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van Schie CC, Lewis K, Barr KR, Jewell M, Malcolmson N, Townsend ML, Grenyer BFS. Borderline personality disorder and stigma: Lived experience perspectives on helpful and hurtful language. Personal Ment Health 2024; 18:216-226. [PMID: 38482732 DOI: 10.1002/pmh.1609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/06/2023] [Accepted: 02/18/2024] [Indexed: 08/13/2024]
Abstract
Borderline personality disorder (BPD) is a severe mental health disorder that is subject to significant stigmatisation. With language being a key reinforcer of stigma, this co-produced study aims to explore the language use regarding BPD and its effect on those with BPD and carers. Recommendations to reduce stigmatisation are provided for both clinicians and researchers. Participants with BPD (consumer n = 33) and those supporting someone with BPD (carer n = 30) discussed their experience of hurtful and helpful language. Reflexive thematic analysis was used to analyse written and verbal responses into core conflictual relationship themes (CCRT) reflecting how different words were heard and experienced. All consumers and carers in the study reported experiences with stigmatising language. Feelings of inadequacy and frustration were common amongst consumers, specifically when they perceived others as trivialising their needs or not seeing them as a unique individual. Carers often reported feelings of frustration when they perceived others as blaming them or not acknowledging their needs. Both consumers and carers reported helpful language as being connecting, validating and accepting. Unhelpful communication patterns have negative consequences for the person's self-understanding (i.e., self-stigma) and their relationships with others, including the therapeutic alliance. A consideration of these communication patterns may foster the use of reflective positive language that is compassionate and hopeful.
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Affiliation(s)
| | - Kate Lewis
- School of Psychology and School of Education, University of Wollongong, Wollongong, NSW, Australia
| | - Karlen R Barr
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Mahlie Jewell
- Project Air Strategy Consumer and Carer Advisory Committee, Wollongong, NSW, Australia
| | - Natalie Malcolmson
- Project Air Strategy Consumer and Carer Advisory Committee, Wollongong, NSW, Australia
| | - Michelle L Townsend
- School of Psychology and School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Brin F S Grenyer
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
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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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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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Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry 2024; 23:4-25. [PMID: 38214629 PMCID: PMC10786009 DOI: 10.1002/wps.21156] [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] [Indexed: 01/13/2024] Open
Abstract
Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Personality Disorders Institute, Weill Cornell Medical College, New York, NY, USA
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Simone Salzer
- International Psychoanalytic University, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
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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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7
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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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Stiles C, Batchelor R, Gumley A, Gajwani R. Experiences of Stigma and Discrimination in Borderline Personality Disorder: A Systematic Review and Qualitative Meta-Synthesis. J Pers Disord 2023; 37:177-194. [PMID: 37002935 DOI: 10.1521/pedi.2023.37.2.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Individuals with a diagnosis of borderline personality disorder (BPD) typically experience discrimination and stigma, resulting in poor identification and delayed care. We conducted a review to examine and synthesize qualitative studies exploring experiences of stigma and discrimination among individuals with BPD. In August 2021, we systematically searched the following databases: Embase, Medline, Cochrane Library, PsycINFO, and Cinhal. We also hand searched reference lists and Google Scholar. We then synthesized studies using meta-ethnography. We included seven articles in the study, all of high or moderate quality. Five themes were identified: (1) resistance from clinicians (withholding information), (2) othering, (3) negative impact on self-image/esteem, (4) hopelessness surrounding the perceived permanency of BPD, and (5) feeling like a burden. This review highlights the need for improved understanding of BPD across health care services. We also discussed the need to introduce a standardized pathway of care across health services following a BPD diagnosis.
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Affiliation(s)
- Ciara Stiles
- NHS Greater Glasgow & Clyde, Glasgow, UK
- Ciara Stiles is now with NHS Lanarkshire
| | | | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK (A. G.)
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Guillén V, Arnal A, Pérez S, Garcia-Alandete J, Fernandez-Felipe I, Grau A, Botella C, Marco JH. Family connections in the treatment of relatives of people with eating disorders and personality disorders: study protocol of a randomized control trial. BMC Psychol 2023; 11:88. [PMID: 36998024 PMCID: PMC10064734 DOI: 10.1186/s40359-023-01138-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are serious disorders that significantly affect not only the lives of patients, but also those of their family members who often experience high levels of burden, suffering and helplessness. If, in addition to ED, the patient has a personality disorder (PD), the psychological distress experienced by family members can be devastating. However, few treatments have been developed for family members of people with ED and PD. Family Connections (FC) is a programme that has been shown to be effective for family members of people with borderline personality disorder. The overall aims of this work are: (a) to adapt FC for application to family members of patients with BPD-PD (FC: ED-PD); (b) to analyse, in a randomised controlled clinical trial, the efficacy of this programme in a Spanish population, compared to a control condition consisting of treatment as usual optimised treatment (TAU-O); (c) to analyse the feasibility of the intervention protocol; (d) to analyse whether the changes that may occur in relatives are related to improvements in the family climate and/or improvements observed in patients; and (e) to analyse the perceptions and opinions of relatives and patients about the two intervention protocols. METHODS The study uses a two-arm randomised controlled clinical trial with two experimental conditions: adaptation of FC programme (FC: ED-PD) or Treatment as usual optimised (TAU-O). Participants will be family members of patients who meet DSM-5 criteria for ED and PD or dysfunctional personality traits. Participants will be assessed before and after treatment and at one-year follow-up. The intention-to-treat principle will be used when analysing the data. DISCUSSION The results obtained are expected to confirm the effectiveness of the programme and its good acceptance by family members. Trial registration ClinicalTrials.gov Identifier: NCT05404035. Accepted: May 2022.
