FAMILY CONNECTIONS FOR FAMILY MEMBERS OF PEOPLE WITH BORDERLINE PERSONALITY DISORDER
What is Borderline Personality Disorder?
Borderline Personality Disorder (BPD) is characterised by an intense and turbulent pattern of interpersonal relationships, characterised by episodes of uncontrollable anger, poor impulse control, emotional instability, cognitive deficits, identity deficits and recurrent suicidal behaviour. According to the DSM-5 (APA, 2013), around 2% of the world’s population suffers from BPD and other studies show prevalence around 6.2% of the general population (Grant, et al, 2008). This disorder is three times more frequent in women, with almost 75% of cases. The age of diagnosis of BPD is between 19-32 years. People with BPD are considered to be at higher risk of developing other psychological disorders. Women are more likely to develop eating disorders and men are more likely to develop addictive disorders. Women, however, have a higher frequency of self-harm and higher rates of suicide use. It has been associated with more traumatic experiences, childhood physical and/or sexual abuse, doubts about sexual identity, and personal and/or family history of psychiatric admissions. This pattern is highly dysfunctional, causing serious consequences in work, family, emotional, interpersonal, and other areas. Therefore, people with BPD (hereafter referred to as patients) account for 20% of hospital admissions in Acute Units. On numerous occasions, suffering from BPD leads to parasuicidal behaviour, suicide, drug addiction, eating disorders, intra-family conflicts, school or work absenteeism, and considerable public health and/or social expenditure due to continual crises and relapses.
How does it affect the family?
This dysfunctional pattern also generates great suffering and dysfunction in their family members. Dysfunctional attachment relationships are frequently observed. However, family members of BPD patients are often the most important source of support for the patients, providing emotional, logistical and financial support. This places an enormous responsibility on family members who often experience clinical symptoms of anxiety and depression, feelings of loss, and emotional exhaustion directly caused by caring for their BPD family member.
Currently, several treatments have been shown to be effective for patients with BPD. However, studies to test the efficacy of treatments to alleviate the impact of BPD on family members are scarce at the moment. From our point of view, family members are the forgotten ones in this problem. Crisis management, constant visits to the emergency room, interpersonal problems, the continuous burden on family members, marital conflicts, etc., make daily life with BPD patients an inexhaustible source of conflict and suffering. In addition, the relationships that are established in the family nucleus are often very harmful to all members of the family. This influence is bidirectional, as the family is affected by the patient and vice versa. It is therefore essential to focus attention, work and resources on the development and testing of effective interventions for family members of patients with BPD.
Interventions for family members.
Fortunately, some studies show that treatment for family members of BPD patients is beginning to play an important role in the recovery of patients and the improvement of family functioning, by providing family members with a series of strategies that help them to relate to the patient with BPD and to know how to act in crises. However, studies focusing on family members are scarce and many of them are pilot studies or uncontrolled studies.
The group that has done the most work so far is Alan Fruzzetti and Perry Hoffman’s group with the “Family Connections” programme (Hoffman et al., 2005; 2007). This programme is based on the basic principles of dialectical behaviour therapy (DBT) (Linehan, 1993) to meet the considerable needs of this population. It is a manualised intervention, based on psychoeducation strategies about BPD and skills training to provide families with strategies. In addition, social support and group contact are well suited to avoid the isolation and stigma so often associated with BPD (Lawn, McMahon, 2015). So far, 5 controlled studies with pre-post have shown statistical differences in relatives of BPD, and one in relatives of suicidal patients. All these studies, supported by the National Education Alliance for Borderline Personality Disorder (NEA-BPD) and more than 20 years of research on this topic, have contributed to filling the gap that existed in this complex problem in different countries (United States, Australia, New Zealand, Ireland, and Italy) in which the programme has been implemented and which so many family members have to deal with daily. However, in Spain, there is currently no initiative to make this help available.
“Who takes care of the caregiver? Treatment for relatives of patients with Borderline Personality Disorder.”
– Funding: Consellería de Innovación, Universidades, Ciencia y Sociedad Digital: proyectos de I+D+I desarrollados por grupos Emergentes. GV/2019.
Duration: 2 years (02/01/2019 to 02/01/2020)
– Principal Researcher: PhD Verónica Guillén Botella.
To advance in this line of work and improve the clinical situation and quality of life of family members of people with BPD in our country, it is necessary to have intervention protocols focused exclusively on family members and to test their efficacy in controlled studies using active control groups. From our point of view, training family members in the different skills required for the effective management of patients with BPD may be a good strategy for them to learn to manage the patients’ crises in a much more effective way, and this may help to alleviate the stress and burden that caregivers bear daily. This, in turn, can help to improve family relationships as well as the family atmosphere. This is precisely what we are pursuing in the present project and for this purpose, the “Family Connections” protocol will be translated, adapted to the Spanish population and its efficacy and efficiency will be tested in a randomised controlled study comparing it with the usual treatment.
Aim of the project:
The general objective of this research project is threefold, on the one hand, to translate, adapt and validate in Spanish population the intervention protocol designed and developed by Fruzzetti’s group “Family Connections”. On the other hand, to test its efficacy and efficiency (understood as the acceptance of the intervention programme by the participants) in relatives of patients with a diagnosis of BPD in a randomised controlled study.
Inclusion and Exclusion Criteria:
In the case of relatives, the following inclusion and exclusion criteria will be followed:
To be a relative of one of the patients with a diagnosis of BPD.
Signing the informed consent form.
The presence of any pathology that prevents the intervention from being carried out (such as major depression, psychosis, schizophrenia, substance dependence, etc.) will be grounds for exclusion.
In the case of patients, the following inclusion and exclusion criteria will be established:
Fulfil the diagnostic criteria for Borderline Personality Disorder.
Signing the informed consent form, and in the case of minors, the consent must be signed by the parents.
The presence of another serious pathology such as psychosis, schizophrenia etc. will be a reason for exclusion.
Those interested will be contacted, a brief evaluation will be carried out, and if they meet the inclusion criteria, they will be able to receive the Family Connections programme for family members of people with BPD.
This is a free intervention, which is part of this research project. The intervention is group-based and lasts for 3 months and includes 12 sessions that follow a 2-hour group format on a weekly basis. The intervention is led by a therapist and co-therapist who are accredited to deliver FC groups.
*This project has now been completed.
Family members of people with borderline personality disorder; Brochure & Flyer