How to Assess Recovery in Borderline Personality Disorder: Psychosocial Functioning and Satisfaction With Life in a Sample of Former DBT Study Patients

Zeitler, Marie-Luise; Bohus, Martin; Kleindienst, Nikolaus; Knies, Rebekka; Ostermann, Miriam; Schmahl, Christian; Lyssenko, Lisa

doi:10.1521/pedi_2018_32_394

Cited by 27 publications

(27 citation statements)

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“…Findings are consistent with those reported by the CLPS and MSAD studies, indicating that the psychosocial functioning of BPD subjects may vary among individuals, but show a significant improvement over time as a group [6]. However, our results do not allow one to conclude whether individuals with BPD can reach normative functional adjustment in the long-term, although previous research indicates that a relevant proportion may suffer from persistent impairments over time [8,9,10,13,52]. In terms of depressive symptoms, the MSAD study also reported a significant decrease in dysphoric states in the long-term, which was more pronounced in recovered patients [51].…”

Section: Discussionsupporting

confidence: 87%

“…The hours of formal therapy fluctuated between 60 and over 600 h, the latter reported by the MBT trial [20]. Among naturalistic studies, two studies followed up samples who initially participated in a clinical trial, although treatment subgroups were not individually studied at follow-up [10,13]. Besides, three naturalistic studies informed of treatment use during follow-up in general terms.…”

Section: Treatment Interventionsmentioning

confidence: 99%

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Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

et al. 2018

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Background:This meta-analytic review is the first to synthesise findings from prospective research on the long-term course of borderline personality disorder in adult clinical populations.Methods:Systematic searches were conducted in Medline, PsycINFO, PsycArticles, PubMed and Scopus within the period 1990-2017. Inclusion criteria were: (1) adult BPD sample diagnosed by a validated, semi-structured interview; (2) at least two prospective assessments of outcomes; and (3) follow-up period ≥ 5 years. Quality of evidence was rated with the Systematic Assessment of Quality in Observational Research (SAQOR). Four outcomes were meta-analysed using mixed-effect methods: remission from BPD diagnosis, completed suicide, depressive symptoms, and functioning. Potential moderators regarding the natural course and the initial treatment received were studied.Results:Eleven studies met the inclusion criteria, with 837 participants from nine countries being followed. Between 50% and 70% of the BPD patients achieved remission in the long-term. Significant reductions in depression and functional impairment were also found. Mean suicide rate ranged from 2% to 5%. Younger age was associated with higher likelihood for remission. Being female was correlated with lower functional improvement. Despite some positive trends, there were no significant associations between treatment moderators and the long-term outcome.Conclusions:Findings suggest that the course of BPD is characterised by symptomatic amelioration and a slight functional improvement in the long-term. Age and gender modulate the long-term prognosis and should be considered to adapt treatment resources. Further research is required to draw robust conclusions on the long-term effects of psychotherapeutic interventions.

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Section: Discussionsupporting

confidence: 87%

Section: Treatment Interventionsmentioning

confidence: 99%

Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

et al. 2018

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“…The sample of clinical controls (CC) was recruited at the Psychiatric Hospital at the University of Freiburg, Germany between 2000 and 2001 [21,32]. This sample consisted of 176 individuals (107 female, 69 male, mean age: 41.44 ranging from 18 to 77) with different axis I disorders (schizophrenia: n = 46, delusional disorder: n = 3, major depressive disorder: n = 75, other affective disorders: n = 6, anxiety disorder: n = 17, obsessive compulsive disorder: n = 27, eating disorder: n = 2).…”

Section: Participantsmentioning

confidence: 99%

A proposed severity classification of borderline symptoms using the borderline symptom list (BSL-23)

