Borderline personality disorder in times of COVID-19 and therapeutic approaches: a narrative review of non-pharmacological approaches

Authors

  • Flávia Marques Melandi de Lima Especializanda em Psiquiatria, Instituição de Ensino Cyro Martins, Porto Alegre, RS, Brasil https://orcid.org/0000-0002-4531-6418
  • Milton Armando Teresa Malai Moçambique Médico Chefe Distrital do Ministério da Saúde de Moçambique, Moçambique https://orcid.org/0000-0002-5288-2207

DOI:

https://doi.org/10.25118/2763-9037.2023.v13.787

Keywords:

COVID-19, borderline personality disorder, non-pharmacological treatment

Abstract

The COVID-19 pandemic affected all aspects of life, as the virus was spread globally, and social isolation was the most widespread preventive measure. The COVID-19 pandemic is a potentially dangerous reality that may negatively influence the clinical conditions of patients with borderline personality disorder (BPD) and cause severe consequences due to lack of support. The aim of this study was to assess how COVID-19 affected patients with BPD and which non-pharmacological approaches were adopted. Patients with BPD are lonelier, have fewer social contacts, and feel less need for and joy in social touch compared to the general population. It is necessary that health professionals be trained briefly therapy programs or psychotherapies. This cost can be compensated by the improvement of the families' well-being, as well as by the reduction of psychiatric symptoms and burden in the family environment. The dialectical behavior therapy (DBT) was the most widely used therapy and showed the most positive results. Compared to DBT, there is still considerable work to be done regarding applying schema therapy (ST) and acceptance and commitment therapy (ACT) in treating patients with BPD, as there are still few trained professionals.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biographies

Flávia Marques Melandi de Lima, Especializanda em Psiquiatria, Instituição de Ensino Cyro Martins, Porto Alegre, RS, Brasil

Milton Armando Teresa Malai Moçambique, Médico Chefe Distrital do Ministério da Saúde de Moçambique, Moçambique

PhD in Psychiatry and Behavioral Sciences, specialist in cognitive behavioral therapy, chemical dependency therapist, psychiatry resident-R3, MD.

References

World Health Organization. WHO Statement regarding cluster of pneumonia cases in Wuhan, China. Geneva: World Health Organization; 2020. https://www.who.int/china/news/detail/09-01-2020-who-statement-regarding-cluster-of-pneumonia-cases-in-wuhan-china

Mahase E. China coronavirus: WHO declares international emergency as death toll exceeds 200. BMJ. 2020;368:m408. https://doi.org/10.1136/bmj.m408 PMID:32005727 DOI: https://doi.org/10.1136/bmj.m408

World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19. Geneva: World Health Organization; 2020. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-COVID-19---11-march-2020

Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20(5):533-4. https://doi.org/10.1016/s1473-3099(20)30120-1 PMID:32087114 - PMCID:PMC7159018 DOI: https://doi.org/10.1016/S1473-3099(20)30120-1

Yudhantara DS, Istiqomah R. Borderline personality disorder during COVID-19 pandemic. J Psychiatry Psychol Behav Res. 2021;2(2):14-7. https://doi.org/10.21776/ub.jppbr.2021.002.02.5 DOI: https://doi.org/10.21776/ub.jppbr.2021.002.02.5

Bourvis N, Aouidad A, Spodenkiewicz M, Palestra G, Aigrain J, Baptista A, Benoliel JJ, Chetouani M, Cohen D. Adolescents with borderline personality disorder show a higher response to stress but a lack of self-perception: evidence through affective computing. Prog Neuropsychopharmacol Biol Psychiatry. 2021;111:110095. https://doi.org/10.1016/j.pnpbp.2020.110095 PMID:32896602 DOI: https://doi.org/10.1016/j.pnpbp.2020.110095

Siever LJ, Torgersen S, Gunderson JG, Livesley WJ, Kendler KS. The borderline diagnosis III: identifying endophenotypes for genetic studies. Biol Psychiatry. 2002;51(12):964-8. https://doi.org/10.1016/s0006-3223(02)01326-4 PMID:12062879 DOI: https://doi.org/10.1016/S0006-3223(02)01326-4

American Psychiatric Association. Manual diagnóstico e estatístico de transtornos mentais: DSM-5. 5. ed. Porto Alegre: Artmed; 2014.

Meaney R, Hasking P, Reupert A. Prevalence of borderline personality disorder in university samples: systematic review, meta-analysis and meta-regression. PLoS One. 2016;11(5):e0155439. https://doi.org/10.1371/journal.pone.0155439 PMID:27171206 - PMCID:PMC4865108 DOI: https://doi.org/10.1371/journal.pone.0155439

Boland R, Verduin ML. Kaplan & Sadock's concise textbook of clinical psychiatry. 5th ed. Philadelphia: LWW; 2022.

