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Renneberg B, Hutsebaut J, Berens A, De Panfilis C, Bertsch K, Kaera A, Kramer U, Schmahl C, Swales M, Taubner S, Alvarez MM, Sieg J. Towards an informed research agenda for the field of personality disorders by experts with lived and living experience and researchers. Borderline Personal Disord Emot Dysregul 2024; 11:14. [PMID: 38973006 PMCID: PMC11229301 DOI: 10.1186/s40479-024-00257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/17/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND We describe a collection of themes for a research agenda for personality disorders that was originally formulated for the ESSPD Borderline Congress in 2022. METHODS Experts with lived and living experience (EE), researchers and clinicians met virtually, exchanged ideas and discussed research topics for the field of personality disorders. The experts - patients, relatives, significant others - named the topics they thought most relevant for further research in the field. These topics were presented at the ESPPD conference in October 2022. RESULTS The five top themes were: 1. Prevention, early detection and intervention, 2. Recovery beyond symptom improvement, 3. Involvement of relatives in treatment, 4. Gender dysphoria, and 5. Stigma. CONCLUSIONS In general, the topics reflect current issues and changes in societal values. Overarching aims of research on these topics are the improvement of social participation and integration in society, better dissemination of research, and better information of the general public and political stakeholders.
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Affiliation(s)
- Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany.
- German Center for Mental Health (DZPG), partner site Berlin, Berlin, Germany.
| | - Joost Hutsebaut
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Ann Berens
- Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium
- Collaborative Antwerp Psychiatric Research Institute, Universiteit Antwerp, Antwerp, Belgium
| | - Chiara De Panfilis
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Katja Bertsch
- Department of Psychology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Andres Kaera
- Department of Psychiatry, Kanta-Häme Central Hospital, Wellbeing Services County of Kanta-Häme, Hämeenlinna, Finland
| | - Ueli Kramer
- Department of Psychiatry, Institute of Psychotherapy and General Psychiatry Service, Université de Lausanne, Lausanne, Switzerland
| | - Christian Schmahl
- Department of Psychosomatic Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim, Mannheim, Germany
| | - Michaela Swales
- North Wales Clinical Psychology Programme, Bangor University, Bangor, Wales
| | - Svenja Taubner
- Institute for Psychosocial Prevention, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Mariana Mendoza Alvarez
- Scientific Initiative of Neuropsychiatric and Psychopharmacological Studies (SINAPS), University Psychiatric Centre Duffel, Duffel, Belgium
- Collaborative Antwerp Psychiatric Research Institute, Universiteit Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Julia Sieg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany
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Culina I, Ranjbar S, Maillard P, Martin-Soelch C, Berney S, Kolly S, André J, Conus P, Kramer U. Symptom domains and psychosocial functioning in borderline personality disorder. Borderline Personal Disord Emot Dysregul 2024; 11:10. [PMID: 38835094 DOI: 10.1186/s40479-024-00255-2] [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: 03/13/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is often characterized by severe functional impairment, even after a decrease in symptoms. A comprehensive understanding of psychosocial functioning in BPD is necessary to tailor treatment offer, which should address relevant aspects of daily life. The aims of the present study are to (1) conduct a cross-sectional comparison of functioning of a group with BPD and a non-BPD clinical comparison group at service entry, and to (2) assess the relationship between intensity of BPD symptom domains and psychosocial functioning. METHODS The sample consists of N = 65 participants with BPD and N = 57 participants from the clinical comparison group without BPD (non-BPD group). The Revised Borderline Follow-up Interview (BFI-R) was used to evaluate psychosocial functioning and the Revised Diagnostic Interview for Borderlines (DIB-R) to assess BPD symptoms. Linear, logistic, and multinomial regression models were run separately for each aspect of functioning as a function of BPD status or BPD symptom domains. RESULTS Only 23% of participants in the BPD group fulfilled criteria for good overall psychosocial functioning, compared to 53% in the non-BPD group. Furthermore, participants in the BPD group were less likely to have completed a high number of years of education, to work consistently, to be financially independent, to be in a cohabiting relationship and have a good relationship with parents. In addition, various links were identified between BPD symptom domains and functional impairments. CONCLUSIONS Consistent with prior research, the main impairments in functioning in the BPD group are found in the educational and vocational domains. Though some domains show impairment, others, like friendships, may act as potential resources. Further investigation on the relationships with symptom domains is required.
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Affiliation(s)
- Ines Culina
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
- Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland.
| | - Setareh Ranjbar
- Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Chantal Martin-Soelch
- Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Sylvie Berney
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Stéphane Kolly
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Jérémie André
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Philippe Conus
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Ueli Kramer
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
- Institute of Psychotherapy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Departement of Psychology, University of Windsor, Windsor, Canada
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Dhar A, Hay P, Meade T. Social and Occupational Functioning in Individuals With BPD: A Systematic Review. J Pers Disord 2023; 37:691-723. [PMID: 38038659 DOI: 10.1521/pedi.2023.37.6.691] [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: 12/02/2023]
Abstract
This systematic review aimed to explore social and occupational functioning levels in individuals with BPD and whether this varies according to symptomatic status, age, or gender. A multi-database search was conducted for articles, and of the 1164 records identified, 19 were included in this review. Of the 15 studies reporting on social functioning, 13 indicated significant levels of impairment, and of the 14 studies reporting on global functioning, all indicated significant impairment across both clinical and in-remission populations. Occupational functioning was primarily assessed as either a part of global functioning or by subscales within social functioning, highlighting a lack of use of dedicated measures for its assessment. This systematic review found that individuals with BPD experience a range of significant impairments in functioning persisting across the lifespan. Further studies are warranted to explore levels of functional impairment across all functional domains and factors associated with continual functional impairment in this population.
