Female prisoners with borderline personality disorder: some promising treatment developments

Abstract

Background: The over-representation of female prisoners with borderline personality disorder (BPD) is an area of concern for HM Prison Service. Pilot programmes of Dialectical Behaviour Therapy (DBT) were undertaken for the first time in three British prisons for women diagnosed with BPD. Standard year-long programmes were piloted in two closed training prisons. Three short-format programmes were undertaken in a local allocation prison.

Method: Evaluation measures included psychometric tests, behavioural data, and interviews with participants and key personnel. Sixteen of the 30 women who embarked on the programmes completed them, though five dropouts were transferred or released, leaving a voluntary attrition rate of 33%. Fourteen completed all measures. A waiting-list control group of eight participants was also set up. Five completed all measures.

Results: The vast majority of completers showed overall improvements in psychometric data often reaching statistical significance, and with notable effect sizes, while there was no significant overall change in the control group (though improvements were seen). A down-turn in overall self-harm was also seen.

Conclusion: Results are tentative at this stage because of the small sample size. However, despite the numerous challenges associated with implementation, outcomes showed real promise for delivering DBT in a prison setting, and its efficacy in reducing criminogenic risk and improving the manageability and quality of life for this highly problematic group. Lessons learned for future implementation in correctional settings are discussed.