Ellison WD, Rosenstein LK, Morgan TA, Zimmerman M. Community and clinical epidemiology of borderline personality disorder. Psychiatr Clin North Am. 2018;41(4):561-73. https://doi.org/10.1016/j.psc.2018.07.008 PMID:30447724 DOI: https://doi.org/10.1016/j.psc.2018.07.008

Gunderson JG. Borderline personality disorder: a clinical guide. Washington: American Psychiatric Association; 2001.

Tomko RL, Trull TJ, Wood PK, Sher KJ. Characteristics of borderline personality disorder in a community sample: comorbidity, treatment utilization, and general functioning. J Pers Disord. 2014;28(5):734-50. https://doi.org/10.1521/pedi_2012_26_093 PMID:25248122 - PMCID:PMC3864176 DOI: https://doi.org/10.1521/pedi_2012_26_093

Grambal A, Prasko J, Ociskova M, Slepecky M, Kotianova A, Sedlackova Z, Zatkova M, Kasalova P, Kamaradova D. Borderline personality disorder and unmet needs. Neuro Endocrinol Lett. 2017;38(4):275-89. PMID:28871714

Álvaro F, Navarro S, Palma C, Farriols N, Aliaga F, Solves L, Hernández M, Antón M, Riera A. Clinical course and predictors in patients with borderline personality disorder during the COVID-19 outbreak: a 2.5-month naturalistic exploratory study in Spain. Psychiatry Res. 2020;292:113306. https://doi.org/10.1016/j.psychres.2020.113306 PMID:32702553 PMCID:PMC7365077 DOI: https://doi.org/10.1016/j.psychres.2020.113306

van Dijk SDM, Bouman R, Folmer EH, den Held RC, Warringa JE, Marijnissen RM, Voshaar RCO. (Vi)-rushed into online group schema therapy based day-treatment for older adults by the COVID-19 outbreak in the Netherlands. Am J Geriatr Psychiatry. 2020;28(9):983-8. https://doi.org/10.1016/j.jagp.2020.05.028 PMID:32622730 - PMCID:PMC7274959 DOI: https://doi.org/10.1016/j.jagp.2020.05.028

Salamin V, Rossier V, Joye D, Nolde C, Pierrehumbert T, Gothuey I, Guenot F. Adaptations de la thérapie comportementale dialectique ambulatoire en période de pandémie COVID-19 et conséquences du confinement sur des patients souffrant d’un état-limite. Ann Med Psychol (Paris). 2021;179(2):131-6. https://doi.org/10.1016/j.amp.2020.08.006 PMID:32843771 PMCID:PMC7439824 DOI: https://doi.org/10.1016/j.amp.2020.08.006

Fernández-Felipe I, Díaz-García A, Marco JH, García-Palacios A, Guillén Botella V. "Family connections", a DBT-based program for relatives of people with borderline personality disorder during the COVID-19 pandemic: a focus group study. Int J Environ Res Public Health. 2022;19(1):79. https://doi.org/10.3390/ijerph19010079 PMID:35010344 - PMCID:PMC8750943 DOI: https://doi.org/10.3390/ijerph19010079

Landes SJ, Pitcock JA, Harned MS, Connolly SL, Meyers LL, Oliver CM. Provider perspectives on delivering dialectical behavior therapy via telehealth during COVID-19 in the department of veterans affairs. Psychol Serv. 2022;19(3):562-72. https://doi.org/10.1037/ser0000571 - PMID:34351209 DOI: https://doi.org/10.1037/ser0000571

Zahl KE, Pedersen G, Eikenaes IU, Stanicke LI, Wilberg T, Baltzersen AL, Pettersen MS, Hummelen B, Arnevik E, Johansen MS, Hartveit Kvarstein E. Avoidant and borderline personality disorder patients during the first COVID-19 wave in Norway - a survey-based comparison of therapy changes and patients' accommodations. Nord J Psychiatry. 2023;77(4):336-44. https://doi.org/10.1080/08039488.2022.2110614 - PMID:35984379 DOI: https://doi.org/10.1080/08039488.2022.2110614

Dharwadkar NP, Broadbear JH, Heidari P, Cheney L, Rao S. Psychotherapy via telehealth during the COVID-19 pandemic in Australia: experience of clients with a diagnosis of borderline personality disorder. Glob J Health Sci. 2022;14(1):29-35. https://doi.org/10.5539/gjhs.v14n1p29 DOI: https://doi.org/10.5539/gjhs.v14n1p29

