each group were conducted and data were analysed with qualitative content analysis. The study was approved by the research ethics committee of Lund (2016-1026). RESULTS The results revealed four themes; not being seen by health care professionals creates hopelessness, being seen by healthcare professionals creates trust, experience of support - helpful or shameful and the step from loosely structured support to a structured support group. Both groups expressed a need for further support as a complement to already existing support. CONCLUSIONS The need of support is extensive. The results suggest a professional coordinator intended for SOs and peer support groups not linked to a particular psychiatric treatment yet offering support in a structured way. Further studies examining these complements to existing support, is therefore recommended.
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Affiliation(s)
- Susanne Ekdahl
- Nyckeln Competence Center, Kalmar County Hospital, Kalmar, Sweden
- Department of Care Science, Malmö University, Malmö, Sweden
| | | | - Ewa Idvall
- Department of Care Science, Malmö University, Malmö, Sweden
| | - Kent-Inge Perseius
- Department of Health and Caring Science, Linnaeus University, Kalmar, Sweden
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Ruiz-Guerrero F, Gomez Del Barrio A, de la Torre-Luque A, Ayad-Ahmed W, Beato-Fernandez L, Polo Montes F, Leon Velasco M, MacDowell KS, Leza JC, Carrasco JL, Díaz-Marsá M. Oxidative stress and inflammatory pathways in female eating disorders and borderline personality disorders with emotional dysregulation as linking factors with impulsivity and trauma. Psychoneuroendocrinology 2023; 158:106383. [PMID: 37714047 DOI: 10.1016/j.psyneuen.2023.106383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/02/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) and eating disorders (ED) are both disorders with emotional dysregulation that may share some similar biological underpinnings, leading to oxidative/inflammatory alterations. Unfortunately, to date, no studies have assessed the relationship between clinical features, inflammatory alterations and childhood trauma across these disorders. Our aim was to identify the potential common and disorder-specific inflammatory pathways and examine possible associations between these dysregulated pathways and the clinical features. METHODS We studied a sample of 108 women (m = 27.17 years; sd = 7.64), divided into four groups: 23 patients with a restrictive ED (ED-R), 23 patients with a bingeeating/ purging ED (ED-P) and 26 patients with BPD; whereas the control group included 23 healthy subjects. Several inflammatory/oxidative parameters: tumor necrosis factor alpha (TNFα), Thiobarbituric Acid Reactive Substances (TBARS), inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX2), p38 mitogenactivated protein kinases, ERK mitogen-activated protein kinases and c-Jun NH2- terminal kinase (JNK), and some antiinflammatory antioxidant elements: glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), Kelch-like ECHassociated protein (Keap1) were determined in plasma or peripheral blood mononuclear cells. Furthermore, clinical, impulsivity, trauma and eating behavior questionnaires were administered. RESULTS Three main inflammatory/oxidative components were extracted using principal component analysis (59.19 % of biomarker variance explained). Disorder-specific dysfunction in the inflammatory and oxidative pathways in patients with BPD and ED were revealed by means of relationships with specific principal components (p < .01). BPD patients showed higher levels of a component featured by elevated levels of JNK and lower of GPx and SOD. ED-R and impulsivity were associated with a component featured by the activation of ERK and negative influence of Keap1. The component featured by the suppression of catalase and COX2 was associated with both ED subtypes and trauma exposure. CONCLUSION Several risk factors such as trauma, impulsivity and eating disorder symptoms were transdiagnostically associated with some inflammatory alterations regardless of diagnosis. These findings suggest that the clinical profile comprising trauma exposure and an emotional dysregulation disorder might constitute a specific endophenotype highly linked with inflammatory alterations.
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Affiliation(s)
- Francisco Ruiz-Guerrero
- Marqués de Valdecilla University Hospital, Eating Disorders Unit, Department of Psychiatry, Santander, Spain; Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Andrés Gomez Del Barrio
- Marqués de Valdecilla University Hospital, Eating Disorders Unit, Department of Psychiatry, Santander, Spain; Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain.
| | - Alejandro de la Torre-Luque
- Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Spain
| | | | | | | | | | - Karina S MacDowell
- Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain; IIS Hospital 12 de Octubre, IUIN-UCM, Madrid, Spain
| | - Juan C Leza
- Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain; IIS Hospital 12 de Octubre, IUIN-UCM, Madrid, Spain
| | - José Luis Carrasco
- Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Spain; IIS Hospital Clínico San Carlos, Madrid, Spain
| | - Marina Díaz-Marsá
- Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Spain; IIS Hospital Clínico San Carlos, Madrid, Spain.