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Affiliation(s)
- Verónica Guillén
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain.
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain.
| | - Antonio Arnal
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain
| | - Sandra Pérez
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain
| | - Joaquín Garcia-Alandete
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain
| | - Isabel Fernandez-Felipe
- Universitat Jaume I de Castelló, Facultad de Ciencias de la Salud, Avda Sos Baynat, S/N, Castellón de la Plana, Castellón, Spain
| | - Antoni Grau
- Ita-Salud Mental, Especialistas en Salud Mental, C/Tavern, 61, 08006, Barcelona, Spain
| | - Cristina Botella
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
- Universitat Jaume I de Castelló, Facultad de Ciencias de la Salud, Avda Sos Baynat, S/N, Castellón de la Plana, Castellón, Spain
| | - José Heliodoro Marco
- Universidad de Valencia, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Avda. Blasco Ibañez, 21, CP 46010, Valencia, Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
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Abstract
IMPORTANCE Borderline personality disorder (BPD) affects approximately 0.7% to 2.7% of adults in the US. The disorder is associated with considerable social and vocational impairments and greater use of medical services. OBSERVATIONS Borderline personality disorder is characterized by sudden shifts in identity, interpersonal relationships, and affect, as well as by impulsive behavior, periodic intense anger, feelings of emptiness, suicidal behavior, self-mutilation, transient, stress-related paranoid ideation, and severe dissociative symptoms (eg, experience of unreality of one's self or surroundings). Borderline personality disorder is typically diagnosed by a mental health specialist using semistructured interviews. Most people with BPD have coexisting mental disorders such as mood disorders (ie, major depression or bipolar disorder) (83%), anxiety disorders (85%), or substance use disorders (78%). The etiology of BPD is related to both genetic factors and adverse childhood experiences, such as sexual and physical abuse. Psychotherapy is the treatment of choice for BPD. Psychotherapy such as dialectical behavior therapy and psychodynamic therapy reduce symptom severity more than usual care, with medium effect sizes (standardized mean difference) between -0.60 and -0.65. There is no evidence that any psychoactive medication consistently improves core symptoms of BPD. For discrete and severe comorbid mental disorders, eg, major depression, pharmacotherapy such as the selective serotonin reuptake inhibitors escitalopram, sertraline, or fluoxetine may be prescribed. For short-term treatment of acute crisis in BPD, consisting of suicidal behavior or ideation, extreme anxiety, psychotic episodes, or other extreme behavior likely to endanger a patient or others, crisis management is required, which may include prescription of low-potency antipsychotics (eg, quetiapine) or off-label use of sedative antihistamines (eg, promethazine). These drugs are preferred over benzodiazepines such as diazepam or lorazepam. CONCLUSIONS AND RELEVANCE Borderline personality disorder affects approximately 0.7% to 2.7% of adults and is associated with functional impairment and greater use of medical services. Psychotherapy with dialectical behavior therapy and psychodynamic therapy are first-line therapies for BPD, while psychoactive medications do not improve the primary symptoms of BPD.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Weill Cornell Medical College, Personality Disorders Institute, New York, New York
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11
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Guillén V, Bolo S, Fonseca-Baeza S, Pérez S, García-Alandete J, Botella C, Marco JH. Psychological assessment of parents of people diagnosed with borderline personality disorder and comparison with parents of people without psychological disorders. Front Psychol 2023; 13:1097959. [PMID: 36710828 PMCID: PMC9880188 DOI: 10.3389/fpsyg.2022.1097959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
BackgroundTo date, several evidence-based interventions have been created to help relatives of people with Borderline Personality Disorder (BPD), but few studies have analyzed the clinical situation of the family members. The aim of this study was twofold: (1) to explore the clinical symptomatology in a sample of parents of people diagnosed with BPD and compare them with a sample of a sample of people without a relative with a personality disorder, (2) to explore whether the parents of people diagnosed with BPD have psychopathology related to personality disorders (PD) or meet the diagnostic criteria for PD.MethodParticipants were 42 (39.6%) fathers and 64 (60.4%) were mothers and mothers (n = XX, −%) of people diagnosed with BPD, who were selected from a specialized PD unit for treatment. The sample of people without a relative with a PD was obtained from social network announcements. To test for differences between the two groups, Student’s t tests were performed for quantitative variables, and Chi-square tests were performed for categorical variables. Cohen’s d was calculated as a measure of the effect size.ResultsParents of people with BPD showed greater depressive and anxious symptomatology, higher levels of expressed emotion, and worse quality of life than the sample of people without a relative with a personality disorder. In addition, a high percentage of the parents of people diagnosed with BPD (50%) met the diagnostic criteria for different PD.ConclusionParents of people diagnosed with BPD may need psychological help in various aspects. Therapists are therefore advised to bear in mind the importance of carrying out a psychological assessment of family members and, if necessary, to offer psychological intervention. It is crucial to invite the family to be part of the treatment, since they can be part of the solution.Clinical Trial registration: ClinicalTrials.gov ID, NCT04160871 (registered November 15, 2019).
