Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for persons with borderline personality disorder (BPD). We describe results from two data sets on outcome in persons who participated in STEPPS with BPD alone or BPD plus antisocial personality disorder (ASPD). In Study 1, we examined the effect of comorbid ASPD on outcome in 65 persons with BPD who participated in a randomized controlled trial at an academic medical center. In Study 2, we examined the effect of comorbid ASPD on outcome in 64 offenders with BPD who participated in STEPPS in correctional settings. All subjects were assessed for the presence of BPD and ASPD. In Study 1, subjects with ASPD experienced greater improvement in BPD symptoms, impulsiveness, and global symptoms. In Study 2, offenders with ASPD experienced greater improvement in positive and negative behaviors and positive affectivity. We conclude that persons with BPD plus ASPD benefit from STEPPS in community and correctional settings. The findings suggest that persons with BPD plus ASPD show greater improvement in some domains than persons with BPD only. People with ASPD should not be automatically excluded from participation in the program.
KeywordsBorderline personality disorder; antisocial personality disorder; STEPPS; randomized controlled trials (RCTs) Borderline personality disorder (BPD) is characterized by a pervasive pattern of emotional instability, impulsivity, and disturbed relationships (Lieb et al., 2004). Psychotherapy has been the most frequently studied treatment and many programs are now evidence-based including Systems Training for Emotional Predictability and Problem Solving (STEPPS) (NICE, 2009). Briefly, STEPPS was developed at the University of Iowa for ambulatory patients with BPD and has been shown to be effective in controlled and uncontrolled studies Bos et al., 2010;Freije et al., 2002;Harvey et al., 2010
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Author ManuscriptAuthor Manuscript affectivity. In some studies, STEPPS also appears to reduce suicidality and, in prison, disciplinary infractions Harvey et al., 2010).BPD is common in the general population with a prevalence between 1%-6% (Grant et al., 2008;Lenzenweger et al., 2007), but is also prevalent in prisons with rates as high as 30% of incarcerated offenders (Black et al., 2007; de Ruiter & Treatment, 2006;Jordan et al., 1996; Zlotnick, 1999). Research shows that there is great overlap of BPD with antisocial personality disorder (ASPD) in these settings. For example, in one study 57% of offenders with BPD also met criteria for ASPD (Black et al., 2007). BPD is problematic in prison settings and contributes to behavioral and management problems (Warren et al., 2002).Despite the high prevalence of BPD in corrections, few formal treatment programs have been developed or implemented in these settings (Berzins & Trestman, 2004;Black et al., 2013;McCann et al., 2000). We have been working with the Iowa Department of Corrections (IDOC) since 2005...