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Affiliation(s)
- Abhijatya Dhar
- School of Psychology, Western Sydney University, NSW, Australia
| | - Phillipa Hay
- School of Medicine, Western Sydney University, NSW, Australia
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Tanya Meade
- School of Psychology, Western Sydney University, NSW, Australia
- Translational Health Research Institute, Western Sydney University, NSW, Australia
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Kramer U, Temes CM, Frankenburg FR, Glass IV, Zanarini MC. Course and predictors of social security disability insurance in patients with borderline personality disorder over 24 years of prospective follow-up. Borderline Personal Disord Emot Dysregul 2023; 10:30. [PMID: 37807072 PMCID: PMC10561411 DOI: 10.1186/s40479-023-00236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND The utilization of Social Security Disability Insurance (SSDI) is frequent in patients with borderline personality disorder (BPD) and may represent a meaningful marker of a patient's symptom severity, poor psychosocial functioning, and/or inner suffering. Over 24 years of prospective follow-up, the present study aims to describe the course of SSDI and assess the role of clinically relevant predictors. METHODS A total of 290 inpatients with BPD were interviewed at baseline and 12 consecutive follow-up waves, each separated by two years, after index hospitalization. Included were also 72 inpatients with other personality disorders. Surviving patients were reinterviewed. A series of interviews and self-report measures were used to assess psychosocial functioning and treatment history, axis I and II disorders, and childhood/adult adversity. RESULTS Results show that rates of SSDI utilization were relatively stable over 24 years of follow-up (on average, 47.2% of the patients with BPD were on SSDI). Patients with BPD were three times more likely to be on SSDI than patients with other PDs. Patients with BPD displayed flexibility in their usage of SSDI. By 24 years, 46% of patients remitted, out of which 85% experienced recurrence and 50% of the patients had a new onset over time. In multivariate analyses, four variables were found to predict SSDI status in patients with BPD over time. These variables were: age 26 or older, lower IQ, severity of non-sexual childhood abuse, and presence of PTSD. CONCLUSIONS The results of this study suggest that a combination of a demographic factors, childhood adversity, natural endowment, and comorbidity are significant predictors of receiving SSDI over time. On a group level, there is a relative stability of SSDI usage over time, but on the individual level, the present study found a high fluctuation in receiving SSDI over 24 months of prospective follow-up.
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Affiliation(s)
- Ueli Kramer
- Department of Psychiatry, Institute of Psychotherapy and General Psychiatry Service, University of Lausanne, Place Chauderon 18, CH-1003, Lausanne, Switzerland.
| | | | - Frances R Frankenburg
- Edith Nourse Rogers VA Medical Center, Boston University School of Medicine, Boston, USA
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Zanarini MC, Hein KE, Temes CM, Frankenburg FR, Fitzmaurice GM. Pathways to Health Reported by Patients With Borderline Personality Disorder With a Good Overall Outcome Versus a Fair-Poor Outcome Over 24 Years of Prospective Follow-Up. J Pers Disord 2023; 37:456-468. [PMID: 37721779 DOI: 10.1521/pedi.2023.37.4.456] [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: 09/19/2023]
Abstract
Our objective was to determine pathways to health reported by patients with borderline personality disorder (BPD) who had and had not attained a good overall outcome over 24 years of prospective follow-up. Overall outcome symptomatically and psychosocially and 11 pathways to health related to vocation, relationships, activities, and psychiatric treatment that patients reported were helpful to their functioning or feeling better about themselves were assessed at 12 contiguous 2-year follow-up periods using a semistructured interview. Good outcome patients reported significantly higher rates of pathways related to work performance, relationships with friends, relationship with a partner/spouse, and athletic activities. In contrast, patients with a fair-poor outcome reported significantly higher rates of psychotherapy and psychotropic medication as pathways. Taken together, the results of this study suggest that a good overall outcome is significantly associated with reported vocational, interpersonal, and activity pathways, while a fair-poor outcome is significantly associated with reported treatment-related pathways.
