Symptom, alexithymia and self-image outcomes of Mentalisation-based treatment for borderline personality disorder: a naturalistic study.
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SUBMITTER: Lof J
PROVIDER: S-EPMC5996479 | biostudies-literature | 2018 Jun
REPOSITORIES: biostudies-literature
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Symptom, alexithymia and self-image outcomes of Mentalisation-based treatment for borderline personality disorder: a naturalistic study.
Löf J J Clinton D D Kaldo V V Rydén G G
BMC psychiatry 20180611 1
<h4>Background</h4>Mentalisation-based treatment (MBT) in borderline personality disorder (BPD) has a growing evidence base, but there is a lack of effectiveness and moderator studies. The present study examined the effectiveness of MBT in a naturalistic setting and explored psychiatric and psychological moderators of outcome.<h4>Method</h4>Borderline and general psychiatric symptoms, suicidality, self-harm, alexithymia and self-image were measured in a group of BPD patients (n = 75) receiving M ...[more]
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Project description:BackgroundNumerous theories posit different core features to borderline personality disorder (BPD). Recent advances in network analysis provide a method of examining the relative centrality of BPD symptoms, as well as examine the replicability of findings across samples. Additionally, despite the increase in research supporting the validity of BPD in adolescents, clinicians are reluctant to diagnose BPD in adolescents. Establishing the replicability of the syndrome across adolescents and adults informs clinical practice and research. This study examined the stability of BPD symptom networks and centrality of symptoms across samples varying in age and clinical characteristics.MethodsCross-sectional analyses of BPD symptoms from semi-structured diagnostic interviews from the Collaborative Longitudinal Study of Personality Disorders (CLPS), the Methods to Improve Diagnostic Assessment and Service (MIDAS) study, and an adolescent clinical sample. Network attributes, including edge (partial association) strength and node (symptom) expected influence, were compared.ResultsThe three networks were largely similar and strongly correlated. Affective instability and identity disturbance emerged as relatively central symptoms across the three samples, and relationship difficulties across adult networks. Differences in network attributes were more evident between networks varying both in age and in BPD symptom severity level.ConclusionsFindings highlight the relative importance of affective, identity, and relationship symptoms, consistent with several leading theories of BPD. The network structure of BPD symptoms appears generally replicable across multiple large samples including adolescents and adults, providing further support for the validity of the diagnosis across these developmental phases.
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Project description:BackgroundStudies on adults suggest that the presence of comorbid depression and Borderline Personality Disorder (BPD) is associated with an elevated risk of self-harming behaviours and that self-harming behaviours, when present, will have higher severity. This comorbidity, furthermore, complicates clinical assessments, which may be an obstacle to early identification and proper intervention. Adolescents who self-harm frequently report high levels of depressive symptoms, but this is often not reflected in the clinicians' assessment. BPD is still a controversial diagnosis in young people, and less is known about the clinical significance of comorbid BPD in adolescent populations.The purpose of the present study was to examine the impact of BPD on the assessment and course of self-reported and clinician-rated depression in self-harming adolescents before and after a treatment period of 19 weeks. We hypothesized that, compared to adolescents without BPD, adolescents with BPD would self-report higher levels of depression at baseline, and that they would have less reduction in depressive symptoms.MethodsA total of 39 adolescents with depressive disorders and BPD-traits participating in a randomised controlled trial on treatment of self-harm with Dialectical Behaviour Therapy adapted for Adolescents or enhanced usual care were included. Adolescents with full-syndrome BPD (n = 10) were compared with adolescents with sub-threshold BPD (n = 29) with respect to their self-reported and clinician-rated depressive symptoms, suicidal ideation and global level of functioning at baseline, and after 19 weeks of treatment (end of trial period).ResultsAt baseline, adolescents with full-syndrome BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation compared to adolescents with sub-threshold BPD, whereas the two groups were rated as equally depressed by the clinicians. At trial completion, all participants had a significant reduction in suicidal ideation, however, adolescents with BPD had a poorer treatment outcome in terms of significantly higher levels of clinician-rated and self-reported depressive symptoms and significantly lower levels of global functioning. At baseline as well as at trial completion, self-reported and clinician-rated levels of depressive symptoms were not significantly correlated in adolescents with BPD. In a multiple linear regression analysis, a diagnosis of BPD and a high baseline level of clinician-rated depressive symptoms predicted higher levels of depressive symptoms at trial completion, whereas receiving Dialectical Behaviour Therapy predicted lower levels of depressive symptoms.ConclusionOur findings suggest that a diagnosis of BPD may have a strong impact on the assessment and course of depressive symptoms in self-harming adolescents. Although rated as equally depressed, adolescents with BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation at baseline, and showed a poorer outcome in terms of higher levels of depressive symptoms and lower levels of global functioning at trial completion compared to adolescents with sub-threshold BPD. Our findings suggest that receiving Dialectical Behaviour Therapy could lead to a greater reduction in depressive symptoms, although firm conclusions cannot be drawn given the limited sample size.Clinicians should be aware of the possibility of underestimating the severity of depression in the context of emotional and behavioral dysregulation. Providing BPD specific treatments seems to be important to achieve sufficient treatment response with regard to depressive symptoms in adolescents with BPD-traits.Trial registrationTreatment for Adolescents With Deliberate Self Harm; NCT00675129, registered May 2008.
