NIMH recently funded Kim Gratz, Ph.D., University of Mississippi Medical Center, and colleagues to continue to test a new group therapy to help women with borderline personality disorder reduce self-harm behaviors and to improve functioning.
Borderline personality disorder is a serious mental illness noted by unstable moods, behavior and relationships, affecting around 1.4 percent of adults in the United States1 This disorder is also commonly associated with deliberate self-harm behaviors, such as cutting, burning, hitting, head banging, and other acts that injure oneself.
Unlike suicide attempts, self-harm behaviors do not arise from a desire to die, although some behaviors may be life-threatening.
“People with borderline personality disorder often carry out self-harm to regulate their emotions, relieve emotional distress, or distract themselves from internal pain,” explains Dr. Gratz. “Because self-harm works so well in the short-term to relieve emotional distress, it can be very difficult to stop.”
Studies have shown that dialectical behavioral therapy and mentalization-based treatment are effective for treating self-harm among people with borderline personality disorder. Dialectical behavior therapy teaches skills to manage emotions, tolerate distress, pay attention to what is happening in the here and now, and improve relationships. Mentalization-based treatment focuses on helping people to recognize that their own behaviors, and the behaviors of people around them, arise from internal, mental states such as thoughts, feelings, and desires. However, these treatments are difficult to implement in real-world treatment settings because they require specialized training, as well as multiple hours of treatment per week for an extended period of time (at least one year, and often longer). As a result, these treatments are not readily available to people living with borderline personality disorder in many communities.
To address this gap, Gratz and colleagues have developed a targeted, short-term, emotion regulation group therapy. This therapy focuses on teaching people healthy ways of managing their emotions (for example, by accepting their emotions) and is intended for people who are already receiving individual therapy in the community. Early tests suggest that this group therapy may be helpful as an add-on treatment.
In the first phase of their two-phase study, the researchers will use this acceptance-based emotion regulation group therapy to treat 24 women who have borderline personality disorder and engage in self-harm behaviors. The researchers will refine the treatment based on these initial findings. Then, during the second phase, 60 self-harming women with borderline personality disorder will be randomly assigned either to receive the group therapy immediately or to wait 14 weeks before receiving this add-on treatment. All participants will also continue in their own original course of treatment. Delaying the add-on treatment in the latter group will allow the researchers to study differences in outcomes that result from treatment.
The researchers expect to use the results of this pilot study to develop a larger-scale treatment outcome study.
1 Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey Replication . Biol Psychiatry. 2007 Sep 15;62(6):553-64.