Schulze A, Biermann M, Atanasova K, Unterseher F, Winkler L, Bohus M, Lis S. Social touch, social isolation, and loneliness in borderline personality disorder during the COVID-19 pandemic. Front Psychiatry. 2022;13:876413. https://doi.org/10.3389/fpsyt.2022.876413 - PMID:35815051 PMCID:PMC9260178 DOI: https://doi.org/10.3389/fpsyt.2022.876413

Zimmerman M, Ward M, D'Avanzato C, Tirpak JW. Telehealth treatment of patients with borderline personality disorder in a partial hospital setting during the COVID-19 pandemic: comparative safety, patient satisfaction, and effectiveness of in-person treatment. J Pers Disord. 2022;36(3):277-95. https://doi.org/10.1521/pedi_2021_35_539 - PMID:34747648 DOI: https://doi.org/10.1521/pedi_2021_35_539

Heidari P, Broadbear JH, Cheney L, Dharwadkar NP, Rao S. The impact of COVID-19 lockdown on the well-being of clients of a specialist personality disorder service. Australas Psychiatry. 2022;30(2):235-8. https://doi.org/10.1177/10398562211057078 PMID:34854337 - PMCID:PMC8990572 DOI: https://doi.org/10.1177/10398562211057078

Hoffman PD, Fruzzetti AE, Buteau E, Neiditch ER, Penney D, Bruce ML, Hellman F, Struening E. Family connections: a program for relatives of persons with borderline personality disorder. Fam Process. 2005;44(2):217-25. https://doi.org/10.1111/j.1545-5300.2005.00055.x - PMID:16013747 DOI: https://doi.org/10.1111/j.1545-5300.2005.00055.x

Zanarini MC, Frankenburg FR. The essential nature of borderline psychopathology. J Pers Disord. 2007;21(5):518-35. https://doi.org/10.1521/pedi.2007.21.5.518 - PMID:17953504 DOI: https://doi.org/10.1521/pedi.2007.21.5.518

Linehan MM. Skills training manual for treating borderline personality disorder. New York: Guilford Press; 1993.

Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline personality disorder. Lancet. 2004;364(9432):453-61. https://doi.org/10.1016/s0140-6736(04)16770-6 - PMID:15288745 DOI: https://doi.org/10.1016/S0140-6736(04)16770-6

Linehan MM, Heard HL, Armstrong HE. Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1993;50(12):971-4. https://doi.org/10.1001/archpsyc.1993.01820240055007 PMID:8250683 DOI: https://doi.org/10.1001/archpsyc.1993.01820240055007

Koons CR, Robins CJ, Tweed JL, Lynch TR, Gonzalez AM, Morse JQ, Bishop GK, Butterfield MI, Bastian LA. Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder. Behav Ther. 2001;32(2):371-90. https://doi.org/10.1016/S0005-7894(01)80009-5 DOI: https://doi.org/10.1016/S0005-7894(01)80009-5

Barbosa LM, Murta SG. Terapia de aceitação e compromisso: história, fundamentos, modelo e evidências. Rev Bras Ter Comport Cogn. 2014;16(3):34-49. https://doi.org/10.31505/rbtcc.v16i3.711 DOI: https://doi.org/10.31505/rbtcc.v16i3.711

Hayes SC, Villatte M, Levin M, Hildebrandt M. Open, aware, and active: contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annu Rev Clin Psychol. 2011;7:141-68. https://doi.org/10.1146/annurev-clinpsy-032210-104449 - PMID:21219193 DOI: https://doi.org/10.1146/annurev-clinpsy-032210-104449

Levin ME, Hildebrandt MJ, Lillis J, Hayes SC. The impact of treatment components suggested by the psychological flexibility model: a meta-analysis of laboratory-based component studies. Behav Ther. 2012;43(4):741-56. https://doi.org/10.1016/j.beth.2012.05.003 PMID:23046777 DOI: https://doi.org/10.1016/j.beth.2012.05.003

Published

2023-09-11

How to Cite

1.
Lima FMM de, Moçambique MATM. Borderline personality disorder in times of COVID-19 and therapeutic approaches: a narrative review of non-pharmacological approaches. Debates em Psiquiatria [Internet]. 2023 Sep. 11 [cited 2024 Dec. 22];13:1-25. Available from: https://revistardp.org.br/revista/article/view/787

Conference Proceedings Volume

Section

Review Articles

Plaudit

Most read articles by the same author(s)