Literature update

OBJECTIVE: The purposes of this study were to determine time to attainment of recovery from borderline personality disorder and to assess the stability of recovery. METHOD: A total of 290 inpatients who met both DSM-III-R and Revised Diagnostic Interview for Borderlines criteria for borderline personality disorder were assessed during their index admission using a series of semistructured interviews and self-report measures. The same instruments were readministered every 2 years for 10 years. RESULTS: Over the study period, 50% of participants achieved recovery from borderline personality disorder, which was defined as remission of symptoms and having good social and vocational functioning during the previous 2 years. Overall, 93% of participants attained a remission of symptoms lasting at least 2 years, and 86% attained a sustained remission lasting at least 4 years. Of those who achieved recovery, 34% lost their recovery. Of those who achieved a 2-year remission of symptoms, 30% had a symptomatic recurrence, and of those who achieved a sustained remission, only 15% experienced a recurrence. CONCLUSIONS: Taken together, the results of this study suggest that recovery from borderline personality disorder, with both symptomatic remission and good psychosocial functioning, seems difficult for many patients to attain. The results also suggest that once attained, such a recovery is relatively stable over time.

BACKGROUND: Dialectic behaviour therapy (DBT) has been widely used with individuals diagnosed with borderline personality disorder who exhibit severe emotional and behavioural dysregulation. There is a paucity of research in assessing the effectiveness of DBT with forensic clients with intellectual disability (ID). METHODS: This pilot study aims to evaluate the effectiveness of the DBT group skills training programme adapted particularly for offenders with ID. Six participants completed the 13-week adapted DBT group skills training programme. All participants exhibited challenging behaviours and have a history of prior charges or convictions for violent crimes. The study conducted pre- and post-tests using instruments that measured dynamic risks, relative strengths, coping skills and global functioning. RESULTS: The study result showed improvement across all measures. A decrease in the level of risks, increase in relative strengths and general improvement in overall functioning were found significant. The results were promising particularly as a stand-alone adapted DBT group skills training programme for this client group.

OBJECTIVE: Deliberate self-harm (DSH) is common in Borderline Personality Disorder, may be due to a variety of reasons, and is associated with different degrees of suicidal intent. Understanding the reasons for episodes of DSH in this population may be helpful in developing interventions to reduce the rate of DSH or to assist in the clinical judgement of suicidal intention after DSH has occurred. METHODS: The Parasuicide History Interview, version 2 (PHI-2) was used to determine the reasons for DSH events in 70 Australian women diagnosed with Borderline Personality Disorder. Factor analysis of the responses identified four empirically derived component factors. Multivariate models were developed to identify the independent predictors of suicidal deliberate self-harm (S-DSH) versus non-suicidal deliberate self-harm (NS-DSH) events. RESULTS: Participants and raters showed strong agreement in classifying S-DSH and NS-DSH events. Methods used that involved self-poisoning, jumping or stabbing showed increased risk for S-DSH, adjusted odds ratio 12.07 (95% CI 2.17, 67.29), compared to the referent group, external damage to skin with no rescue contact being sought. Although no grouping of reasons were independently significant, the lower the effectiveness of the DSH event to resolve the reasons for the event, the higher the risk of it having been a S-DSH event. CONCLUSION: In clinical situations, any Borderline Personality Disorder patient seeking help or medical attention, using any method other than superficial external injury to skin, or reporting a failure to effectively resolve the reasons for the DSH event, should be considered as likely to have had a S-DSH event (greater suicidal intention). However, specific reasons for the DSH event, or individual subject characteristics, did not meaningfully distinguish S-DSH from NS-DSH events.

This study investigated the relationship between five forms of childhood maltreatment (sexual, physical and emotional abuse, emotional and physical neglect) and 10 personality disorders (PDs). PDs were assessed by means of SCID II, and childhood maltreatment was retrospectively measured with the Interview for Traumatic Events in Childhood. Both PDs and childhood maltreatment were expressed continuously, and relations were assessed by means of structural equation modelling in a sample of 409 participants. Results indicated that sexual abuse was associated with symptoms of paranoid, schizoid, borderline, and avoidant PD; physical abuse with antisocial PD; emotional abuse with paranoid, schizotypal, borderline, and cluster C PD; and emotional neglect with histrionic and borderline PD. No independent relationships between physical neglect and PDs were found. The findings provide clear, albeit retrospective, evidence that different forms of childhood maltreatment have differential effects on PD pathology.