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Affiliation(s)
- Verónica Guillén
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Carlos, Spain,*Correspondence: Verónica Guillén,
| | - Sara Bolo
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Sara Fonseca-Baeza
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Sandra Pérez
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Joaquín García-Alandete
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Cristina Botella
- Ciber Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Carlos, Spain,Department of Psicología Básica, Clínica y Psicobiología, Universidad Jaime I de Castellón, Plana, Spain
| | - José Heliodoro Marco
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain,Ciber Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Carlos, Spain
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12
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Fitzgeraldson E, Kay-Lambkin F, Harding N, McNaughton KM, Triandafilidis Z, Heath J, Lyford B, Charnley J, Fitzpatrick S. Supports and Interventions for Carers of a Person with Depressive or Anxiety Symptomology: A Systematic Review. EUROPES JOURNAL OF PSYCHOLOGY 2022; 18:476-493. [PMID: 36605087 PMCID: PMC9780730 DOI: 10.5964/ejop.6407] [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: 03/24/2021] [Accepted: 09/03/2021] [Indexed: 12/05/2022]
Abstract
An increasing body of research attests to the capacity of evidence-based interventions to improve outcomes for informal carers. A review of suitable supports and interventions for carers of a person with depressive or anxiety symptomology is timely. This systematic review explores intervention suitability evidence for this carer group. Searches for relevant primary studies were conducted in six databases across a 15-year timeframe (October 2004-October 2019). Studies were assessed and compared narratively and thematically. Qualitative themes were synthesised with quantitative studies to explore the extent to which carer preferences were embedded in interventions. The initial literature search produced 13,183 studies. Six studies-three randomised controlled trials (RCTs) and three mixed-method studies-were included following a double-blinded screening process, a review of reference lists and risk of bias assessment. Included studies contributed either intervention efficacy or acceptability evidence. The synthesis of qualitative themes with quantitative studies found that carer-specific needs and targeted psychoeducation were featured in interventions from all six quantitative studies. Current evidence for appropriate supports and interventions for this carer group is limited. The review uncovers a lack of interventions for carers of a person with anxiety symptomology and limited intervention suitability evidence for carers of a person with depressive symptomology. More research is needed to explore the needs and preferences of this carer group, and how best to support them.
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Affiliation(s)
| | - Frances Kay-Lambkin
- University of Newcastle, Newcastle, Australia,NHMRC Centre for Research Excellence in Mental Health & Substance Abuse, Macquarie University, Sydney, Australia,Hunter Medical Research Institute, Newcastle, Australia,Centre for Brain and Mental Health Priority Research Centre, University of Newcastle, Newcastle, Australia,Society for Mental Health Research, Victoria, Australia,International Society for Research on Internet Interventions, Sanford, NC, USA
| | - Natasha Harding
- University of Newcastle, Newcastle, Australia,Everymind, Newcastle, Australia
| | - Kimie M. McNaughton
- University of Newcastle, Newcastle, Australia,Hunter Medical Research Institute, Newcastle, Australia,Centre for Brain and Mental Health Priority Research Centre, University of Newcastle, Newcastle, Australia
| | - Zoi Triandafilidis
- University of Newcastle, Newcastle, Australia,Centre for Brain and Mental Health Priority Research Centre, University of Newcastle, Newcastle, Australia
| | - Jacinta Heath
- Child and Adolescent Mental Health Service, Hunter New England Health, Sydney, Australia
| | - Bronte Lyford
- University of Newcastle, Newcastle, Australia,Everymind, Newcastle, Australia
| | - Janine Charnley
- University of Newcastle, Newcastle, Australia,Hunter Medical Research Institute, Newcastle, Australia,Centre for Brain and Mental Health Priority Research Centre, University of Newcastle, Newcastle, Australia,Society for Mental Health Research, Victoria, Australia
| | - Sally Fitzpatrick
- University of Newcastle, Newcastle, Australia,Everymind, Newcastle, Australia,Centre for Emotional Health, Macquarie University, Sydney, Australia
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13
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Friesen L, Gaine G, Klaver E, Burback L, Agyapong V. Key stakeholders’ experiences and expectations of the care system for individuals affected by borderline personality disorder: An interpretative phenomenological analysis towards co-production of care. PLoS One 2022; 17:e0274197. [PMID: 36137103 PMCID: PMC9499299 DOI: 10.1371/journal.pone.0274197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background The diagnosis of borderline personality disorder (BPD) consists of extreme emotional dysregulation and long-term disability when left untreated. It is associated with ineffective use of health care systems and mismanaged care in emergency departments, which can result in a revolving door phenomenon of urgent system usage, poor treatment outcomes, or patients falling out of care entirely–all of which primarily affect patients with BPD as well as their caregivers and clinicians. This crisis must be addressed with a comprehensive understanding of key stakeholder perspectives on the challenges of the system and potential solutions. Objective This study explored the perspectives of three key stakeholder groups (i.e., patients, clinicians, and caregivers) in relation to their experiences with and future expectations of the care system for those affected by BPD. Methods Four patients with BPD, three generalist clinicians with experience treating BPD, and three caregivers of individuals with BPD participated in individual semi-structured interviews. Participants were asked about their experiences with the current healthcare system and their suggestions for improvement. Responses were analyzed using interpretative phenomenological analysis. Findings In-depth analysis of the qualitative data revealed twelve shared themes and three themes that were unique to each key stakeholder group. These themes are discussed and used to inform recommendations for promising practices, policies, and training in this area. Conclusion Findings support the importance of a comprehensive mental health system approach for improving the accessibility, effectiveness, and acceptability of the management and treatment of BPD.