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Affiliation(s)
- Mary C Zanarini
- McLean Hospital, Belmont, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Christina M Temes
- Harvard Medical School, Boston, Massachusetts
- Oklahoma State University, Stillwater, Oklahoma
| | | | - Garrett M Fitzmaurice
- McLean Hospital, Belmont, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Woodbridge J, Townsend ML, Reis SL, Grenyer BFS. Patient perspectives on non-response to psychotherapy for borderline personality disorder: a qualitative study. Borderline Personal Disord Emot Dysregul 2023; 10:13. [PMID: 37072881 PMCID: PMC10114439 DOI: 10.1186/s40479-023-00219-y] [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: 05/27/2022] [Accepted: 03/27/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Despite increasing evidence for the effectiveness of psychotherapy for Borderline Personality Disorder (BPD), estimates show that approximately half of those in treatment do not clinically improve or reach reliable change criteria. There are limited qualitative descriptions of treatment factors associated with non-response from the perspectives of those struggling to improve. METHOD Eighteen people (72.2% female, mean age 29.4 (SD = 8)) with experience of receiving psychotherapeutic treatment for BPD were interviewed to obtain their perspectives on hindering factors in treatment and what may be helpful to reduce non-response. The data in this qualitative study was analysed thematically. RESULTS Four domains were created from the insights patients shared on non-response and what may be needed to mitigate it. The focus of Domain 1 was that therapy cannot be effective until two factors are in place. First, the patient needs sufficient safety and stability in their environment in order to face the challenges of therapy. Second, they need to be able to access therapy. Domain 2 described factors the patients themselves contribute. The themes in this domain were described as phases that need to be progressed through before therapy can be effective. These phases were ceasing denial that help is warranted and deserved, taking responsibility for behaviours that contribute to unwellness, and committing to the hard work that is required for change. Domain 3 described how the lack of a safe alliance and ruptures in the safety of the relationship with the therapist can contribute to non-response. Domain 4 was comprised of factors that patients identified as supportive of moving through the barriers to response. The first theme in this domain was prioritising the safety of the therapy relationship. The second theme was giving a clear diagnosis and taking a collaborative approach in sessions. The final theme described the importance of focusing on practical goals with the patient to create tangible life changes. CONCLUSION This study found that non-response is complex and multifaceted. First, it is clear that systems need to be in place to support access to adequate care and foster life stability. Second, considerable effort may be needed at the engagement phase of therapy to clarify expectations. Third, attention to specific interpersonal challenges between patients and therapists is an important focus. Finally, structured work to improve relationships and vocational outcomes is indicated.
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Affiliation(s)
- Jane Woodbridge
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW, 2522, Australia
| | - Michelle L Townsend
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW, 2522, Australia
| | - Samantha L Reis
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW, 2522, Australia
| | - Brin F S Grenyer
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW, 2522, Australia.
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Gull M, Kaur N, Akhouri D. Perceived social support as related to social wellbeing in patients with Emotionally Unstable Personality Disorder (EUPD). MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00264-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Abstract
Background
People diagnosed with EUPD also known as borderline personality disorder (BPD) experience different challenges in their lives. These challenges include compulsive behavior, irritability, depression, sadness, guilt, shame, loneliness, grandiosity, and feeling of worthlessness. It is noteworthy that such challenges trigger among them a self-destructive behaviour, in addition to social isolation, and impaired social relationships. It is also found to significantly impact their physical, mental, and social wellbeing. This study is a humble attempt to examine the role of perceived social support in improving the social wellbeing of BPD outpatients. Through the purposive sampling technique, 100 BPD outpatients were selected for the study. The mean age of the participant was 25 years.
Results
It was found that perceived social support (family, friends, and significant others) plays a vital role in the wellbeing of these participants. The correlation between the two is positive as well as statistically significant. This means higher the support these patients experience from their relatives, the better is their social wellbeing.
Conclusions
This study has practical implications for counselors, clinical psychologists, and psychiatrists working in the field.
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Grenyer BFS, Townsend ML, Lewis K, Day N. To love and work: A longitudinal study of everyday life factors in recovery from borderline personality disorder. Personal Ment Health 2022; 16:138-154. [PMID: 35538561 PMCID: PMC9287094 DOI: 10.1002/pmh.1547] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
Although recovery from borderline personality disorder (BPD) is common, not all individuals improve over time. This study sought to examine the features that contribute to response or non-response for individuals at different stages of recovery from BPD over a longitudinal follow-up. Participants were individuals with a diagnosis of BPD that were followed up after 1 year of receiving psychological treatment. There were no significant differences between participants at intake across key indices; however, at 1-year follow-up, two groups were distinguishable as either 'functioning well' (n = 23) or 'functioning poorly' (n = 25) based on symptomatology and functional impairment. Participant qualitative responses were analysed thematically and via Leximancer content analysis. Thematic analysis indicated three key themes: (1) love of self and others, (2) making a contribution through work and study and (3) stability in daily life. Participants who were 'functioning well' described meaningful relationships with others, enjoyment in vocation, and described less frequent or manageable life crises. The 'functioning poorly' group described relationship conflicts, vocational challenges, feelings of aimlessness and purposelessness, instability in daily living and frequent crises. Leximancer content analysis visually depicted these divergent thematic nomological networks. Corroborating quantitative analyses indicated significant differences between these groups for social, occupational and symptom profiles. These findings highlight the centrality of achieving the capacity to 'love and work' in fostering a sense of personal recovery. Treatments may need specific focus on these factors, as they appeared to reinforce symptomatic trajectories of either improvement or poor non-response to therapy.
