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. 2024 Jun 18;11(1):12.
doi: 10.1186/s40479-024-00256-1.

The evaluation of a stepped care approach for early intervention of borderline personality disorder

Marialuisa Cavelti  1 , Yasmine Blaha  1 , Stefan Lerch  1 , Christian Hertel  1 , Thomas Berger  2 , Corinna Reichl  1 , Julian Koenig  3 , Michael Kaess  4   5
Affiliations

The evaluation of a stepped care approach for early intervention of borderline personality disorder

Marialuisa Cavelti et al. Borderline Personal Disord Emot Dysregul. .

Abstract

Background: The current study evaluated the stepped care approach applied in AtR!Sk; a specialized outpatient clinic for adolescents with BPD features that offers a brief psychotherapeutic intervention (Cutting Down Program; CDP) to all patients, followed by a more intensive Dialectical Behavioral Therapy for Adolescents (DBT-A) for those whose symptoms persist.

Methods: The sample consisted of 127 patients recruited from two AtR!Sk clinics. The number of BPD criteria, psychosocial functioning, severity of overall psychopathology, number of days with non-suicidal self-injury (NSSI; past month), and the number of suicide attempts (last 3 months) were assessed at clinic entry (T0), after CDP (T1), and at 1- and 2-year follow-up (T2, T3). Based on the T1 assessment (decision criteria for DBT-A: ≥ 3 BPD criteria & ZAN-BPD ≥ 6), participants were allocated into three groups; CDP only (n = 74), CDP + DBT-A (eligible and accepted; n = 36), CDP no DBT-A (eligible, but declined; n = 17).

Results: CDP only showed significantly fewer BPD criteria (T2: β = 3.42, p < 0.001; T3: β = 1.97, p = 0.008), higher levels of psychosocial functioning (T2: β = -1.23, p < 0.001; T3: β = -1.66, p < 0.001), and lower severity of overall psychopathology (T2: β = 1.47, p < 0.001; T3: β = 1.43, p = 0.002) over two years compared with CDP no DBT-A, while no group differences were found with regard to NSSI and suicide attempts. There were no group differences between CDP + DBT-A and CDP no DBT-A, neither at T2 nor at T3.

Discussion: The findings support the decision criterion for the offer of a more intense therapy after CDP. However, there was no evidence for the efficacy of additional DBT-A, which might be explained by insufficient statistical power in the current analysis.

Keywords: Adolescence; Borderline personality disorder; Cutting down program; Dialectical behavioral therapy; Early intervention; Stepped care.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Courses of outcome variables over time (T0 = baseline, T1 = after CDP, T2 = 1-year follow-up, T3 = 2-year follow-up) separated by group (CDP only, CDP + DBT-A, CDP no DBT-A). CDP = Cutting Down Program; DBT-A Dialectical Behavioral Therapy for Adolescents; BPD = borderline personality disorder; LoF = Level of Functioning; CGI-S = Clinical Global Impression Scale – Severity; NSSI = non-suicidal self-injury. Shaded points represent the raw data point with additional 5% spherical jitter. The connected solid points represent the marginal predicted mean by the model with the 95% confidence interval
See this image and copyright information in PMC

References

    1. Chanen AM, Sharp C, Hoffman P, Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder Prevention and early intervention for borderline personality disorder: a novel public health priority. World Psychiatry. 2017;16:215–6. doi: 10.1002/wps.20429. - DOI - PMC - PubMed
    1. Cavelti M, Sharp C, Chanen AM, Kaess M. Commentary: commentary on the Twitter comments evoked by the May 2022 debate on diagnosing personality disorders in adolescents. Child Adolesc Ment Health. 2023;28:86–191. - PubMed
    1. Elvins R, Kaess M. Editorial: should child and adolescent mental health professionals be diagnosing personality disorder in adolescence? Child Adoles Ment Health. 2022;27:101–102. doi: 10.1111/camh.12560. - DOI - PubMed
    1. Sharp C. Bridging the gap: the assessment and treatment of adolescent personality disorder in routine clinical care. Arch Dis Child. 2017;102:103–108. doi: 10.1136/archdischild-2015-310072. - DOI - PubMed
    1. Chanen AM, Nicol K, Betts JK, Thompson KN. Diagnosis and treatment of borderline personality disorder in young people. Curr Psychiatry Rep. 2020;22:25. doi: 10.1007/s11920-020-01144-5. - DOI - PubMed