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Affiliation(s)
- Laura Friesen
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- * E-mail:
| | - Graham Gaine
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ellen Klaver
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lisa Burback
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Vincent Agyapong
- Addiction and Mental Health, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
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14
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Fernández-Felipe I, Guillén V, Castilla D, Navarro-Haro MV, García-Palacios A. A smartphone application of "Family Connections" to increase the use of skills and improve psychological symptoms in relatives of people with borderline personality disorder: A study protocol for a randomized controlled trial. Internet Interv 2022; 29:100546. [PMID: 35607385 PMCID: PMC9123206 DOI: 10.1016/j.invent.2022.100546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Verónica Guillén
- University of Valencia and Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
| | | | | | - Azucena García-Palacios
- Universitat Jaume I and Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
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15
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Woodbridge J, Townsend M, Reis S, Singh S, Grenyer BFS. Non-response to psychotherapy for borderline personality disorder: A systematic review. Aust N Z J Psychiatry 2022; 56:771-787. [PMID: 34525867 PMCID: PMC9218414 DOI: 10.1177/00048674211046893] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
HIGHLIGHT This is the first systematic review to investigate non-response to psychotherapy for borderline personality disorder. BACKGROUND Psychotherapy is the recommended treatment for borderline personality disorder. While systematic reviews have demonstrated the effectiveness of psychotherapy for borderline personality disorder, effect sizes remain small and influenced by bias. Furthermore, the proportion of people who do not respond to treatment is seldom reported or analysed. OBJECTIVE To obtain an informed estimate of the proportion of people who do not respond to psychotherapy for borderline personality disorder. METHODS Systematic searches of five databases, PubMed, Web of Science, Scopus, PsycINFO and the Cochrane Library, occurred in November 2020. Inclusion criteria: participants diagnosed with borderline personality disorder, treated with psychotherapy and data reporting either (a) the proportion of the sample that experienced 'reliable change' or (b) the percentage of sample that no longer met criteria for borderline personality disorder at conclusion of therapy. Exclusion criteria: studies published prior to 1980 or not in English. Of the 19,517 studies identified, 28 met inclusion criteria. RESULTS Twenty-eight studies were included in the review comprising a total of 2436 participants. Average treatment duration was 11 months using well-known evidence-based approaches. Approximately half did not respond to treatment; M = 48.80% (SD = 22.77). LIMITATIONS Data regarding within sample variability and non-response are seldom reported. Methods of reporting data on dosage and comorbidities were highly divergent which precluded the ability to conduct predictive analyses. Other limitations include lack of sensitivity analysis, and studies published in English only. CONCLUSION Results of this review suggest that a large proportion of people are not responding to psychotherapy for borderline personality disorder and that factors relating to non-response are both elusive and inconsistently reported. Novel, tailored or enhanced interventions are needed to improve outcomes for individuals not responding to current established treatments.
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Affiliation(s)
| | | | | | | | - Brin FS Grenyer
- Brin F Grenyer, Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Building 22, Wollongong, NSW 2522, Australia.
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16
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Rubió F, Navarrete J, Cebolla A, Guillén V, Jorquera M, Baños RM. Expressed Emotion and Health Care Use in Borderline Personality Disorder Patients and Relatives. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2022. [DOI: 10.1521/jscp.2022.41.3.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Expressed emotion (EE) is a global index of attitudes, emotions, and behaviors of relatives who have family members with a mental or psychiatric disorder. The objective of this cross-sectional study was to study EE in relatives and patients’ perceived EE in a borderline personality disorder (BPD) outpatient sample. Methods: The sample was composed of 134 relatives and 111 BPD outpatients who were receiving psychological treatment. Relevant clinical outcomes, number of medical visits, EE in relatives and perceived EE in BPD patients were measured. Subsequently, descriptive statistical analyses, dependent-samples t tests, and correlation analyses were performed. Results: Relatives' EE was not significantly different than patients' perceived EE. Expressed emotion factors were weakly associated to emergency department visits and hospital admissions. Discussion: Contrary to EE studies in other diagnoses, results show that the BPD patients' emotional climate in their proximate relationships might not influence health care use.