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Bosworth C, Watsford C, Naylor A, Buckmaster D, Rickwood D. The experiences of parents in an early-intervention program for young people with borderline personality disorder features. FAMILY PROCESS 2023; 62:1524-1541. [PMID: 37602926 DOI: 10.1111/famp.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 07/07/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
Previous research demonstrates that parents' communication skills may contribute to the development and maintenance of their young person's borderline personality disorder (BPD). Carers of people with BPD also experience their own psychosocial stressors and feel unsupported. Consequently, Dialectical Behavior Therapy for adolescents (DBT-A) invites parents to partake in group therapy alongside their young person. Despite this involvement, little research exists examining parents' perspective of engaging in a DBT-A program, and specifically whether they experience their own benefits and changes from being part of the program. To examine this, the current study interviews 34 parents who engaged in an early intervention DBT-A program. Thematic analysis resulted in seven key themes and 16 subthemes beginning with parents' expectations of the program, followed by the key elements of the program that facilitated change, and the actual changes and benefits attributed to these elements. Overall, parents were surprised by their own gains from the program, and how the skills they learned facilitated personal development that improved family communication and functioning with their young person and more broadly. This study addresses the gap in understanding the parent perspective with clinical implications for the benefits of involving parents in therapy more generally.
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Affiliation(s)
- Chloe Bosworth
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Clare Watsford
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Annaleise Naylor
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Dean Buckmaster
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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Rexhaj S, Martinez D, Golay P, Coloni-Terrapon C, Monteiro S, Buisson L, Drainville AL, Bonsack C, Ismailaj A, Nguyen A, Favrod J. A randomized controlled trial of a targeted support program for informal caregivers in adult psychiatry. Front Psychiatry 2023; 14:1284096. [PMID: 38098635 PMCID: PMC10719931 DOI: 10.3389/fpsyt.2023.1284096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
Background The importance of informal caregivers for persons with severe mental illness has been demonstrated. However, this role may cause a high care burden that considerably affects caregiver health. The Ensemble program is a five-session brief individual intervention designed to support informal caregivers. This trial aimed to assess the efficacy of the program versus SAU (support as usual) for participants with a high care burden. Methods A single-center randomized controlled trial including 149 participants was conducted. Caregivers in the intervention arm participated in the Ensemble program. The effects of the intervention were assessed using mixed models for repeated measures analysis of variance on improvements in informal caregivers' psychological health status, optimism levels, burden scores, and quality of life at three time points (T0 = pretest; T1 = posttest at 2 months, and T2 = follow-up at 4 months). Results Analysis of the Global Psychological Index showed no significant effect at the two endpoints in favor of the Ensemble group. However, the Brief Symptom Inventory-Positive Symptom Distress Index was significantly lower at the two-month follow-up. A significant reduction in burden on the Zarit Burden Interview was observed post-intervention, along with an increase in optimism levels on the Life Orientation Test-Revised at follow-up in the Ensemble group. No significant differences were observed in quality of life. Clinical improvements in both psychological health status and burden levels were also identified. Conclusion The Ensemble program offers an inclusive approach based on a recovery perspective that significantly reduces symptom distress and burden and increases optimism among informal caregivers.Clinical trial registration: https://clinicaltrials.gov/, NCT04020497.