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Project description:ImportanceA decline in nonsuicidal self-injury (NSSI) behavior is often viewed as an indication of mental health improvement when treating adolescents and young adults with borderline personality pathology. However, evidence shows that an initial decrease in NSSI behavior does not always signal recovery, and potential symptom shifting needs to be considered.ObjectiveTo examine the codevelopment of NSSI and substance use in adolescents and young adults receiving treatment for NSSI behavior and to explore whether shifting from NSSI behavior to substance use is associated with emerging or persistent borderline personality pathology.Design, setting, and participantsThis cohort study used data from the AtR!Sk study. The study included a consecutive sample of adolescents and young adults with NSSI behavior who presented to a specialized outpatient clinic for early intervention of borderline personality pathology. A baseline assessment (between May 3, 2016, and December 19, 2019) and 2 annual follow-up assessments were conducted. Data were analyzed from April 15, 2023, to September 5, 2024.Main outcomes and measuresThe frequencies of NSSI behavior and substance use were self-reported. Diagnostic interviews were carried out to assess borderline personality pathology. Growth mixture models were specified to identify latent classes with different joint trajectories of NSSI behavior and substance use, and the classes were compared for the number of fulfilled borderline personality disorder (BPD) diagnostic criteria.ResultsOverall, 277 adolescents and young adults (249 [89.9%] female; mean [SD] age at baseline, 14.9 [1.5] years) were included in the study (number at first follow-up, 135; number at second follow-up, 82). Three latent classes were extracted from the data. A decline in NSSI behavior following treatment was common. Class 1 (estimated class count: 32.5; 11.7% of participants) was further characterized by a decline in substance use; class 2 (210.1; 75.9% of participants), by a moderate increase in substance use; and class 3 (34.4; 12.4% of participants), by a strong increase in substance use. The number of fulfilled BPD diagnostic criteria in class 1 (mean [SE], 4.64 [0.40]; comparison: χ2, 11.64; P < .001) and class 3 (mean [SE], 4.29 [0.41]; comparison: χ2, 5.98; P = .01) was greater than that in class 2 (mean [SE], 3.18 [0.15]) at baseline. The number of fulfilled BPD criteria remained high at the second follow-up assessment in class 3 (mean [SE], 5.15 [0.84]) but not in class 1 (mean [SE], 2.05 [0.54]).Conclusions and relevanceIn this cohort study of adolescent patients with NSSI behavior, a decline in this behavior was commonly paired with an increase in substance use. This finding suggests that a decrease in NSSI behavior alone may be insufficient to indicate treatment success. Monitoring the joint trajectories of NSSI behavior and substance use may be a promising avenue toward early detection and targeted treatment of adolescent borderline personality pathology.
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Project description: Not available
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Project description:BackgroundTraditionally, assessment of psychiatric symptoms has been relying on their retrospective report to a trained interviewer. The emergence of smartphones facilitates passive sensor-based monitoring and active real-time monitoring through time-stamped prompts; however there are few validated self-report measures designed for this purpose.MethodsWe introduce a novel, compact questionnaire, Mood Zoom (MZ), embedded in a customised smart-phone application. MZ asks participants to rate anxiety, elation, sadness, anger, irritability and energy on a 7-point Likert scale. For comparison, we used four standard clinical questionnaires administered to participants weekly to quantify mania (ASRM), depression (QIDS), anxiety (GAD-7), and quality of life (EQ-5D). We monitored 48 Bipolar Disorder (BD), 31 Borderline Personality Disorders (BPD) and 51 Healthy control (HC) participants to study longitudinal (median±iqr: 313±194 days) variation and differences of mood traits by exploring the data using diverse time-series tools.ResultsMZ correlated well (|R|>0.5,p<0.0001) with QIDS, GAD-7, and EQ-5D. We found statistically strong (|R|>0.3,p<0.0001) differences in variability in all questionnaires for the three cohorts. Compared to HC, BD and BPD participants exhibit different trends and variability, and on average had higher self-reported scores in mania, depression, and anxiety, and lower quality of life. In particular, analysis of MZ variability can differentiate BD and BPD which was not hitherto possible using the weekly questionnaires.LimitationsAll reported scores rely on self-assessment; there is a lack of ongoing clinical assessment by experts to validate the findings.ConclusionsMZ could be used for efficient, long-term, effective daily monitoring of mood instability in clinical psychiatric practice.
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Project description:BackgroundPeople with personality disorder experience long waiting times for access to psychological treatments, resulting from a limited availability of long-term psychotherapies and a paucity of evidence-based brief interventions. Mentalisation-based treatment (MBT) is an efficacious therapeutic modality for personality disorder, but little is known about its viability as a short-term treatment.AimsWe aimed to evaluate mental health, client satisfaction and psychological functioning outcomes before and after a 10-week group MBT programme as part of a stepped-care out-patient personality disorder service.MethodWe examined routinely collected pre-post treatment outcomes from 176 individuals (73% female) aged 20-63 years, attending a dedicated out-patient personality disorder service, who completed MBT treatment. Participants completed assessments examining mentalising capacity, client satisfaction, emotional reactivity, psychiatric symptom distress and social functioning.ResultsPost-MBT outcomes suggested increased mentalising capacity (mean difference 5.1, 95% CI 3.4-6.8, P < 0.001) and increased client satisfaction with care (mean difference 4.3, 95% CI 3.3-5.2, P < 0.001). Post-MBT emotional reactivity (mean difference -6.3, 95% CI -8.4 to -4.3, P < 0.001), psychiatric symptom distress (mean difference -5.2, 95% CI -6.8 to -3.7, P < 0.001) and impaired social functioning (mean difference -0.7, 95% CI -1.2 to -0.3, P = 0.002) were significantly lower than pre-treatment. Improved mentalising capacity predicted improvements in emotional reactivity (β = -0.56, P < 0.001) and social functioning (β = -0.35, P < 0.001).ConclusionsShort-term MBT as a low-intensity treatment for personality disorder was associated with positive pre-post treatment changes in social and psychological functioning. MBT as deployed in this out-patient service expands access to personality disorder treatment.
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