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Affiliation(s)
| | - Jaime Navarrete
- Department of Personality, Evaluation, and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Ausiàs Cebolla
- Department of Personality, Evaluation, and Psychological Treatments, Universidad de Valencia, Valencia, Spain, and CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Verónica Guillén
- Department of Personality, Evaluation, and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | | | - Rosa M. Baños
- Department of Personality, Evaluation, and Psychological Treatments, Universidad de Valencia, Valencia, Spain, and CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
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17
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Marco JH, Fonseca S, Fernandez-Felipe I, García-Palacios A, Baños R, Perez S, Garcia-Alandete J, Guillen V. Family connections vs treatment at usual optimized in the treatment of relatives of people with suicidal behavior disorder: study protocol of a randomized control trial. BMC Psychiatry 2022; 22:335. [PMID: 35570289 PMCID: PMC9107725 DOI: 10.1186/s12888-022-03965-5] [Citation(s) in RCA: 2] [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] [Received: 02/25/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relatives of people diagnosed with suicidal behavior disorder (SBD) feel guilty, afraid, hopeless, depression and anxiety. It is necessary to help the relatives of people with SBD to reduce their discomfort and burden. Family Connections (FC) is a program that has been shown to be effective in reducing burden, depression, and anxiety, and increasing dominance and validating behaviors in relatives of people with borderline personality disorder. However, there are no RCTs that demonstrate the efficacy of the FC program in patients with SBD. Our research team adapted FC for relatives of people with SBD for delivery in the Spanish population (FC-SBD). The FC-SBD program contains 12 two-hour sessions held once a week. The first aim is to verify the efficacy of the FC-SBD intervention for relatives of people diagnosed with SBD in a randomized control trial with a Spanish sample. The second objective is to analyze the feasibility and acceptance of FC-SBD in relatives. The third aim is to analyze whether the changes produced in the psychological variables in the relatives after the intervention are related to changes in the psychological variables of the patients. This paper presents the study protocol. METHODS The study design consists of a two-arm randomized controlled trial with two conditions: FC-SBD or Treatment as usual optimized (TAU-O). Participants will be relatives of patients who meet DSM-5 criteria for SBD. The caregivers` primary outcome measures will be the BAS. Secondary outcomes will be DASS-21, FES, DERS, QoL. The patient's primary outcome measures will be the frequency of critical incidents with the family member with SBD. Secondary measures will be the INQ, PHQ-9, OASIS. Participants will be assessed at pretreatment, post-treatment, and 6-month follow-up. The intention-to-treat principle will be used when analyzing the data. DISCUSSION This study will provide results that confirm the efficacy of the FC-SBD in relatives of people with SBD. These results will also confirm its good acceptance by family members and help us to find out whether it is a good program to improve the prevention of suicidal behaviors in the family environment. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05157607 . Registered 15 December 2021.
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Affiliation(s)
- José H. Marco
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España ,grid.484042.e0000 0004 5930 4615Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, España
| | - Sara Fonseca
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España
| | - Isabel Fernandez-Felipe
- grid.9612.c0000 0001 1957 9153Universitat Jaume I de Castelló, España. Facultad de Ciencias de la Salud, Avda Sos Baynat, S/N, Castellón, España
| | - Azucena García-Palacios
- grid.484042.e0000 0004 5930 4615Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, España ,grid.9612.c0000 0001 1957 9153Universitat Jaume I de Castelló, España. Facultad de Ciencias de la Salud, Avda Sos Baynat, S/N, Castellón, España
| | - Rosa Baños
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España ,grid.484042.e0000 0004 5930 4615Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, España
| | - Sandra Perez
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España
| | - Joaquín Garcia-Alandete
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España
| | - Verónica Guillen
- grid.5338.d0000 0001 2173 938XDepartamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Facultad de Psicología, España. Avda. Blasco Ibañez, 21, Valencia, España ,grid.484042.e0000 0004 5930 4615Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, España
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18
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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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19
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Marco JH, Fernandez-Felipe I, García-Alandete J, Fonseca-Baeza S, Baños RM, Garcia-Palacios A, Pérez Rodríguez S, Guillén V. Multicultural Quality of Life Index in Relatives of People With Borderline Personality Disorder. Front Psychiatry 2022; 13:897692. [PMID: 35782442 PMCID: PMC9247397 DOI: 10.3389/fpsyt.2022.897692] [Citation(s) in RCA: 2] [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] [Received: 03/16/2022] [Accepted: 04/29/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of the present study was to confirm the original factor structure of the Multicultural Quality of Life Index (MQLI) and analyze its psychometric properties in a sample of caregivers of people with borderline personality disorder (BPD). METHODS The MQLI was administered to 233 relatives of people with BPD. Participants completed the MQLI, the Depression, Anxiety and Stress Scale (DASS-21), and the Connor-Davidson Resilience Scale (CD-RISC). RESULTS Factor analysis of the relatives indicated that the MQLI generated a one-factor solution. The MQLI showed good internal consistency, ϖ = 0.91 [95% CI (0.90, 0.93)] and correlated significantly and positively with the CD-RISC (r s = 0.576) and negatively with the DASS-21 (r s = -0.583). CONCLUSION Consistent with other studies, the MQLI demonstrated feasibility, strong internal consistency, and good convergent and discriminant validity, which means it is a psychometrically robust measure for the assessment of quality of life in relatives of people with BPD. Along with other validation studies, this measure will be a useful tool for assessing quality of life in relatives of people with mental disorders.