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Affiliation(s)
- Brin F S Grenyer
- School of Psychology, Building 22, University of Wollongong, Wollongong, New South Wales.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales
| | - Michelle L Townsend
- School of Psychology, Building 22, University of Wollongong, Wollongong, New South Wales.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales
| | - Kate Lewis
- School of Education, University of Wollongong, Wollongong, New South Wales, Australia.,Early Start, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nicholas Day
- School of Psychology, Building 22, University of Wollongong, Wollongong, New South Wales.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales
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Ikhtabi S, Pitman A, Toh G, Birken M, Pearce E, Johnson S. The experience of loneliness among people with a "personality disorder" diagnosis or traits: a qualitative meta-synthesis. BMC Psychiatry 2022; 22:130. [PMID: 35177022 PMCID: PMC8855579 DOI: 10.1186/s12888-022-03767-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Loneliness is prevalent among people with a "personality disorder" diagnosis or who have related personality traits, but the experience of loneliness among people with "personality disorder" diagnoses/traits has not been well described. A qualitative approach has potential to help understand the experience of loneliness among people with "personality disorder" diagnoses/traits, and to develop interventions that promote recovery. We therefore aimed to synthesise the qualitative literature relevant to this topic. METHOD We conducted a meta-synthesis of qualitative studies exploring the subjective experience of loneliness as reported by people with "personality disorder" diagnoses/traits. We searched four databases using pre-formulated search terms, selected eligible articles, appraised the quality of each, and analyzed data from eligible studies using thematic synthesis. RESULT We identified 39 articles that described the experience of loneliness in people with "personality disorder" diagnoses/traits. From extracted data, we identified seven themes: (1) disconnection and emptiness: a "haunting alienation", (2) alienation arising from childhood experiences, (3) thwarted desire for closeness and connection, (4) paradox: for both closeness and distance, (5) experiences of existential loneliness, (6) recovery, embedded in a social world, and (7) group therapy: a setback. Our results suggest that for our sample early alienating and traumatic experiences may pave the way for experiences of loneliness, which further exacerbate "personality disorder" symptoms and distress. CONCLUSION Despite describing a need to belong and efforts to cope with unmet social needs, people with "personality disorder" diagnoses/traits (particularly "emotionally unstable personality disorder") report experiencing an intense disconnection from other people. This seems rooted in early adversities, reinforced by later traumatic experiences. Given the apparent salience of loneliness to people with "personality disorder" diagnoses/traits, interventions focused on helping people connect with others, which may include both psychological and social components, have potential to be beneficial in reducing loneliness and promoting recovery.
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Affiliation(s)
| | - Alexandra Pitman
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
| | - Gigi Toh
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK
| | - Mary Birken
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK
| | - Eiluned Pearce
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201UCL Division of Psychiatry, London, UK ,grid.450564.60000 0000 8609 9937Camden and Islington NHS Foundation Trust, London, UK
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Wibbelink CJM, Arntz A, Grasman RPPP, Sinnaeve R, Boog M, Bremer OMC, Dek ECP, Alkan SG, James C, Koppeschaar AM, Kramer L, Ploegmakers M, Schaling A, Smits FI, Kamphuis JH. Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy. BMC Psychiatry 2022; 22:89. [PMID: 35123450 PMCID: PMC8817780 DOI: 10.1186/s12888-021-03670-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated. METHODS The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being. DISCUSSION The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on "Which treatment - DBT or ST - works the best for which BPD patient, and why?", which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments). TRIAL REGISTRATION Netherlands Trial Register, NL7699 , registered 25/04/2019 - retrospectively registered.
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Affiliation(s)
- Carlijn J. M. Wibbelink
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Arnoud Arntz
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Raoul P. P. P. Grasman
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Roland Sinnaeve
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, Mind Body Research, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Michiel Boog
- grid.491189.cDepartment of Addiction and Personality, Antes Mental Health Care, Max Euwelaan 1, Rotterdam, 3062 MA the Netherlands ,grid.6906.90000000092621349Institute of Psychology, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands
| | - Odile M. C. Bremer
- grid.491093.60000 0004 0378 2028Arkin Mental Health, NPI Institute for Personality Disorders, Domselaerstraat 128, Amsterdam, 1093 MB the Netherlands
| | - Eliane C. P. Dek
- grid.491389.ePsyQ Personality Disorders Rotterdam-Kralingen, Max Euwelaan 70, Rotterdam, 3062 MA the Netherlands
| | | | - Chrissy James
- grid.420193.d0000 0004 0546 0540Department of Personality Disorders, Outpatient Clinic De Nieuwe Valerius, GGZ inGeest, Amstelveenseweg 589, Amsterdam, 1082 JC the Netherlands
| | | | - Linda Kramer
- grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Stationsplein 138, 1703 WC Heerhugowaard, the Netherlands
| | - Maria Ploegmakers
- grid.491369.00000 0004 0466 1666Pro Persona, Siependaallaan 3, Tiel, 4003 LE the Netherlands
| | - Arita Schaling
- grid.491369.00000 0004 0466 1666Pro Persona, Willy Brandtlaan 20, Ede, 6716 RR the Netherlands
| | - Faye I. Smits
- grid.468622.c0000 0004 0501 8787GGZ Rivierduinen, Sandifortdreef 19, Leiden, 2333 ZZ the Netherlands
| | - Jan H. Kamphuis
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
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Sheridan Rains L, Echave A, Rees J, Scott HR, Lever Taylor B, Broeckelmann E, Steare T, Barnett P, Cooper C, Jeynes T, Russell J, Oram S, Rowe S, Johnson S. Service user experiences of community services for complex emotional needs: A qualitative thematic synthesis. PLoS One 2021; 16:e0248316. [PMID: 33914750 PMCID: PMC8084224 DOI: 10.1371/journal.pone.0248316] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a recognised need to develop clear service models and pathways to provide high quality care in the community for people with complex emotional needs, who may have been given a "personality disorder" diagnosis. Services should be informed by the views of people with these experiences. AIMS To identify and synthesise qualitative studies on service user experiences of community mental health care for Complex Emotional Needs. METHODS We searched six bibliographic databases for papers published since 2003. We included peer reviewed studies reporting data on service user experiences and views about good care from community-based mental health services for adults with CEN, including generic mental health services and specialist "personality disorder" services. Studies using any qualitative method were included and thematic synthesis used to identify over-arching themes. RESULTS Forty-seven papers were included. Main themes were: 1) The need for a long-term perspective on treatment journeys; 2) The need for individualised and holistic care; 3) Large variations in accessibility and quality of mental health services; 4) The centrality of therapeutic relationships; 5) Impacts of 'personality disorder' diagnosis. Themes tended to recur across studies from different countries and years. DISCUSSION Recurrent major themes included wanting support that is individualised and holistic, provides continuity over long journeys towards recovery, and that is delivered by empathetic and well-informed clinicians who are hopeful but realistic about the prospects of treatment. Care that met these simple and clearly stated priorities tended to be restricted to often limited periods of treatment by specialist "personality disorder" services: generic and primary care services were often reported as far from adequate. There is an urgent need to co-design and test strategies for improving long-term support and treatment care for people with "personality disorders" throughout the mental health care system.
