Borderline personality disorder (BPD) is an illness characterized by stormy relationships, low self-regard and problems managing strong emotions. People with BPD are more frequently hospitalized for psychiatric care than patients with other kinds of personality disorders or those with major depression. How to successfully reduce the number of required inpatient services was the subject of a recent study.
DBT Versus Standard Care
The research looked specifically at differences in outcomes when patients received a year of dialectical behavioral therapy (DBT) compared to when patients received standard psychotherapy. DBT was developed specifically for patients with BPD. It is similar to cognitive behavioral therapy in emphasizing a need for change in thinking and behavior, but DBT includes important aspects of validation that help patients with BPD stick with the treatment. The therapy emphasizes self-acceptance while delving into the urge to self-harm.
This study used two specific measures to determine the effectiveness of standard care and DBT: hospitalizations and instances of self-harm. Researchers interviewed patients with BPD at two-month intervals for one year and then again at a six-month follow-up. Investigators assessed hospitalizations based on a Client Service Receipt Inventory and electronic medical records.
For one year patients received either DBT or the standard treatment program. Over the course of the study year, 11 of the patients receiving standard treatment required hospitalization. During the same time, two patients treated with DBT were hospitalized. It should be noted that one of the two hospitalized DBT subjects had opted out of DBT treatment before being hospitalized. The second subject had an extensive history of inpatient care.
Using statistical methods (logistic regression) investigators discovered that patients receiving standard treatment faced a far higher risk of hospitalization compared to those receiving DBT. Even after accounting for prior hospitalizations, the increased odds for hospitalization remained. No patients who completed the year of DBT treatment were hospitalized for six months afterward.
Thoughts of suicide, attempted suicide and urges to self-harm are common problems for people with BPD and often precede hospitalization. Specific self-harm interviews were used following the year-long treatment to assess which approach most reduced the frequency of these behaviors.
During the final eight weeks of DBT treatment, self-harm occurred a mean of 1.79 days. Six months after treatment completion, the mean rate was one day per each eight-week stretch. The difference between groups was not statistically significant.
Based on the results, investigators concluded that DBT is more effective than standard care for patients with BPD. DBT treatment is beneficial to the patient because it lowers distress and dependency, and to the general public since it lowers the financial stress of costly hospitalizations.