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Affiliation(s)
- Jose Heliodoro Marco
- Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain.,CiberObn Pathophysiology of Obesity and Nutrition (CB06/03), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Fernandez-Felipe
- Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellón de la Plana, Spain
| | - Joaquín García-Alandete
- Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Sara Fonseca-Baeza
- Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Rosa M Baños
- Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain.,CiberObn Pathophysiology of Obesity and Nutrition (CB06/03), Instituto de Salud Carlos III, Madrid, Spain
| | - Azucena Garcia-Palacios
- CiberObn Pathophysiology of Obesity and Nutrition (CB06/03), Instituto de Salud Carlos III, Madrid, Spain.,Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellón de la Plana, Spain
| | - Sandra Pérez Rodríguez
- Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Verónica Guillén
- Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain.,CiberObn Pathophysiology of Obesity and Nutrition (CB06/03), Instituto de Salud Carlos III, Madrid, Spain
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20
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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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21
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Bohus M, Stoffers-Winterling J, Sharp C, Krause-Utz A, Schmahl C, Lieb K. Borderline personality disorder. Lancet 2021; 398:1528-1540. [PMID: 34688371 DOI: 10.1016/s0140-6736(21)00476-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 02/18/2021] [Indexed: 12/15/2022]
Abstract
Borderline personality disorder (BPD) is a mental disorder with a high burden on patients, family members, and health-care systems. The condition was previously regarded as untreatable, but progress in understanding and management has resulted in earlier diagnosis and better treatment outcomes. A coherent syndrome of BPD typically onsets during adolescence (after age 12 years). BPD is often preceded by or co-develops with symptoms of internalising disorders (depression and anxiety), externalising disorders (conduct problems, hyperactivity, and substance use), or both. BPD is associated with various poor outcomes, including low occupational and educational attainment, lack of long-term relationships, increased partner conflict, sexual risk-taking, low levels of social support, low life satisfaction, and increased service use. Psychotherapy is the main treatment for BPD; drug treatment is only indicated for comorbid conditions that require medication, or during a crisis if psychosocial interventions are insufficient. Awareness of BPD by non-specialists, as well as specialists, is key to appropriate early intervention.
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Affiliation(s)
- Martin Bohus
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Harvard Medical School, Boston, MA, USA
| | - Jutta Stoffers-Winterling
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Annegret Krause-Utz
- Department of Clinical Psychology, Leiden University, Leiden Institute of Brain and Cognition, Leiden, Netherlands
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany.
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22
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Jørgensen MS, Storebø OJ, Poulsen S, Simonsen E. Burden and Treatment Satisfaction among Caregivers of Adolescents with Borderline Personality Disorder. FAMILY PROCESS 2021; 60:772-787. [PMID: 33010045 DOI: 10.1111/famp.12593] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite the fact that family involvement is encouraged in early interventions for borderline personality disorder (BPD), there is a limited knowledge on the experience of caring for adolescents with BPD. This is an exploratory retrospective study nested within a randomized controlled trial that compared mentalization-based treatment (MBT) in groups to treatment as usual for adolescents with BPD. Caregivers received six MBT-Parents sessions or standard care over one year. Three months after end of treatment (EOT), 75 caregivers (35 in MBT, 40 in TAU) filled out the Burden Assessment Scale, and 71 (34 in MBT, 37 in TAU) the Family Satisfaction Survey. The adolescents filled out the Borderline Personality Features Scale for Children at baseline and after twelve months at EOT. We tested whether caregiver demographics, adolescents' severity of BPD, treatment and adolescents' dropout from treatment predicted levels of caregiver burden and satisfaction with treatment. The caregivers reported high levels of burden on the BAS (M = 40.3, SD = 12.2). Our study suggests that higher BPD severity at EOT among the adolescents predicted caregiver burden (p = .03), whereas higher baseline BPD severity predicted satisfaction with treatment (p = .04) and that biological mothers could be more burdened than other types of caregivers but also might be more satisfied with treatment. Treatment and adolescents' dropout from treatment were not related to caregiver burden or satisfaction with treatment. To help inform future research and to devise appropriate interventions for caregivers and adolescents with BPD, it is important to identify possible predictors of caregiver burden. The results of this initial exploratory study indicate that caregivers (and particularly biological mothers) of adolescents with more severe levels of BPD could be particularly vulnerable toward feelings of burden and therefore are in need of support.
