Borderline personality disorder and Mental Health Services: from the diagnostic pathway to the implementation of good practices. A real-world feasibility study
A. Zucchetti, A. Cassandra Julia, B. Deborah, G. Agnese, B. Stefano, V. AntonioIntroduction
Borderline Personality Disorder (BPD) is a mental disorder that impacts psychosocial functioning, typically resulting in reduced occupational and educational achievement, inability to maintain long-term relationships, increased conflict between partners, and low levels of social support. Patients and family members also report low satisfaction in quality of life. Treatment requires a multidisciplinary approach: psychopharmacological therapy, psychotherapy, psychosocial therapies and caregivers support.
Objectives
The aim of this study is to explore the feasibility of good practice care in terms of changes in symptom severity and psychosocial functioning in a sample of patients with BPD in a real-world clinical setting.
The study also examines whether training of family members has an impact on the perceived burden of caring and on the development of skills for managing their relative’s disorder.
Methods
Fifteen BPD patients at first contact with a Mental Health Service (MHS) of the Department of Mental Health of Spedali Civili Hospital, Brescia were recruited and underwent the following assessment: Toronto Alexithymia Scale (TAS-20), Barratt Impulsiveness Scale (BIS-11), Difficulties in Emotion Regulation Scale (DERS), Zanarini Rating Scale for BPD (ZAN-BPD), Personal and Social Performance Scale (PSP), and Health of the Nation Outcome Scale (HONOS), before and after the interventions. All the patients participated for 9 months in the following evidence-based (EB) interventions for BPD: DBT skills training and psychoeducation with Good Psychiatric Management. A group of patients’ relatives (N=6) underwent for 3 months the Family Connection (FC) group.
Statistical data were calculated using Rstudio software.
Results
Patients (N=14, one drop out) demonstrated improvement in clinical dimensions (TAS-20 p<0.05; BIS-11 p<0.05; DERS p<0.05; ZAN-BPD p<0.001) and in psychosocial functioning (PSP p<0.05; HONOS p<0.05) after the integrated treatment (Wilcoxon test). Patients were then divided into two groups, based on whether or not their parents had completed the FC programme, no significant changes between the two groups were found. A decrease in the perceived burden on family members was observed, although this result did not reach statistical significance.
Image 1: Long description.