The relevance of different patterns of instability in the treatment of borderline personality disorder - results of the Basel borderline inpatient study (BABIS)

Borderline Personality Disorder (BPD) is a severe psychiatric illness that is characterized by instability in affect regulation, interpersonal relationships, impulse control as well as by a distorted self image. The Basel Borderline Inpatient Study (BABIS) aimed to find out more about this disorder, perhaps even being able to define certain subgroups. On the other hand, a disorder-specific treatment in a specialized unit of the “Universitäre Psychiatrische Kliniken” (UPK) Basel was to be compared to a treatment as usual in other wards of the UPK. All of the following articles emerged from the BABIS-Study.
The first article provides an overview of a specialized form of depression, the so called atypical depression (AD), which often occurs in BPD and shows similarities to it. Included in the article is the german translation of the “Atypical Depression Diagnostic Scale” (ADDS) by Stewart and Colleagues, a special interview to assess AD. The interview was used in addition to the SKID I interview.
In the second article we investigate the relationship of BPD and comorbid AD and found this co-occurrence in nearly a third of the patients. Compared to patients without a comorbid AD, the BPD group with AD shows significant higher scores in anxiety, global severity as well as interpersonal problems. However, there are no differences regarding aggression or impulsivity.
The third article compares borderline patients with high versus low identity diffusion with respect to psychopathology and other Axis II Disorders. The results show that patients don’t differ in social data but the group with high identity diffusion has significant higher scores in depression, anxiety, anger and general psychiatric symptoms. The same group is also diagnosed more frequently with an additional Axis II disorder, predominantly a Cluster C disorder.
The fourth article explores the outcome of a disorder-specific inpatient treatment (DST) for borderline patients with regard to identity diffusion and psychopathology. This specialized treatment combines a psychodynamic transference-focused psychotherapy (TFP) approach with modules of dialectical behavioural skills training. Compared with treatment as usual (TAU) patients, the DST group shows a significant decrease in identity diffusion as well as anger and depression. However, there are no significant changes for the TAU group.
The role of interpersonal problems in BPD is eventually the subject of the fifth article. Patients with higher interpersonal problems have significant higher scores in identity diffusion and several psychopathological symptoms such as depression or anxiety but not in anger or impulsivity scores. After treatment, all patients show a significant de-crease in interpersonal problems as well as in identity diffusion, depression and anger.
In summary the clinical picture of BPD remains complex and we didn’t succeed in finding clearly definable subgroups. However it seems that borderline patients do benefit from a disorder-specific treatment. In order to confirm our results, further research with larger study samples would pe preferable.