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Affiliation(s)
- Luke Sheridan Rains
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Athena Echave
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jessica Rees
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Billie Lever Taylor
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Eva Broeckelmann
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Thomas Steare
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
| | - Phoebe Barnett
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Chris Cooper
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Tamar Jeynes
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jessica Russell
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Sian Oram
- Health Service and Population Research Department, NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Sarah Rowe
- Division of Psychiatry, University College London, London, United Kingdom
| | - Sonia Johnson
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
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Esposito G, Perla V, Passeggia R, Fertuck E, Mergenthaler E. Reflective functioning and personal recovery process of users with borderline personality disorder on Instagram: an explorative study using computerized and thematic analysis. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:463. [PMID: 33585291 PMCID: PMC7875072 DOI: 10.4081/ripppo.2020.463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/12/2020] [Indexed: 11/30/2022]
Abstract
Although recent literature has stated that mentalizing (or reflective functioning; RF) promoted the clinical recovery (symptomatic remission; CR) of individuals with borderline personality disorder (BPD), to our knowledge, there have been no studies that analyzed the relationship between RF and a process more complex than CR, namely personal recovery (PR) - a deep and unique process of change in one's attitudes, values, feelings, goals and/or roles. Furthermore, while there have been a few studies concerning PR of BPD individuals, but to date none analyzed PR of BPD individuals through online narratives shared on social media platforms. This study investigates the relationship between RF and PR of 14 Instagram users with a selfreported diagnosis of BPD. Two groups of users were distinguished on the basis of hashtags, #bpd and #bpdrecovery. Seventy randomized text posts (5 from each user) were extracted from users' profiles: 35 from the #bpd group and 35 from #bpdrecovery. Two methods of analysis were applied: i) a thematic analysis, by using the theoretical framework CHIME, which identifies five dimensions of PR; and ii) a stylistic analysis of RF utilizing computerized reflective functioning (CRF), which identifies RF lexical markers. Results indicate that the #bpdrecovery group presented more dimensions of PR, and that its posts showed a significantly higher RF than the #bpd group. These findings suggest that RF could be involved in the PR of BPD individuals, thus mentalization-based treatment could be effective in supporting PR processes and enhancing the impaired RF in BPD users even in the online context.
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Affiliation(s)
| | - Viviana Perla
- Department of Humanities, University of Naples Federico II, Italy
| | | | - Erik Fertuck
- City University of New York Graduate Center, New York, NY, USA
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13
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Milasan LH, Bingley AF, Fisher NR. The big picture of recovery: a systematic review on the evidence of photography-based methods in researching recovery from mental distress. Arts Health 2020; 14:165-185. [PMID: 33252304 DOI: 10.1080/17533015.2020.1855453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: In the context of a growing body of literature on incorporating visual media in researching well-being and mental health, this systematic review examined the evidence of using photography-based research methods in exploring recovery from mental distress, their outcomes, but also limitations and challenges encountered by researchers.Methodology: Six cross-disciplinary electronic databases (CINAHL, MEDLINE, Web of Science, Scopus, PsycINFO, Arts & Humanities) were systematically searched resulting in a total of 15 qualitative and mixed-methods studies included in a thematic synthesis.Results: Photo-elicitation and photovoice were identified as the main photographic methods employed in recovery research along with less common, but nonetheless creative, techniques. Four key themes were identified through thematic analysis in photography-based recovery studies: enhanced understanding, collaboration and empowerment, situatedness, and storytelling. The results of this review revealed photography as a valuable methodological tool with potential to contribute to conceptualising recovery from the stance of research participants, but also facilitate and support their recovery processes.Conclusions: Recovery research can benefit from the use of photographic methods that are widely accessible, versatile, and interactive. They may offer mental health researchers alternative ways to explore individuals' perspective on recovery in ways that are creative, empowering, and supportive of their recovery.
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Affiliation(s)
- Lucian H Milasan
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Amanda F Bingley
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Naomi R Fisher
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
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14
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Martin K, Holz T, Woodward G, Cameron M. Exploring the Impact of a Peer-Led Education Group for Loved Ones of Individuals with Borderline Personality Disorder: A Pilot Study. CONTEMPORARY FAMILY THERAPY 2020. [DOI: 10.1007/s10591-020-09543-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Larivière N, Gauthier-Boudreault C, Morin P, Boyer R. Les visions du rétablissement dans des services résidentiels en santé mentale d’une région québécoise. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1070241ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectif À la suite d’une réorganisation dans le secteur de l’hébergement en santé mentale dans une région québécoise, cette étude descriptive a évalué l’intégration des principes de rétablissement selon des utilisateurs de services (n = 25), des responsables de milieux d’hébergement (n=19) et des professionnels de la santé et de services sociaux (n = 30).
