Symposium abstract (Chair: Michael Kaess):
A growing body of evidence suggest that personality disorder can be diagnosed reliably in adolescents, its precursors even in children. These research results pave the way for effective early intervention in young people with emerging personality disorders. To date, several groups worldwide have invested substantial efforts to implement and investigate treatment approaches for personality disorders in children and adolescents with personality disorders or subclinical challenges. This invited symposium aims to bring experts for treatment of personality disorders in children and adolescents together in order to present their latest research results on the topic and discuss further avenues of research in this area. Dr Andrewes from the HYPE clinic in Melbourne and Dr Reichl from the ATR!SK clinic in Bern will present longitudinal data on predictors and outcomes of specialized early intervention of borderline personality disorder (BPD); Prof. Taubner from Heidelberg will present data from a MBT-A study for the treatment of conduct disorder; Prof. Sharp will present data on the innovative approach of transgenerational prevention of personality disorders.
Individual abstracts:
Baseline predictors of functional impairment at 12 months in young people with borderline personality disorder receiving targeted early intervention.
Prof. Andrew M. Chanen, Dr Holly Andrewes, Dr Jennifer Betts, Prof. Henry Jackson, Prof. Sue Cotton, Prof. John Gleeson, Prof. Christopher Davey, Dr Sharnel Perera, Victoria Rayner, Dr Louise McCutcheon
Background and Aim: Poor functioning is a hallmark characteristic of BPD, which persists over-time. Despite this, few targeted psychosocial intervention trials in youth with BPD have identified changes in functioning following treatment and none have investigated factors which predict changes in functioning following treatment. The current study aimed to examine which demographic, symptomatic and treatment characteristics predict improved functioning at 12 months in young people with BPD receiving targeted intervention within a randomised control trial (MOBY). Method: Ninety-six young people (aged 15 to 25 years) with a SCID-IV diagnosis of BPD completed a semi-structured interview and self-report measures assessing demographic, mental health symptom and treatment characteristics at baseline and at 12 months follow-up. Hierarchical regression analyses were used to examine predictors of improved interpersonal and role function at 12 months. Results: When controlling for other demographic, clinical and treatment characteristics, greater impairments interpersonal function were predicted by higher ratings of BPD severity and lower rating of social and occupational functioning at baseline. Greater impairments in role function were predicted by higher ratings of BPD severity and having neither care-giver in employment at baseline. Conclusion: Young people presenting with greater severity of BPD, poorer social and occupational functioning at baseline and those without a caregiver in employment are good candidates for targeted early intervention that address functional difficulties.
The Outcomes of Early Intervention of Borderline Personality Disorder
Corinna Reichl, Marialuisa Cavelti, Madelyn Thomson, Yasmine Blaha, Stefan Lerch, Julian Koenig, Michael Kaess
Background: Results from the specialized outpatient clinic AtR!Sk for adolescents with (sub-threshold) borderline personality disorder (BPD) will be presented, evaluating a stepped care approach (study 1) and investigating age effects on the course of BPD (study 2). Methods: In study 1 (n = 110), treatment effects during 2-years follow-ups were compared between three groups: CDP only (cutting down program); CDP + DBT-A (dialectical behavioral therapy for adolescents) and CDP no DBT-A (eligible for DBT-A, but declined). In study 2, BPD criteria were assessed during 2 years in a consecutively recruited sample (n= 626). Results: In study 1, CDP no DBT-A had significantly less favorable therapy outcomes compared with CDP only. When comparing CDP + DBT-A and CDP no DBT-A, no differences were found. In study 2, effectiveness of treatment was shown to be similar at all ages. However, older adolescents presented with more BPD criteria and showed a steeper decline of BPD criteria compared with younger adolescents who remained stable in BPD symptomatology over the 2-years period potentially counteracting the expected normative increase in BPD pathology. Discussion: The findings support the decision criteria for the offer of DBT-A after CDP for those in need, but question its efficacy. Overall, early intervention of BPD is effective across all ages but manifests differently in younger individuals.
Mentalization-based treatment for adolescents with Conduct Disorder (MBT-CD): a feasibility study
Svenja Taubner, Lea Kasper, Sophie Hauschild
Introduction: Conduct disorder (CD) is a common psychiatric disorder in youth characterized by persisting norm-violating or aggressive behaviour. Considering high individual and societal burden, feasible and effective psychotherapeutic treatment is desirable. Yet, treatments and research in this patient group are scarce. This study investigates the feasibility of mentalization-based treatment for adolescents with CD (MBT-CD) in terms of acceptability of MBT-CD, features of successful cases and drop-out. Methods: Recruitment, adherence and treatment session numbers were descriptively analysed. Treatment evaluation interviews were qualitatively analysed. A subset of sessions was rated for MBT-adherence, MBT-Interventions, changes in mentalization (RF) and working-alliance (observer-based). Quantitative data were used to plan a consecutive RCT. Pre to post treatment changes in diagnosis and self-reported aggression, mentalizing and personality functioning were preliminarily analysed. Results: Adolescents with CD were successfully recruited (n=45). 43% dropped out and those had lower personality functioning and lower alliance quality in the initial sessions. Mean session number was 30.3. Most treatment completers were satisfied with MBT-CD and 68% changes in diagnoses clinically meaningful. Nine of 16 sessions rated for MBT-adherence were adherent. From self-reported data, empathy pathology improved significantly. Main interventions used were clarification, however high RF was prompted by mentalizing the relationship between patient and therapist Discussion: Findings provide a sound basis for a consecutive feasibility and pilot RCT as well as adapting the manual to focus more on mentalizing relationships and adherence to MBT.
The potential of enhancing caregiver mentalizing as intergenerational prevention strategy for personality pathology
Carla Sharp, Kiana Cano
Research has indicated that personality pathology may interfere with the capacity for optimal caregiving. Sub-optimal caregiving, in turn, has a negative impact on offspring mental health thereby maintaining the intergenerational transmission of risk. While a few interventions have been developed to interrupt this cycle, these interventions tend to be deficit-based, skills-based and do not directly address attachment related processes of caregiving. Relational interventions that focus on enhancing mentalizing capacity are needed. In this talk, we introduce a mentalization-based intervention called the Mediational Intervention for Sensitizing Caregivers which has an evidence base in other populations where attachment disruption occurs. We will present the first few phases of the ADAPT-ITT model (Wingood and DiClemente, 2008) which we are using to adapt the MISC for mothers with personality pathology. In Phase 1, 170 mother without personality pathology are compared to 82 mothers with personality pathology on a range of parenting measures. Next, the data of qualitative interviews with 15 mothers are presented further elaborating the lived experience of motherhood in those with personality pathology. Phase 2 presents qualitative data from another set of 15 interviews in which the MISC is theatre tested and feasibility and acceptability are assessed. This formative work lays the foundation for a randomized control trial to assess the effectiveness of MISC in this population.