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Affiliation(s)
- Shyhrete Rexhaj
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences, Lausanne, Switzerland
| | - Debora Martinez
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences, Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, University Hospital, CHUV, University of Lausanne, Lausanne, Switzerland
- Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
| | - Claire Coloni-Terrapon
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences, Lausanne, Switzerland
| | - Shadya Monteiro
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences, Lausanne, Switzerland
| | - Leslie Buisson
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences, Lausanne, Switzerland
| | - Anne-Laure Drainville
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences, Lausanne, Switzerland
| | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, University Hospital, CHUV, University of Lausanne, Lausanne, Switzerland
| | | | - Alexandra Nguyen
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences, Lausanne, Switzerland
| | - Jérôme Favrod
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences, Lausanne, Switzerland
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Fonseca-Baeza S, García-Alandete J, Marco JH, Pérez Rodríguez S, Baños RM, Guillén V. Difficulties in emotional regulation mediates the impact of burden on quality of life and mental health in a sample of family members of people diagnosed with Borderline Personality Disorder. Front Psychol 2023; 14:1270379. [PMID: 38054179 PMCID: PMC10694221 DOI: 10.3389/fpsyg.2023.1270379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
Background Although it has been suggested that family members of persons suffering from Borderline Personality Disorder (BPD) endure high levels of burden, however, the process and the impact of this burden in their lives, and specifically the relation between the burden and emotional regulation has not been broadly investigated among this population. The main objective of this study is to examine the impact of burden on quality of life and depression, anxiety and stress, as mediated by difficulties in emotional regulation in family members of persons diagnosed with BPD. Method Participants were 167 family members of persons diagnosed with BPD. The Burden Assessment Scale, Difficulties in Emotion Regulation Scale, Multicultural Quality of Life Index, and Depression Anxiety Stress Scale-21 were filled out. Mediation analysis was conducted using the Maximum Likelihood estimator, bootstrap method and listwise deletion for missing data. Results Burden showed a significant, negative effect on quality of life and positive on depression, anxiety and stress. Difficulties in emotion regulation significantly mediated these relations. After accounting for the mediating role of difficulties in emotion regulation, burden still had an impact on quality of life, depression, anxiety and stress. Women showed a higher level in both burden and stress than men. The caregivers with secondary and higher studies showed higher levels in burden than those with no studies. Not significant differences in burden, emotion regulation, depression, anxiety and stress were found related to marital status. Conclusion Difficulties in emotion regulation mediate the relations between burden and quality of life, depression, anxiety, and stress. Family members could engage in group interventions designed specifically for family members of people with BPD, oriented toward understanding the disorder or learning skills.
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Affiliation(s)
- Sara Fonseca-Baeza
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Joaquín García-Alandete
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - José Heliodoro Marco
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Sandra Pérez Rodríguez
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Rosa M. Baños
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Verónica Guillén
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Valencia, Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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Betts JK, Seigerman MR, Hulbert C, McKechnie B, Rayner VK, Jovev M, Cotton SM, McCutcheon LK, McNab C, Burke E, Chanen AM. A randomised controlled trial of a psychoeducational group intervention for family and friends of young people with borderline personality disorder features. Aust N Z J Psychiatry 2023; 57:1453-1464. [PMID: 37170885 PMCID: PMC10619189 DOI: 10.1177/00048674231172108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Preliminary evidence indicates that interventions designed to support family and friends ('carers') of young people with early-stage borderline personality disorder effectively improve carer outcomes. None of these interventions have been tested in a randomised controlled trial. METHOD This clustered, partially nested, randomised controlled trial was conducted at Orygen, Melbourne, Australia. Carers of young people (aged 15-25 years) with borderline personality disorder features were randomly assigned as a unit in a 1:1 ratio, balanced for young person's sex and age, to receive a 15-day intervention comprising: (1) the three-session, in-person, Making Sense of BPD (MS-BPD) multi-family group programme, plus two self-directed online psychoeducational modules (MS-BPD + Online, n = 38), or (2) the two self-directed online psychoeducational modules alone (Online, n = 41). The primary outcome was 'negative experiences of care', measured with the Experience of Caregiving Inventory, at the 7-week endpoint. RESULTS A total of 79 carers were randomised (pool of 281, 197 excluded, 94 declined) and 73 carers (51 females [69.9%], Mage = 43.8 years [standard deviation, SD = 12.9], MS-BPD + Online n = 35 [47.9%], Online n = 38 [52.1%]) provided follow-up data and were included in the intent-to-treat analysis. The intent-to-treat (and per protocol) analyses did not find any significant differences between the groups on the primary (d = -0.32; 95% confidence interval = [-17.05, 3.97]) or secondary outcomes. Regardless of treatment group, caregivers improved significantly in their personality disorder knowledge. CONCLUSION Delivering MS-BPD in conjunction with an online psychoeducational intervention was not found to provide additional benefit over and above access to an online intervention alone. In accordance with national guidelines, carer interventions should be routinely offered by youth mental health services as part of early intervention programmes for borderline personality disorder. Further research is warranted into which interventions work for whom, carers' preferences for support and barriers to care.
