Avoidant and borderline personality disorder patients during the first Covid-19 wave in Norway – a survey-based comparison of therapy changes and patients’ accommodations

Abstract

Background

Patients with personality disorders (PDs) often have insecure attachment patterns and may be especially vulnerable to abrupt treatment changes. Patients with borderline PD (BPD) are often considered vulnerable to treatment interruption due to chronic fear of abandonment. Nonetheless, other PDs are poorly investigated. In the first Covid-19 wave in Norway, in-person treatment facilities and group treatments were strongly restricted from March 12th until May/June 2020.

Objectives

To examine and compare changes in outpatient treatment for patients with avoidant (AvPD) and BPD during the first Covid-19 wave in Norway, and patients’ reactions to these changes.

Methods

The study is based on a cross-sectional survey distributed to 1120 patients referred to 12 different PD treatment units on a specialist mental health service level within the Norwegian Network for Personality Disorders. The survey included questions on treatment situation, immediate reactions, and changes during the crisis. From 133 responders (response rate 12%), 40 patients reported BPD and 30 AvPD as diagnosis.

Results

All patients were followed up from their therapist after March 12th. Almost all patients in both groups expressed satisfaction under the new circumstances. Both groups experienced the same regularity as before, but more AvPD patients reported less than weekly consultations. AvPD patients reported more negative feelings about changes in therapy, and missed the therapy and group members more than the BPD group.

Conclusion

After the lockdown, BPD patients received a closer follow-up than AvPD patients, and the latter reported more negative feelings related to change in their treatment situation.

Keywords:

• Avoidant personality disorder
• borderline personality disorder
• Covid-19
• treatment changes
• telepsychiatry

Acknowledgements

We 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. We also wish to thank the patients and staff from the following 12 units of the Norwegian Network for Personality Disorders for their contribution to this study: Unit for Group Therapy, Øvre Romerike District Psychiatric Center, Akershus University Hospital HF, Jessheim; Group Therapy Unit, Nedre Romerike District Psychiatric Center, Akershus University Hospital, Lillestrøm; Group Therapy Unit, Follo District Psychiatric Center, Akershus University Hospital, Ski; Group Therapy Unit, Kongsvinger District Psychiatric Center, Akershus University Hospital; Section for Personality psychiatry and specialized treatments, Oslo University Hospital, Oslo; Group Therapy Unit, Lovisenberg District Psychiatric Center, Lovisenberg Hospital, Oslo; Unit of Personality psychiatry, Vinderen Psychiatric Center, Diakonhjemmet Hospital, Oslo; Unit of Personality psychiatry, Vestfold District Psychiatric Center, Sandefjord; Unit for Intensive Group Therapy, Aust-Agder District Psychiatric Center, Sørlandet Hospital, Arendal; Unit for Group Therapy, District Psychiatric Center, Strømme, Sørlandet Hospital HF, Kristiansand; Group Therapy Unit, Stavanger District Psychiatric Center, Stavanger University Hospital, Stavanger; Section for group treatment, Kronstad District Psychiatric Center, Helse Bergen and Haukeland University Hospital, Bergen.

Disclosure statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

Output files from SPSS data are available on request from corresponding author.

Additional information

Notes on contributors

Kjell-Einar Zahl

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).

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

Geir Pedersen

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.

Ingeborg Ulltveit-Moe Eikenaes

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.

Line Indrevoll Stänicke

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.

Theresa Wilberg

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.

Åse-Line Baltzersen

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.

Mona Skjeklesaether Pettersen

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.

Benjamin Hummelen

EA (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.

Espen Arnevik

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.

Merete Selsbakk Johansen

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

Elfrida Hartveit Kvarstein

EHK (MD, PhD) has clinical and research experience within differential diagnostic assessment and treatment of patients with personality disorder.