1. Y.A. Westad, J. Vigfusdottìr, E. Jonsbu and K. Hagen
The cessation of self-harm behavior in patients with Borderline personality disorder
Y.A. Westad, J. Vigfusdottìr, E. Jonsbu and K. Hagen
Helse Møre og Romsdal, Molde poliklinikk, Norway
Introduction
Methods
Discussion
The sample consisted of 46 patients receiving DBT for their BPD traits and self-harm behavior. The participants where split into two groups, based on median amount of time (8 weeks) in DBT before stopping self-harm behavior, termed early- and late responders.
Personality traits were assessed with the Personality Diagnostic Questionnaire for DSM 4, and the Structured Clinical Interview for DSM-4 Axis 2 Personality Disorders (SCID II).
Additional assessment instruments used were: Beck Depression Inventory (BDI), Becks Hopelessness Scale (BHS), WHO Quality of Life-Brief (WHOQOL-Brief), and the Global Assessment of Functioning, split version (GAF-F/GAF-S).
Systematic review of patient journals was used to collect data on method and duration of self-harm behavior.
Results
93.5% of the patients stopped self-harming during treatment.
On average the patients stopped self-harm behavior 15,5 (SD=17.8) weeks into the treatment (range 0-73).
The late and early responders as groups did not differ in method, or severity of self-harm. No participant died by suicide in the treatment period.
We found no differences between the early and the late responders in demographic, clinical or outcome measures (Table 1 and Table 2).
Figure 1: Cumulative percentage of patients that terminated self-harm behavior in the treatment period (weeks)
Dialectical Behavior Therapy (DBT) is developed and proven effective in reducing self-harm behavior in patients with Borderline Personality Disorder (BPD). Self-harm behavior is a known risk factor for suicide. Suicide attempts are common (46-92%) among BPD patients, and as many as 10 % of the patient population dies by suicide.
Reduction of self-harm behavior is an important step to achieve a more adaptive emotional control and reduce the risk of suicide.
Purpose
The aim of this study was to:
A) Register when and if self-harm behavior ceased in the course of DBT program.
B) Compare patients who stopped self-harm behavior early or late in the course of DBT program in regards to: Symptom severity pre- and post treatment, comorbidity, demography and instances of suicide.
The results support previous findings that DBT is a highly effective treatment in reducing self-harm behavior in patients displaying traits of BPD.
The time in treatment before self-harm behavior ceases is not necessarily related to symptom severity or symptom reduction.
This highlights the importance of retaining patients in DBT treatment, although they may strive to end their self-harm behavior.
The findings may also indicate that the process of self-harm behavior may be a specific component relatively unrelated to other symptom domains. Further research on the subject is needed.
Table 1: Baseline Demographics and clinical characteristics
Measure
Early responders (n=23)
Late responders (n=21)
Age (M/SD)
23.0 (5.7)
25.1 (8.8)
Women(%)
90.5
91.3
BPD (%)
57.1
54.5
Comorbid disorders
2.3 (1.3)
2.9 (1.3)
Bibliography
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Zanarini, M. C., Frankenburg, F. R., Reich, D. B., Fitzmaurice, G., Weinberg, I., & Gunderson, J. G. (2008). The 10‐year course of physically self‐destructive acts reported by borderline patients and axis II comparison subjects. Acta Psychiatr Scand, 117(3), doi: /j
Priebe, S., Bhatti, N., Barnicot, K., Bremner, S., Gaglia, A., Katsakou, C., Zinkler, M. (2012). Effectiveness and cost-effectiveness of dialectical behaviour therapy for self-harming patients with personality disorder: a pragmatic randomised controlled trial. Psychother Psychosom, 81(6), doi: /
Table 2: Means and standard deviation for BDI, BHS, PDQ-4 and GAF-F/S
Measure
Early responders (n=23)
Late responders (n=21)
Pre Mean (SD)
Post Mean (SD)
BDI
31.9 (10.5)
13.6 (10.0)
28.3 (8.4)
13.5(9.7)
BHS
13.5 (4.7)
5.5 (4.9)
12.8 (4.9)
6.3 (5.1)
PDQ-4
46.0 (12.7)
30.1(11.7)
41.8 (11.0)
26.9 (10.6)
GAF-F
51.8 (6.5)
69.5 (12.3)
54.4 (11.8)
68.5 (11.1)
GAF-S
50.8 (5.0)
52.6 (7.2)
70.2 (11.8)
66.0 (10.6)