Improvement of emotional dysregulation, aggression, and self-harm among people treated within outpatient personality disorder mental health services. A large longitudinal, observational, multi-centre study.

OBJECTIVE

Psychotherapy research addressing emotional dysregulation and personality disorders (PDs) is mainly limited to borderline PD (BPD). This longitudinal study aimed to investigate dysregulation for a broader range of patients treated within PD treatment services and its associations with psychosocial impairment.

METHOD: Quality register data included initial PD status and repeated assessment of emotional dysregulation and psychosocial functioning. Main statistical analyses were based on linear mixed models.

Results

In a sample of mixed personality pathology (N = 848, 82% with PD, mean number of criteria 11, SD 6), 75% reported emotional dysregulation, 57% verbal aggression, 49% physical aggression (objects: 31%, people: 19%), and 33% self-harm. Improvement of dysregulation was significant during treatment (mean d = 0.7). BPD, schizotypal PD, and paranoid PD were associated with more severe initial dysregulation and higher improvement rates (BPD mean d = 1.0). Avoidant PD was associated with less initial dysregulation and modest change (mean d = 0.5). Antisocial PD was associated with severe initial dysregulation and little change over time. Poorer psychosocial functioning was at all time points associated with more severe dysregulation.

CONCLUSION

High clinical relevance of emotional dysregulation was demonstrated across PD conditions, including considerable pretreatment problems, strong associations with psychosocial impairment, and significant improvements during treatment.