Méthode La version française du Recovery Self-Assessment a été remplie par tous. Les utilisateurs de services ont également rempli l’Échelle de satisfaction envers les domaines de la vie. Des questions qualitatives supplémentaires écrites ont été posées.
Résultats La plupart des utilisateurs de services étaient globalement satisfaits de leur résidence actuelle, mais ont noté que les options d’intervention et aborder les besoins sexuels pourraient être améliorés. Les intervenants considèrent qu’il y a une intégration significativement plus faible des différentes dimensions du rétablissement que les deux autres groupes (p < 0,001). Les trois groupes ont indiqué que les utilisateurs de services devraient être davantage impliqués dans la planification des services en résidence.
Conclusion L’intégration des points de vue a mis en lumière le besoin de travailler de façon collaborative pour soutenir le processus de rétablissement dans les milieux d’hébergement et impliquer davantage les personnes utilisatrices de services.
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Affiliation(s)
- Nadine Larivière
- Erg., Ph. D., École de réadaptation, Université de Sherbrooke ; Institut universitaire de première ligne en santé et services sociaux, Sherbrooke
| | | | - Paul Morin
- Ph. D., École de service social, Université de Sherbrooke ; Institut universitaire de première ligne en santé et services sociaux, Sherbrooke
| | - Richard Boyer
- Ph. D., Faculté de médecine, Université de Montréal ; Institut universitaire de santé mentale de Montréal
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16
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Zeitler ML, Bohus M, Kleindienst N, Knies R, Ostermann M, Schmahl C, Lyssenko L. How to Assess Recovery in Borderline Personality Disorder: Psychosocial Functioning and Satisfaction With Life in a Sample of Former DBT Study Patients. J Pers Disord 2020; 34:289-307. [PMID: 30179577 DOI: 10.1521/pedi_2018_32_394] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Longitudinal studies provide substantial evidence for a high rate of symptomatic remission in borderline personality disorder (BPD), while social and vocational functioning seems to remain consistently impaired. Less data is available on recovery and the associated objective and personal indicators. We examined 58 patients 12-18 years after their diagnosis of BPD and compared two different recovery criteria: observer-based global assessment of functioning and self-rated satisfaction with life (SWL). Symptomatic remission was observed in 81% of the participants (according to DSM-IV), but only 44% of them achieved a GAF level > 60, and only 49% reported SWL within the range of one standard deviation of the normal population. In line with previous research, our data show that DSM symptom remission alone is an insufficient indicator for recovery from BPD. Replacing the GAF with patient-reported satisfaction with life considers empowerment in BPD and offers an efficient alternative criterion for recovery.
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Affiliation(s)
- Marie-Luise Zeitler
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
| | - Martin Bohus
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany.,Department of Health, Antwerp University, Antwerp, Belgium
| | - Nikolaus Kleindienst
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
| | - Rebekka Knies
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
| | - Miriam Ostermann
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatics and Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University.,Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lisa Lyssenko
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Heidelberg, Germany
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Lamont E, Dickens GL. Mental health services, care provision, and professional support for people diagnosed with borderline personality disorder: systematic review of service-user, family, and carer perspectives. J Ment Health 2019; 30:619-633. [DOI: 10.1080/09638237.2019.1608923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Emma Lamont
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Geoffrey L. Dickens
- Division of Mental Health Nursing and Counselling, Abertay University, Dundee, UK
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18
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Dean R, Siddiqui S, Beesley F, Fox J, Berry K. Staff perceptions of borderline personality disorder and recovery: A Q-sort method approach. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 57:473-490. [PMID: 29659031 DOI: 10.1111/bjc.12180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/21/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study was the first to explore how staff that work with people diagnosed with borderline personality disorder (BPD) perceive recovery in this client group. These views are important because of the crucial role that staff play in the care of people with BPD, and the challenges that staff experience with these clients. DESIGN A Q methodology design was used, containing 58 statements about recovery. METHODS Twenty-nine mental health staff sorted recovery statements according to perceived importance to recovery in BPD. RESULTS There were two different viewpoints about recovery in BPD. A medically oriented group viewed coping with symptoms and behaviours specific to BPD as being most important to recovery, whereas participants who were more well-being oriented viewed achieving overall well-being that was universally valued regardless of diagnosis as more important. Both groups reported that engaging in socially valued activities such as work and education was not an important aspect of recovery and that people with BPD could be considered to have recovered despite continued impairments in everyday functioning. CONCLUSIONS Staff perceptions of recovery in BPD can differ, which poses risks for consistent team working, a particularly important issue in this client group due to the relational difficulties associated with the diagnosis. Multidisciplinary teams working with people diagnosed with BPD therefore need to find a forum to promote a shared understanding of each patient's needs and support plans. We advocate that team formulation is a promising approach to achieve more consistent ways of working within teams. PRACTITIONER POINTS Findings Multidisciplinary teams working with people with borderline personality disorder should use team formulations to create a shared understanding of individual patient's needs and goals for recovery, so they can deliver a consistent approach to care. Recovery questionnaires should be used to develop an understanding of a patient's individual recovery goals. Limitations Opportunity sampling was utilized in recruitment, and the sample was not representative of the general population of staff working with borderline personality disorder. Although views from a wide range of professions were sampled in this research, the views of psychiatrists were not represented.
