Which Factors Are Relevant for Treatment Outcome in Dialectical Behaviour Therapy for Borderline Personality Disorder?

Study Overview
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Brief Summary
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The objective of this project is to investigate factors that contribute to the success and lack of success in DBT among individuals with BPD and a history of self-harm in a clinical psychiatric setting. Do certain personality factors and identity disturbance predict the treatment outcome of DBT in individuals with BPD? Do changes in identity disturbance, self-hate, or emotion regulation mediate the treatment outcome of DBT in individuals with BPD? Do specific personality profiles moderate the treatment outcomes of DBT for individuals with BPD? When does the primary treatment effect occur, and does this effect persist after a 12-month follow-up period?

Detailed Description
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Borderline Personality Disorder (BPD) is a complex and enduring mental health condition characterized by a range of symptoms. The consequences of BPD are severe, causing individual suffering, impairments in daily functioning, and increased mortality rates. Dialectical behavior therapy (DBT) is one of the most widely used treatment models for BPD and self-harm. DBT has demonstrated positive outcomes but not all individuals benefit equally from this therapy, highlighting the need for further exploration. Specifically, there is a knowledge gap regarding what predicts positive treatment response. Research exploring this topic, has highlighted the potential significance of emotion regulation, personality profiles, self-concept, and identity disturbance in understanding the outcomes of individuals with BPD. The primary objective of this research project is to investigate the factors that contribute to the success and lack of success in DBT. All individuals referred to DBT-treatment in the Adult psychiatric clinic in Lund will be offered participation in the study. All study participants receive the same treatment as those who chose not to participate. Measures will commence after treatment contracts have been negotiated and the treatment will continue up to a maximum treatment length of one year. Data will be retrieved from databases, medical records as well as collected as self-report forms. Self-report measures will be conducted every three months, at end of treatment and at follow up 12 months after end of treatment. Data from registries and charts will be collected at time of consent and at follow up 12 months after treatment.

Official Title
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Vilka Faktorer påverkar Behandlingsutfall Vid Dialektisk Beteendeterapi för Borderline Personlighetssyndrom?

Conditions
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Borderline Personality Disorder, Non-suicidal Self-injury, Deliberate Self Harm

Intervention / Treatment
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* Behavioral: Dialectibal Behaviour Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Borderline personality disorder as defined by the DSM-V Self-harm over the past 12 months Offered DBT at the Lund adult psychiatric clinic Exclusion Criteria: Unable to read or communicate in Swedish

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Individuals with BPD<br>Individuals with BPD, as defined by the DSM-V, and a recent history (past 12 months) of self-harming behaviour. | Behavioral: Dialectibal Behaviour Therapy<br>* Standard Dialectical Behaviour Therapy of up to 12 months as described Professor Linehan<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Five Self-harm Behaviour Groupings Measure (5S-HM) | Indirect and direct self-harm | Treatment start, 3,6,9 and at end of treatment and at follow up at 24 months. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The World Health Organization Disability Assessment Schedule II (WHODAS 2) | Daily functioning and impairment | Treatment start, 3,6,9 and at end of treatment and at follow up at 24 months. | 
| The Borderline Symptom List-23 (BSL-23) | Borderline symptoms | Treatment start, 3,6,9 and at end of treatment and at follow up at 24 months. | 
| The Level of Personality Functioning Scale-Brief Form 2.0 (LPFS 2.0) | Personality functioning | Treatment start, 3,6,9 and at end of treatment and at follow up at 24 months. | 
| The Personality Inventory for DSM-V Brief Form (PID-5-BF) | Personality structure | Treatment start, 3,6,9 and at end of treatment and at follow up at 24 months. | 
| Hospitilization days | Days admitted to a psychiatric ward past year | Treatment at end of treatment and at follow up at 24 months. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Borderline Personality Disorder, Dialectical Behavior Therapy, Deliberate Self-Harm, Non-suicidal Self-injury, Self-concept, Personality