Do people with borderline personality disorder complicated by antisocial personality disorder benefit from the STEPPS treatment program?

Abstract

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 HHS Public Access Author ManuscriptAuthor Manuscript 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...

Dialectical Behavior Therapy for Men With Borderline Personality Disorder and Antisocial Behavior: A Clinical Trial

“…One dataset included 65 participants from a randomized trial at an academic medical center, the other was from a correctional setting with 64 offenders. Intriguingly, their results indicated that participants with comorbid BPD and ASPD improved more on BPD symptoms than those with only BPD (in Trial 1), and in positive and negative behaviors in the offender sample (Black et al, 2016). Again, no antisocial behavior outcomes were collected, and only 16 of 60 participants with BPD/ASPD comorbidity were male.…”

“…Outcome measures did not include antisocial behavior, and the authors noted that the study was underpowered, describing it as a demonstration of feasibility rather than effectiveness (Bateman et al, 2016). Black, Simsek-Duran, Blum, McCormick, and Allen (2016) reported outcomes from two studies investigating 20-week STEPPS programs (systems training for emotional predictability and problem solving), comparing participants with BPD alone to participants with comorbid BPD and ASPD. One dataset included 65 participants from a randomized trial at an academic medical center, the other was from a correctional setting with 64 offenders.…”

“…Again, no antisocial behavior outcomes were collected, and only 16 of 60 participants with BPD/ASPD comorbidity were male. Still, these two reports from interventions originally developed to treat BPD indicate that people with comorbid BPD and ASPD can be treated effectively and should not be excluded from these programs (Bateman et al, 2016;Black et al, 2016).…”

A preliminary service evaluation of a personality disorder case management service

“…Research has also evaluated services based on the systems training for emotional predictability and problem solving programme within more naturalistic settings, in both generic mental health teams and prisons, and other community forensic pathways have been evaluated …”

“…Research has also evaluated services based on the systems training for emotional predictability and problem solving programme within more naturalistic settings, in both generic mental health teams 10 and prisons, 11 and other community forensic pathways have been evaluated. [12][13][14] To evaluate community interventions for personality disorder (PD) within the UK, a series of pilot services were established, and the subsequent review indicated that these services were effective.…”