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Affiliation(s)
- Rebecca Dean
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | | | | | - John Fox
- Doctoral Programme in Clinical Psychology, School of Psychology, Cardiff University, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
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19
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Duarte J, Fischersworring M, Martínez C, Tomicic A. "I couldn't change the past; the answer wasn't there": A case study on the subjective construction of psychotherapeutic change of a patient with a Borderline Personality Disorder diagnosis and her therapist. Psychother Res 2017; 29:445-462. [PMID: 28774224 DOI: 10.1080/10503307.2017.1359426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Qualitative research has provided knowledge about the subjective experiences of therapists and patients regarding the psychotherapy process and its results. Only few studies have attempted to integrate both perspectives, considering the influence of a patient's characteristics and diagnosis in the construction of this experience. AIM To identify aspects of psychotherapy that contribute to therapeutic change based on the experience of a patient and her therapist, and to construct an integrated comprehension of the change process of a patient with Borderline Personality Disorder. METHOD A single case was used to carry out a qualitative analysis of follow-up interviews of the participants of a long-term psychotherapy. Two qualitative approaches were combined into a model entitled "Discovery-Oriented Biographical Analysis" to reconstruct an integrated narrative. RESULTS This method yielded an integrated narrative organized into four "chapters" that reflect the subjective construction of both the patient's and the therapist's experience of psychotherapy in terms of meaning. DISCUSSION The understanding of psychotherapy as a multilevel process, in which different themes occur and develop simultaneously, is discussed. From this perspective, psychotherapy can be characterized as a process that involves the recovery of trust in others through corrective emotional experiences and the construction of a shared implicit relational knowledge. Clinical or methodological significance of this article: Research on the subjective experiences of psychotherapy must consider both patient and therapist as privileged but always complementary witnesses of their interaction. In addition, it should be noted that the experience of studying this biographical reconstruction generates a space where research and practice converge. The analysis of participants' narratives provides fascinating windows into their perceptions of psychotherapy and the process of change (Safran, 2013); here, the researcher is not merely a advantaged observer or a good summarizer: He/she has the chance to imbue the psychotherapy with a new meaning by connecting it with a common set of knowledge and a body of socially shared experience.
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Affiliation(s)
- Javiera Duarte
- a Faculty of Medicine and Faculty of Social Sciences , Universidad de Chile , Santiago , Chile.,b Millennium Institute for Depression and Personality Research (MIDAP) , Santiago , Chile
| | - Martina Fischersworring
- a Faculty of Medicine and Faculty of Social Sciences , Universidad de Chile , Santiago , Chile.,b Millennium Institute for Depression and Personality Research (MIDAP) , Santiago , Chile
| | - Claudio Martínez
- b Millennium Institute for Depression and Personality Research (MIDAP) , Santiago , Chile.,c Faculty of Psychology , Universidad Diego Portales , Santiago , Chile
| | - Alemka Tomicic
- b Millennium Institute for Depression and Personality Research (MIDAP) , Santiago , Chile.,c Faculty of Psychology , Universidad Diego Portales , Santiago , Chile
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Katsakou C, Pistrang N, Barnicot K, White H, Priebe S. Processes of recovery through routine or specialist treatment for borderline personality disorder (BPD): a qualitative study. J Ment Health 2017; 28:604-612. [DOI: 10.1080/09638237.2017.1340631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Christina Katsakou
- Tower Hamlets Psychological Therapies Service, East London NHS Foundation Trust, London, UK,
| | - Nancy Pistrang
- Department of Clinical, Educational and Health Psychology, University College London, London, UK,
| | - Kirsten Barnicot
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK,
| | - Hayley White
- Therapeutic Community and Outreach Service, Hackney, East London NHS Foundation Trust, London, UK, and
| | - Stefan Priebe
- Unit for Social & Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Service Development, Queen Mary University of London, London, UK
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21
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Katsakou C, Pistrang N. Clients’ experiences of treatment and recovery in borderline personality disorder: A meta-synthesis of qualitative studies. Psychother Res 2017; 28:940-957. [DOI: 10.1080/10503307.2016.1277040] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Christina Katsakou
- a Department of Clinical, Educational and Health Psychology , University College London , London , UK
| | - Nancy Pistrang
- a Department of Clinical, Educational and Health Psychology , University College London , London , UK
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22
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Larivière N, Denis C, Payeur A, Ferron A, Levesque S, Rivard G. Comparison of Objective and Subjective Life Balance Between Women With and Without a Personality Disorder. Psychiatr Q 2016; 87:663-673. [PMID: 26875106 DOI: 10.1007/s11126-016-9417-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Life balance is associated to health, well-being and quality of life and is a target of psychiatric rehabilitation interventions. However, little is known about this life dimension in women living with personality disorders. The purpose of this descriptive-correlational study was to compare and explore relationships between subjective life balance, objective time use, quality of life and perceived stress in women without a mental health disorder (n = 43) and women with a personality disorder (clusters B and C) (n = 30), aged between 18 and 50 years old. The variables were measured with the Life Balance Inventory (subjective life balance), the Occupational Questionnaire (objective time use), the Depression Anxiety Stress Scale (perceived stress) and the Quality of Life Index (satisfaction and importance with life domains). The analyses showed that women with a personality disorder spend significantly less time in work but more time in daily tasks and leisure. Subjective life balance, quality of life and perceived stress were significantly lower in women with a personality disorder (p < 0.05). In women with a personality disorder, subjective life balance was explained by quality of life (R2 = 27.5 %). In women without a mental illness, subjective life balance was explained by quality of life and motherhood (R2 = 36.1 %). To support the recovery of women with personality disorders and their quality of life, it is important to address objective and subjective time use to enable accomplishment of a variety of meaningful activities.
