Vulnerability of personality disorder during the Covid-19 crises – a multicenter survey of treatment experiences among patients referred to treatment

Abstract

Background

The societal shutdown due to the Covid-19 pandemic involved mental health services for personality disorder (PD) and was introduced from 12 March 2020 in Norway. Rapid implementation of treatment modifications was required for patients typically characterized by insecure attachment and vulnerability to separation.

Aim

To investigate immediate reactions to the shutdown of services; alternative treatment received; and differences related to age in a clinical sample of patients with PD.

Design

A survey performed from June to October 2020 (after the first Covid-19 wave) among 1120 patients from 12 units offering comprehensive group-based PD programs.

Results

The response-rate was 12% (N = 133). Negative feelings of anxiety, sadness, and helplessness were noteworthy immediate reactions, but the dominating attitude was accommodation. Younger patients (<26 years) reported more skepticism and less relief. Modified treatment was mainly telephone therapy. Digital therapy was less available, but was more frequent among younger patients. A minority received digital group therapy. Most patients rated the frequency and quality of modified treatments as satisfactory in the given situation, but also worried about own treatment progress, lack of group therapy, and 47% missed seeing the therapist when having telephone consultations.

Conclusion

The survey confirms a radical modification from comprehensive group-based PD programs to telephone consultations, low availability of digital consultations and group treatments. Taking a short-term, first wave perspective, the survey indicates a noteworthy capacity among poorly functioning patients for accommodating to a clearly challenging situation, as well as considerable concern about treatment progress.

Keywords:

• Personality disorder
• Covid-19 crises
• treatment experience

Acknowledgements

We wish to thank the patients and staff from the Network of Personality Disorders in Norway for their contribution to this study. The 12 participating treatment units include Unit for Group Therapy, Øvre Romerike District Psychiatric Center, Akershus University Hospital, Jessheim; Group Therapy Unit, Nedre Romerike District Psychiatric Center, Akershus University Hospital, Lillestrøm; Group Therapy Unit, Follo District Psychiatric Center, Akershus University Hospital; Group Therapy Unit, Kongsvinger District Psychiatric Center, Akershus University Hospital; Clinic for Personality disorders, Outpatient Clinic for Specialized Treatment of Personality Disorders, Section for Personality psychiatry and specialized treatments, Oslo University Hospital, Oslo; Group Therapy Unit, Lovisenberg District Psychiatric Center, Lovisenberg Hospital, Oslo; Group Therapy Team, Vinderen Psychiatric Center, Diakonhjemmet Hospital, Oslo; Unit of Personality psychiatry, Vestfold District Psychiatric Center; Unit for Intensive Group Therapy, Aust-Agder District Psychiatric Center, Sørlandet Hospital, Arendal; Unit for Group Therapy, District Psychiatric Center, Strømme, Sørlandet Hospital, Kristiansand; Group Therapy Unit, Stavanger District Psychiatric Center, Stavanger University Hospital, Stavanger; Section for group treatment, Kronstad District Psychiatric Center, Haukeland University Hospital, Bergen. We also acknowledge the efficient research assistance of Elise Bynander, Outpatient Clinic for Specialized Treatment of Personality Disorders, Section for Personality psychiatry and specialized treatments, Oslo University Hospital, Oslo.

Disclosure statement

None of the above authors have any financial disclosure or other conflicts of interest related to this study. Data collection was funded by Oslo University Hospital.

Notes on contributors

All authors collaborate in the research group of Personality Psychiatry, University of Oslo, which is headed by EHK (MD, PhD, associate professor/Head senior consultant, Section for Personality Psychiatry).

EHK has clinical and research experience within differential diagnostic assessment and treatment of patients with personality disorder.

GP (MA, PhD, head of the Norwegian Network for Personality Disorders) has experience within clinical research implementation, and psychometric assessments. EHK and GP are joint principle investigators in this project.

KEZ (MA) is a senior psychologist and represents five of the participating units. KEZ has engaged in clinical research within treatment of patients with personality disorder.

LIS (MA, PhD) is a researcher/senior psychologist. Her main research interests are within qualitative methodology, case studies, and research focusing on self-harming behaviors among adolescents.

MSP (MA) has a Masters degree of Nursing - Clinical Research and Professional Development and works currently within the addiction field. She has experience with qualitative research methods and also represents a user perspective.

ÅLB (BA) works currently as communications advisor at the National Advisory Unit for Personality Psychiatry. She is also engaged in health service implementation, qualitative research and user representation.

MSJ (MD, PhD, head senior consultant) heads one of the participating clinical units. She has clinical and research experience within assessment and treatment of patients with personality disorder.

IU-ME (MD, PhD) is head of the National Advisory Unit for Personality Psychiatry and has clinical and research experience within assessment and treatment of patients with personality disorder.

EAA (MA, PhD) is a clinical psychologist/researcher and head of an addiction research unit. He has clinical and research experience within assessment of patients with personality disorder and a broad range of treatments.

BH (MD, PhD) is a senior consultant/researcher with broad experience of clinical research, project implementation, statistical methodology, diagnostic assessment and treatment of personality disorder.

TW (MD, PhD) is a senior consultant/researcher with broad experience of clinical research, project implementation, psychotherapy research, assessment and treatment of personality disorder.

Data availability statement

A data set is not directly available, but data can be made available upon specified request to the main, corresponding author/principal investigator/last author Geir Pedersen. However, this will require additional application for ethical approval by the board for medical research ethics, South Eastern Norway.