Kleindienst

Jungkunz

Bohus

2020

bord personal disord emot dysregul

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Background: The Borderline Symptom List (BSL-23) is a well-established self-rating instrument to assess the severity of borderline typical psychopathology. However, a classification of severity levels for the BSL-23 is missing. Methods: Data from 1.090 adults were used to develop a severity classification for the Borderline Symptom List (BSL-23). The severity grading was based on the distribution of the BSL-23 in 241 individuals with a diagnosis of BPD. Data from three independent samples were used to validate the previously defined severity grades. These validation samples included a group of treatment seeking patients with a diagnosis of BPD (n = 317), a sample of individuals with mental illnesses other than BPD (n = 176), and a healthy control sample (n = 356). The severity grades were validated from comparisons with established assessment instruments such as the International Personality Disorders Examination, the Structured Clinical Interview for DSM-IV, the global severity index of the Symptom Checklist (GSI, SCL-90), the Global Assessment of Functioning (GAF), and the Beck Depression Inventory (BDI-II). Results: Six grades of symptom severity were defined for the BSL-23 mean score: none or low: 0-0.3; mild: 0.3-0.7; moderate: 0.7-1.7; high: 1.7-2.7; very high: 2.7-3.5; and extremely high: 3.5-4. These grades received consistent empirical support from the independent instruments and samples. For instance, individuals with a severity grade of none or low were virtually free from diagnostic BPD-criteria, had a GSI below the normative population, and a high level of global functioning corresponding to few or no symptoms. Severity grades indicating high to extremely high levels of BPD symptoms were observed at a much higher rate in treatment-seeking patients (70.0%) than in clinical controls (17.6%) and healthy controls (0.0%). The BSL-23 score that best separated treatment-seeking BPD patients and clinical controls was 1.50, whereas the clearest discrimination of BPD patients and healthy controls was found at a score of 0.64. Conclusions: The grades of BPD-specific symptom severity derived from the distribution of the BSL-23 scores received consistent empirical validation from established assessments for psychopathology. Future studies should expand this validation by including additional instruments e.g., to assess self-esteem, loneliness, connectedness, and quality of life.

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“…Relatedly, dysfunctional behavior or suicide attempts accumulate in the course of problematic interactions [3,4]. Improvements in social functioning are comparatively weak in those with BPD [5], and even remitted BPD patients are characterized by low social functioning [6]. Recent research on social interaction in BPD suggests that impairments in interpersonal relationships can be related to reduced trust [7], deficits in cooperation [8], and alterations in social cognition [9].…”

Section: Introductionmentioning

confidence: 99%

Impaired memory for cooperative interaction partners in borderline personality disorder

Niedtfeld

Kroneisen

2020

bord personal disord emot dysregul

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Background Interpersonal disturbances in Borderline Personality Disorder (BPD) have been attributed to a negativity bias in social cognition. Adding to this literature, we experimentally tested whether those with BPD show altered memory for cooperative versus non-cooperative interaction partners. Methods In a source memory paradigm, 51 female BPD patients and 50 healthy controls (HC) played a trust game with 40 different female target characters (trustworthy vs untrustworthy). In a subsequent surprise memory test, participants had to recognize those target individuals (vs distractor pictures), and had to recall whether they had shown cooperative behavior during the trust game. We hypothesized that BPD patients have better memory for uncooperative interaction partners as compared to cooperative interaction partners, and that a-priori expectations of untrustworthiness would influence recall. Results During the trust game, BPD individuals invested lower amounts of money than HC for trustworthy targets, but no differences were found for untrustworthy targets. During the memory test, BPD patients had significant difficulties to remember cooperative targets, as compared to HC. More specifically, those with BPD indicated more often than HC that they had not previously interacted with cooperative targets of the previous trust game. We did not detect any differences between BPD and HC in source memory, or with regard to the effects of trustworthiness expectations. Conclusions The observed tendency to forget cooperative interaction partners in BPD is possibly caused by dysfunctional cognitive schemas. At the same time, it might also corroborate patients’ assumptions that others are untrustworthy, thereby fuelling interpersonal disturbances in BPD.

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How to Assess Recovery in Borderline Personality Disorder: Psychosocial Functioning and Satisfaction With Life in a Sample of Former DBT Study Patients

Cited by 27 publications

References 47 publications

Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies

A proposed severity classification of borderline symptoms using the borderline symptom list (BSL-23)

Impaired memory for cooperative interaction partners in borderline personality disorder

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