Inpatient treatment of borderline personality disorder in adults with intellectual disability: reflections on practice

Abstract

Purpose There are few publications on personality disorder in adults with intellectual disability (ID), and on borderline personality disorder (BPD) specifically. Publications concerning treatment are sparse, despite the high symptom burden in these patients. This paper aims to discuss these issues. Design/methodology/approach Six patients with BPD and ID were recruited from the same inpatient unit. Behaviour problems and mental health symptoms were scored on admission and discharge. Information about treatment, length of stay, etc. was taken from case files. Findings Both mental health symptoms measured by the SCL-90-R, and behaviour problems measured by the Aberrant Behaviour Checklist were significantly reduced on discharge. In the active treatment period, the two main aspects of treatment were validation and practicing new solutions when emotional and behavioural problems occur, i.e. skills training. Research limitations/implications The limitations related to this study are that the study is conducted in one milieu only. Another limitation is that the patients were admitted over a five-year period, where, some changes were made in the treatment approach. Practical implications Inpatient treatment of this patient group seems to be effective if individually adjusted to the patient’s psychopathology, ID and communication style. Close co-operation between the individual therapist and milieu therapists is essential. Originality/value There is a need for intervention studies on BPD in ID. This study may be a valuable contribution.

Case Report: Mechanisms in Misdiagnosis of Autism as Borderline Personality Disorder

“…Adrian agreed to practice making contact with nursing staff whenever he felt anxious or had an impulse to engage in NSSI. In these instances, staff focused on helping Adrian to identify and experience alternative strategies for relieving inner tension, an approach inspired by strategies from dialectical behavior therapy (Iversen et al, 2019; see also Hartmann et al, 2012;Bemmouna et al, 2021).…”

Mirror Psycho-Pedagogy in the Population with Severe Intellectual Disability and Severe Autism (SIDSA)

“…A person with autism who lives in contact with an often-changing socio-educational team will not have the same ability to adapt to other people, lacking the stable and reassuring support of a presence comparable to that of the parents. Changes of location, for example between apartment and workshop, must also respect the need for a predictable and reassuring environment (McGill et al, 2020;Iversen et al, 2019;Burke & Cocoman, 2020).…”

“…For the reasons briefly stated above, it is important that the day's activities and the waking up and going to bed rituals are repetitive to allow the person to be reassured by finding time and space landmarks that can be vicarious of the inevitable instability of the socio-educational team (Iversen et al, 2019;Mansell et al, 2008).…”

Psychosocial treatment of major depression in people with intellectual disabilities. Improvements within the last four decades: points of view

“…Research from the four last decades emphasizes adjustments of treatment methods for mental illness developed for the general population, when treating people with ID (Iversen et al 2019. Sovner and Hurley's first work together was in a facility for adults with intellectual disability.…”

“…The close relationship between individual therapist and mental health nursing staff is well known in clinical settings of mental health services for people with ID (Iversen et al 2019). However, this topic is only briefly mentioned in papers on treatment of mental illness in ID generally, usually stating that close co-operation between professional caregivers and family members is needed when the treatment includes task solving between sessions, like training on new skills.…”