Recovery from disability for individuals with borderline personality disorder: a feasibility trial of DBT-ACES.
OBJECTIVE
Employment and recovery can be difficult goals to reach for individuals with severe borderline personality disorder, even for those who have successfully completed dialectical behavior therapy (DBT) and are no longer in crisis. This study examined the feasibility of DBT-Accepting the Challenges of Exiting the System (DBT-ACES), a follow-up to standard DBT (SDBT).


METHODS
A pre-post evaluation was conducted of the outcomes for 30 clients with borderline personality disorder who entered DBT-ACES during the study period (April 2000 to June 2005). Outcomes included employment, exit from the public mental health system, and quality of life, as well as self-inflicted injury and emergency and inpatient admissions.


RESULTS
From the end of SDBT to the end of DBT-ACES, the study found a significant improvement in participants' odds of being employed or in school (odds ratio [OR]=3.34, p<.05), working at least 20 hours per week (OR=4.93, p=.01), and subjective quality of life (B=.49, p=.03) and a decrease in the number of inpatient admissions (RR=.07, p<.05). Comparing the end of SDBT to a year after DBT-ACES, the latter two outcomes were mostly retained, but the findings were not significant. One year after leaving DBT-ACES, only 36% of DBT-ACES clients were still receiving public mental health services. Emergency room admissions, inpatient psychiatry admissions, and medically treated self-inflicted injuries all decreased during SDBT and remained low during and following DBT-ACES.


CONCLUSIONS
This study demonstrated the feasibility of meaningful recovery from severe borderline personality disorder with a combination of SDBT and DBT-ACES, but controlled research is needed.
Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 9th Ave., Box 359911, Seattle, WA 98104, USA. comtois@u.washington.edu
Katherine Anne
KA
Comtois
Amanda Holland
AH
Kerbrat
David C
DC
Atkins
Melanie S
MS
Harned
Lynn
L
Elwood
D000328:Adult; D001883:Borderline Personality Disorder / Q000534:rehabilitation* / Q000628:therapy; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation; D004651:Employment / Q000523:psychology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012050:Rehabilitation, Vocational / Q000379:methods* / Q000523:psychology; D055815:Young Adult