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Affiliation(s)
- Mie Sedoc Jørgensen
- Child and Adolescent Psychiatry, Region Zealand, Roskilde, Denmark
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Jakob Storebø
- Child and Adolescent Psychiatry, Region Zealand, Roskilde, Denmark
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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23
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Guillén V, Díaz-García A, Mira A, García-Palacios A, Escrivá-Martínez T, Baños R, Botella C. Interventions for Family Members and Carers of Patients with Borderline Personality Disorder: A Systematic Review. FAMILY PROCESS 2021; 60:134-144. [PMID: 32304101 DOI: 10.1111/famp.12537] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Carers of patients with borderline personality disorder (BPD) experience high levels of distress. Several studies have been carried out on interventions designed to decrease their burden. However, the evidence from these studies has not been summarized. The objective of this work is to explore the clinical utility of interventions developed for family members of patients with BPD. A systematic review was conducted following the PRISMA guidelines (registration number CRD42018107318), including psychological interventions focused on relatives of patients with BPD. The following databases were used: PsycINFO, PubMed, EBSCOhost, and Web of Science. Two independent researchers reviewed the studies to determine whether the eligibility criteria were met. A total of 2,303 abstracts were identified. After duplicates had been removed, 1,746 studies were screened. Finally, 433 full-text articles were reviewed, yielding 11 studies that satisfied the inclusion criteria. Results show that these interventions with different clinical formats and settings are effective. The quality of the included studies varies, and the empirical support for these programs is still preliminary. The results help to establish a general framework for interventions specifically developed for family members of patients with BPD, but additional efforts should be made to improve the methodological quality of this field of research and more solidly determine the utility of these interventions. Given the paucity of data so far, this information may open up new lines of research to improve the effectiveness of future programs for carers of patients with BPD and help to reduce their burden.
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Affiliation(s)
- Verónica Guillén
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, València, Spain
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Amanda Díaz-García
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| | - Adriana Mira
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, València, Spain
| | - Azucena García-Palacios
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
| | - Tamara Escrivá-Martínez
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, València, Spain
| | - Rosa Baños
- Department of Personality, Evaluation, and Psychological Treatment, University of Valencia, València, Spain
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Cristina Botella
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón, Spain
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24
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Meshkinyazd A, Bordbar MF, Heydari A. Experiences of Family Caregivers of Patients with Borderline Personality Disorder of Social Stigma. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:18-24. [PMID: 33954094 PMCID: PMC8074737 DOI: 10.4103/ijnmr.ijnmr_267_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/06/2020] [Accepted: 10/07/2020] [Indexed: 11/05/2022]
Abstract
Background: Social stigma is the most common and challenging burden of care on the family of people with Borderline Personality Disorder (BPD) In Iran, despite the cultural and social influences, this issue has been less studied. Therefore, present study was conducted to determine the lived experiences of caregivers of patients with BPD of social stigma. Materials and Methods: This qualitative study was performed at Ibn Sina hospital in Mashhad, Iran from 2017 to 2019. Participants were selected by purposive and snowball sampling method. Data were collected through semi-structured interviews. Data saturation was achieved after 16 interviews. Finally, the data were analyzed by the method proposed by Diekelmann (1989). Results: In data analysis, one main theme and two sub-themes emerged. The main themes include Black shadow. Two sub-themes consisted of society dagger and secrecy. The sub-theme of society dagger included the two common meanings (inner turmoil in response to the stigma of others and weakening of family status among relatives and acquaintances). The sub-theme of secrecy comprised of the three common meanings (concealment of disease, hide hospitalization, and seclusion). Conclusions: An understanding of the experience of family stigma can lead to the development of supportive strategies to manage this problem among caregivers of patients with BPD. Nurses can support caregivers by offering them opportunities to discuss how stigma is disrupting their caregiving roles. They can also support the caregivers in negotiating the experienced social and emotional distress and when necessary, refer them to the other members of healthcare teams.
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Affiliation(s)
- Ali Meshkinyazd
- PhD Student in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Abbas Heydari
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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25
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Day NJS, Bourke ME, Townsend ML, Grenyer BFS. Pathological Narcissism: A Study of Burden on Partners and Family. J Pers Disord 2020; 34:799-813. [PMID: 30730784 DOI: 10.1521/pedi_2019_33_413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pathological narcissism is characterized by impaired interpersonal functioning, but few studies have examined the impact of the disorder on those living in a close relationship. Participants (N = 683; comprising romantic partners [77.8%], mothers [8.5%] or other family members [10%]) in a close relationship with a relative with pathological narcissism completed measures assessing levels of grief, burden, mental health, and coping style. Participants' reported burden was over 1.5 standard deviations above comparison carers of people with mood, neurotic, or psychotic disorders, and higher than carers of people with borderline personality disorder. Similarly, caseness for depression (69% of sample) or anxiety disorders (82%) in the sample was high. Relationship type, subtype expression (vulnerable/grandiose), and coping style were all found to significantly relate to experienced psychopathology. Although limitations exist regarding sample selection that may influence interpretation of results, these findings quantify the significant interpersonal impact of pathological narcissism in this sample.