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Affiliation(s)
- Nadine Larivière
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, J1H 5N4, Canada.
| | - Catherine Denis
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, J1H 5N4, Canada
| | - Amélie Payeur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, J1H 5N4, Canada
| | - Amélie Ferron
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, J1H 5N4, Canada
| | - Stéphanie Levesque
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, J1H 5N4, Canada
| | - Guillaume Rivard
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, J1H 5N4, Canada
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23
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Ng FYY, Bourke ME, Grenyer BFS. Recovery from Borderline Personality Disorder: A Systematic Review of the Perspectives of Consumers, Clinicians, Family and Carers. PLoS One 2016; 11:e0160515. [PMID: 27504634 PMCID: PMC4978398 DOI: 10.1371/journal.pone.0160515] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/20/2016] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Longitudinal studies support that symptomatic remission from Borderline Personality Disorder (BPD) is common, but recovery from the disorder probably involves a broader set of changes in psychosocial function over and above symptom relief. A systematic review of literature on both symptomatic and personal recovery from BPD was conducted including the views of consumers, clinicians, family and carers. MATERIALS AND METHODS A PRISMA guided systematic search identified research examining the process of recovery from BPD. Longitudinal studies with a follow-up period of five or more years were included to avoid treatment effects. RESULTS There were 19 studies, representing 11 unique cohorts (1,122 consumers) meeting the review criteria. There was a limited focus on personal recovery and the views of family and carers were absent from the literature. Rates of remission and recovery differ depending upon individual and methodological differences between studies. Data on symptomatic remission, recurrence and diagnosis retainment suggests that BPD is a stable condition, where symptomatic remission is possible and the likelihood of recurrence following a period of remission is low. CONCLUSION Symptomatic remission from BPD is common. However, recovery including capacities such as engaging in meaningful work was seldom described. Future research needs broader measures of recovery as a sub-syndromal experience, monitoring consumer engagement in meaningful vocation and relationships, with or without the limitations of BPD.
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Affiliation(s)
- Fiona Y. Y. Ng
- School of Psychology, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marianne E. Bourke
- School of Psychology, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brin F. S. Grenyer
- School of Psychology, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- * E-mail:
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Grambal A, Prasko J, Kamaradova D, Latalova K, Holubova M, Sedláčková Z, Hruby R. Quality of life in borderline patients comorbid with anxiety spectrum disorders - a cross-sectional study. Patient Prefer Adherence 2016; 10:1421-33. [PMID: 27536074 PMCID: PMC4975144 DOI: 10.2147/ppa.s108777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Borderline personality disorder (BPD) significantly reduces the quality of life (QoL) in mental, social, and work domains. Patients with BPD often suffer from depressive anxiety symptoms. The purpose of this cross-sectional study was to compare the QoL and demographic and clinical factors of inpatients diagnosed with BPD and comorbid anxiety spectrum disorders, and healthy controls. METHODS Ninety-two hospitalized patients treated in the psychotherapeutic department and 40 healthy controls were included. Subjects were assessed by the Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), Dissociative Experiences Scale, Beck Depression Inventory (BDI)-II, Beck Anxiety Inventory, Clinical Global Impression, demographic questionnaire, Sheehan Disability Scale (SDS), and Sheehan Anxiety Scale. RESULTS BPD patients suffered from comorbid anxiety disorders, panic disorder (18.5%), social phobia (20.7%), generalized anxiety disorder/mixed anxiety depression disorder (17.4%), adjustment disorder (22.8%), and posttraumatic stress disorder (8.7%); 19.6% patients had two or more anxiety disorder comorbidities. Patients score in Q-LES-Q (general) was 36.24±9.21, which was significantly lower in comparison to controls (57.83±10.21) and similar in all domains (physical health, feelings, work, household, school/study, leisure, social activities). The subjective level of depression measured by BDI and SDS (social life and family subscales) negatively correlated with all Q-LES-Q domains. CONCLUSION Patients suffering from BPD and comorbid anxiety disorders have a lower level of QoL compared to healthy controls in all measured domains. Negative correlations of the Q-LES-Q domains with clinical scales (Dissociative Experiences Scale, BDI, Beck Anxiety Inventory, Sheehan Anxiety Scale, Clinical Global Impression, and SDS) are noticeable.
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Affiliation(s)
- Ales Grambal
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
- Correspondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, IP Pavlova 6, 77520 Olomouc, Czech Republic, Tel +420 603 414 930, Email
| | - Dana Kamaradova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
| | - Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
| | - Michaela Holubova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
- Department of Psychiatry, Hospital Liberec, Liberec
| | - Zuzana Sedláčková
- Department of Psychology, Faculty of Arts, Palacky University Olomouc, Olomouc, Czech Republic
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