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Affiliation(s)
- Jennifer K Betts
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mirra R Seigerman
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Victoria K Rayner
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Martina Jovev
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sue M Cotton
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | | | | | - Andrew M Chanen
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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Hayes A, Dempsey M, Kells M, Murphy M. The relationship between social support, coping strategies and psychological distress and positive mental well-being in carers of people with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2023; 10:31. [PMID: 37821995 PMCID: PMC10568807 DOI: 10.1186/s40479-023-00237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Informal carers of people with BPD experience high levels of burden and psychological distress relative to other populations. There is a scarcity of research evidencing the influence of modifiable factors on carer outcomes to inform interventions. This study aimed to investigate the relationship between social support, coping strategies and psychological distress and positive mental well-being in this carer population. METHODS In this cross-sectional study, 1207 carers completed the McLean Screening Instrument for BPD-Carer Version, the Brief COPE, the Multidimensional Scale of Perceived Social Support, the Kessler Psychological Distress scale, the WHO-5 Well-being Index, and the Coronavirus Anxiety Scale. Data for 863 participants who met the inclusion criteria were analysed. RESULTS Carers reported low positive mental well-being and high psychological distress. Perceived social support and several coping strategies were significant unique predictors of psychological distress and positive mental well-being. Perceived social support and positive reframing were the strongest predictors of higher positive mental well-being and lower psychological distress. Self-blame, behavioural disengagement and substance use were the strongest predictors of adverse outcomes. CONCLUSIONS The findings evidence modifiable factors that may be used to improve informal carer outcomes and indicate that carer interventions may be improved by focusing on reducing the use of self-blame, behavioural disengagement and substance use, and development of quality social support and skills to positively reframe caregiving situations.
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Affiliation(s)
- Aoife Hayes
- School of Applied Psychology, University College Cork, Cork, Ireland.
| | - Maria Dempsey
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Mary Kells
- Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Cork, Ireland
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
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Smith L, Hunt K, Parker S, Camp J, Stewart C, Morris A. Parent and Carer Skills Groups in Dialectical Behaviour Therapy for High-Risk Adolescents with Severe Emotion Dysregulation: A Mixed-Methods Evaluation of Participants' Outcomes and Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6334. [PMID: 37510567 PMCID: PMC10379026 DOI: 10.3390/ijerph20146334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND There is an established evidence-base for dialectical behaviour therapy for adolescents (DBT-A) in the treatment of young people with severe emotion dysregulation and related problems, including repeated self-harm and suicidal behaviours. However, few studies have reported on parental involvement in such treatments. This study aims to explore the outcomes and experiences of participants of a dedicated skills group for parents and carers embedded within an adapted DBT-A programme in the United Kingdom. METHOD This study was conducted within a specialist outpatient Child and Adolescent Mental Health Services (CAMHS) DBT programme in the National Health Service (NHS) in London. Participants were parents and carers of adolescents engaged in the DBT-A programme. Participants attended a 6-month parent and carer skills group intervention and completed self-report measures relating to carer distress, communication and family functioning, at pre-intervention and post-intervention. Following the intervention, semi-structured interviews were also completed with a subgroup of participants to explore their experiences of the skills group and how they perceived its effectiveness. Quantitative and qualitative methods were used to analyse the data collected from participants. RESULTS Forty-one parents and carers completed the intervention. Participants reported a number of statistically significant changes from pre- to post-intervention: general levels of distress and problems in family communication decreased, while perceived openness of family communication and strengths and adaptability in family functioning increased. A thematic analysis of post-intervention interviews examining participant experiences identified six themes: (1) experiences prior to DBT; (2) safety in DBT; (3) experiences with other parents and carers; (4) new understandings; (5) changes in behaviours; and (6) future suggestions. DISCUSSION Parents and carers who attended a dedicated DBT skills groups, adapted for local needs, reported improvements in their wellbeing, as well as interactions with their adolescents and more general family functioning, by the end of the intervention. Further studies are needed which report on caregiver involvement in DBT.