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Affiliation(s)
- Nicholas J S Day
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Australia
| | - Marianne E Bourke
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Australia
| | - Michelle L Townsend
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Australia
| | - Brin F S Grenyer
- Illawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Australia
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26
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Kaufman EA, Victor SE, Hipwell AE, Stepp SD. Reciprocal Influences of Parent and Adolescent Borderline Personality Symptoms Over 3 Years. J Pers Disord 2020; 34:130-145. [PMID: 32539621 PMCID: PMC10454519 DOI: 10.1521/pedi_2020_34_483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Leading etiological theories implicate the family environment in shaping borderline personality disorder (BPD). Although a substantive literature explores familial aggregation of this condition, most studies focus on parent influence(s) on offspring symptoms without examining youth symptom influence on the parent. The current study investigated reciprocal relations between parent and adolescent BPD symptoms over time. Participants were 498 dyads composed of urban-living girls and their parents enrolled in a longitudinal cohort study (Pittsburgh Girls Study). The authors examined BPD severity scores assessed yearly when youth were ages 15-17 years in a series of cross-lagged panel models. After controlling for autoregressive effects, a measure of parent-child conflict, and an indicator of socioeconomic status, evidence of parental influence on adolescent symptoms did not emerge. However, adolescent BPD symptoms at age 16 predicted greater parent BPD symptoms at age 17 above the influence of depression. Results highlight the importance of considering the influence of youth BPD on parental symptoms.
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Affiliation(s)
- Erin A Kaufman
- University of Western Ontario, Department of Psychology, London, Ontario, Canada
| | - Sarah E Victor
- Texas Tech University, Department of Psychology, Lubbock, Texas
| | - Alison E Hipwell
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, Pennsylvania
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27
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Fernández-Felipe I, Guillén V, Marco H, Díaz-García A, Botella C, Jorquera M, Baños R, García-Palacios A. Efficacy of "Family Connections", a program for relatives of people with borderline personality disorder, in the Spanish population: study protocol for a randomized controlled trial. BMC Psychiatry 2020; 20:302. [PMID: 32539740 PMCID: PMC7296953 DOI: 10.1186/s12888-020-02708-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/01/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with borderline personality disorder (BPD) experience significant affect regulation difficulties that cause serious consequences in their work, emotional, and social environments. This dysfunctional pattern also produces great suffering and a heavy burden on their relatives. Fortunately, some studies show that treatment of relatives of people with BPD begins to be important in the patients' recovery and in improving family dynamics. One of the treatments that has obtained the most empirical support is Family connections (FC). This 12-session program is an adaptation of different Dialectical Behavior Therapy strategies. To test the efficacy of FC, five uncontrolled clinical trials were conducted, with pre-post treatment and follow-up assessments. The results of these studies and subsequent replications showed an improvement in family attitudes and caregiver burnout. Our research team adapted FC for delivery in the Spanish population. We intend to test the efficacy of this program versus a treatment as usual condition. Moreover, we aim to test the efficacy of this program and study its effectiveness (in terms of participants' acceptance). This paper presents the study protocol. METHODS The study is a randomized controlled trial. The participants will be recruited in a Personality Disorders Unit and randomly assigned to one of two treatment conditions: Family Connections group (FC) or Treatment As Usual (TAU). Primary outcome measures will be the BAS and FAD-GFS. Secondary outcomes will include DASS-21, FES, GS, and QLI. Participants' treatment acceptance and degree of satisfaction will also be measured. Participants will be assessed at pre-, post-treatment, and 6-month follow-up. Intention to treat and per protocol analyses will be performed. DISCUSSION This is the first study on FC for relatives of people with borderline personality disorder (BPD) compared to an active condition (TAU), and this is the first time relatives' and patients' data will be analyzed. In addition, it is the first study to test the efficacy of the program in Spain. This intervention could contribute to improving the efficiency and effectiveness of current treatment programs for relatives of people with BPD, help to decrease burden, and improve the family connection. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT04160871. Registered November 15th 2019.
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Affiliation(s)
| | | | | | | | | | - Mercedes Jorquera
- ITA-PREVI (Personality Disorders Centre), Castellón, Valencia and Alicante, Spain
| | - Rosa Baños
- Universidad de Valencia, Valencia, Spain
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28
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Meshkinyazd A, Heydari A, Fayyazi Bordbar M. Lived Experiences of Caregivers of Patients with Borderline Personality Disorder: A Phenomenological Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2020; 8:177-188. [PMID: 32309458 PMCID: PMC7153420 DOI: 10.30476/ijcbnm.2020.83358.1154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Having a patient with borderline personality disorder (BPD) in the family is a complicated and stressful experience. The caregivers' experiences and the problems they have in care of patient with BPD have remained unknown. The aim of this research was to explore the experiences of the caregivers while living with BPD patients in Iran. Methods This interpretive phenomenological research was performed on 10 caregivers of patients with BPD at Ibn-sina Hospital in Mashhad, Iran, in 2019. Purposeful sampling was used for sampling. Data were collected through semi-structured interviews and saturated after 16 interviews. The analysis of data was concurrently carried out using the method proposed by Diekelman (1989). The MAXQDA software (Ver.10) was used for data organization. Results The participants in this study were aged 25 to 55 years. After data analysis, three themes ("life in hell", "chain to the feet", and "black shadow of stigma") and six sub-themes ("disrupted from the life", "self-discrepancy", "care bottlenecks", "in the fence of restriction", "society dagger" and "resort to secrecy") emerged. Conclusion The results of this study showed that the caregivers of patients with BPD during the period of care were faced with a variety of problems. It is suggested that health policy-makers should pay more attention to the problems related to the mental health of caregivers.
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Affiliation(s)
- Ali Meshkinyazd
- Department of Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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