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Affiliation(s)
- Lindsay Smith
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Katrina Hunt
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Sam Parker
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Jake Camp
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Catherine Stewart
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Andre Morris
- National and Specialist Child and Adolescent Mental Health Services (CAMHS), South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
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Psychoeducational groups for close relatives of patients with borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01395-8. [PMID: 35294615 DOI: 10.1007/s00406-022-01395-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/01/2022] [Indexed: 11/03/2022]
Abstract
Psychoeducational groups for family members of patients with schizophrenia have proven to be effective. Borderline personality disorder (BPD) implies serious impairment in interpersonal relationships. Close relatives of individuals with BPD also show high levels of burden and need support. Psychoeducational groups could help to cope with the interactional problems in a relationship with a person with BPD. A manualised psychoeducational programme of 10 group sessions for close relatives of patients with BPD was tested. Measures administered at pretest and after 10 sessions were: perceived burden (IEQ-EU), knowledge about the disorder (WFBBPS-A) and quality of life (WHOQOL-BREF). For formative evaluation, a "Group Therapy Session Questionnaire" (participant and therapist version; GTS-A, GTS-T) was used. A total of 33 persons in three groups took part. Pre-post evaluations revealed a significantly lower level of burden and a significantly better knowledge about the disorder after participating in the psychoeducational group. Reduction of burden correlated significantly with the assessment of patients' symptom severity and carers' level of burden at study entry. There was no change in the quality of life. The participants and therapists generally rated the psychoeducational sessions very positively. The highest ratings were found in the sessions about communication skills and coping with crises. Findings indicate that the psychoeducational programme is well accepted and supportive for persons with close relationships to patients with BPD.
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Gleeson J, Alvarez-Jimenez M, Betts JK, McCutcheon L, Jovev M, Lederman R, Herrman H, Cotton SM, Bendall S, McKechnie B, Burke E, Koval P, Smith J, D'Alfonso S, Mallawaarachchi S, Chanen AM. A pilot trial of moderated online social therapy for family and friends of young people with borderline personality disorder features. Early Interv Psychiatry 2021; 15:1564-1574. [PMID: 33260274 DOI: 10.1111/eip.13094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022]
Abstract
AIM We evaluated the acceptability, usability and safety of Kindred, a novel online intervention for carers of young people with borderline personality disorder (BPD) using a pre-post pilot trial design. The secondary aim explored whether Kindred use was associated with clinical improvements for caregivers on measures of burden of caregiving, stress, expressed emotion, family communication, disability, coping and knowledge of BPD and for patients on measures of severity of BPD symptoms and level of functional impairment. METHODS The trial site was the Helping Young People Early program for young people with BPD at Orygen in Melbourne, Australia. Informed consent was obtained from 20 adult carers (i.e., relatives or friends) and 10 young people aged 15-25 with BPD. Kindred, which was available for 3 months, incorporated online psychoeducation, carer-to-carer social networking and guidance from expert and peer moderators. Assessments were completed at baseline and 3 months follow-up. Multiple indicators of acceptability, usability and safety were utilized. RESULTS Seventeen carers were enrolled in Kindred and eight young people completed baseline measures. A priori acceptability, usability and safety criteria were met. Carer burden, stress, expressed emotion, family communication, quality of life, functioning, coping and perceived knowledge of BPD improved at follow-up. Sixty-six percent of the young people (4/6) reported that they believed Kindred had improved their carers' understanding of BPD. CONCLUSION Kindred was shown to be acceptable, usable and safe, with encouraging improvements in both carer and young person outcomes. Kindred warrants evaluation of its efficacy via an randomized controlled trial.
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Affiliation(s)
- John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jennifer K Betts
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Louise McCutcheon
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | - Reeva Lederman
- School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Helen Herrman
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Susan M Cotton
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Sarah Bendall
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | | | | | - Peter Koval
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Jesse Smith
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Simon D'Alfonso
- Orygen, Melbourne, Australia.,School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Sumudu Mallawaarachchi
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Andrew M Chanen
- Orygen, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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Wall K, Kerr S, Sharp C. Barriers to care for adolescents with borderline personality disorder. Curr Opin Psychol 2020; 37:54-60. [PMID: 32853877 DOI: 10.1016/j.copsyc.2020.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/29/2020] [Indexed: 12/22/2022]
Abstract
Intervention for borderline personality disorder (BPD) in adolescence is crucial as early onset of the disorder predicts more severe course, and intervention 'late' in the course of the disorder is associated with more negative outcomes. In spite of this, access to services is poor. This is because several unique barriers to accessing care exist for adolescents with BPD. In this article we highlight key barriers to care for adolescents with BPD utilizing a conceptual model for understanding health care access that emphasizes the interaction between patient and health care system characteristics. We conclude with proposed recommendations to address these identified barriers.
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