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

Figures & data

Table 1. Overview of treatment within the Norwegian Network for Personality Disorders.

	Specification of treatment	Frequency (% of N = 171)
Manual-based PD treatment programs combining group and individual modalities	Mentalization-based treatment (MBT)	42
	Schema-focused therapy	8
	Dialectical behavioral therapy	3
	Metacognitive interpersonal therapy group or individual	3
Stand alone or preparatory before MBT	MBT psychoeducation	20
Other group-based therapies, stand-alone and individualized combinations with other groups/individual therapy	Psychodynamic group therapy	23
	Physical activity group	15
	Body awareness group	15
	Art therapy	14
	Family therapy	10
	Stabilization group (trauma therapy)	2
	Mindfulness group	1
	Cognitive therapy group, social anxiety	1
	Solution-focused group therapy	2
	Other approaches	14
Individual therapies stand-alone or in individualized combination with groups	Individual psychodynamic therapy	14
	Individual cognitive therapy	3
	Supportive therapy	1
	Trauma exposure therapy	1
	Other approaches	4

Based on information collected from the Norwegian Network for Personality Disorders representing all patients who started treatment in units within the network during the first half of 2018 (N = 171).

Table 2. Overview of the survey.

	Topics	Psychometric instrument	Survey-specific questions
Sociodemographic status	Gender		x
	Age		x
	Living and family situation		x
	Vocational status		x
	Caring for children		x
Covid-19 exposure and health-related situation	Covid-19 exposure		x
	Health-related anxiety		x
	Hospital and emergency mental health services		x
	Physical illness and use of other health services		x
Mental status	Depression	PHQ-9 [36]
	Anxiety	GAD-7 [37]
	Aggression	MOAS [38]
	Personality functioning	LPFS-BF [5]
	Health-related life quality	EQ-5D [39]
Social situation	Isolation and loneliness		x
	More initiative/energy		x
Self-destructive behaviors	Non-suicidal self-injury		x
	Suicide ideation		x
	Suicide attempts		x
Substance use and medication	Substance use		x
	Medication		x
Diagnoses received before March 12	Personality disorder		x
	Symptom disorder		x
Treatment situation	Contact with treatment unit before March 12		x
	Immediate emotional reactions to the shutdown of treatment		x
	Modified treatment received after March 12		x
	Experience of modified treatment		x

All topics addressed in the survey, self-report instruments are further specified in a separate study focusing on mental distress [30]. Topics focused in this study are marked with grey shaded cells, and survey-specific questions in this study are elaborated in the methods section.

Table 3. Patients’ immediate emotional reaction to the changed treatment situation.

	% (N = 133)
	No, not at all	Yes and no (partly)	Yes absolutely (clearly)
Negative feelings/attitudes
Anxious	33	42	25
Angry	70	22	8
Sad	40	34	26
Rejected	62	25	13
Abandoned	59	24	17
Worthless	61	21	18
Downgraded	56	31	13
Helpless	39	41	21
Skeptical	58	34	9
Violated	93	6	2
Ashamed	80	16	4
Let down	64	26	10
Neutral feelings
Indifferent	58	32	10
Positive feelings/attitudes
Releaved	60	29	11
Satisfied	68	23	9
Accommodating	7	27	66

Table 4. Clinical status before 12 March 2020.

	Study sample N = 133		Network for personality disorders Pretreatment data, N = 1609
	Mean (SD)	%	Mean (SD)	%
Age	33 (11)*		30 (9)
Gender female		87		77
Occupational status
Mean months in >50% work/study last 6 months	2.4 (2.8)		2.3 (2.6)
Less than 50% work/study last 6 months		53		49
Living situation
Living alone or with parents		48		47
Living with partner/spouse/cohabiting		46		32
Living alone with children in care		3		8
Treatment situation
Early phase, pretreatment assessment		14		100
Attending psychotherapy for PD		83		0
Receiving psychotropic medication		51		37
Planning psychotherapy termination		20		0
Number of months since referred to unit	16.2 (14)
Diagnoses
Do not know if symptom disorder		6
Mood disorder		56*		65
Anxiety disorder		50		49
OCD		9*		5
Eating disorder		11		8
PTSD		27*		13
Substance use disorder		2*		10
Psychosis		2		1
Autism		0		1
Do not know if PD diagnoses		10
Borderline PD		44*		33
Avoidant PD		35		36
Other PD		12		23
LPFS-BF total sum-score^a	18 (7)		17 (7)
Self-harm/suicide
Non-suicidal self-injury		33		36
Suicide attempts		5		12

Comparison statistics: *p< .05.

^a Levels of Personality Functioning Scale – Brief Form: LPFS-BF [5].

Figure 1. Immediate reactions reported partly or clearly to the shut-down of services; three negative feelings, accommodating attitudes (% of whole sample) and significant (p< .05) age-related differences in reactions of skepticism and relief (% within subgroup).

Figure 2. Implementation of alternative therapy formats. The different formats of therapy available to patients before and after March 12, blue and red columns indicate proportions within the two age groups and significant differences in face-to-face and digital therapies (p<.05). Green columns indicate individual and group therapy received.

Figure 3. Experience of alternative formats. Patients’ overall satisfaction with therapist contact and treatment (intermediate = acceptable), experienced quality and purpose (intermediate = unchanged), privacy concerns (intermediate = yes, sometimes), the remote telephone-format (intermediate = acceptable), and worry about continuity of group-based treatment (intermediate = yes, partly).

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Kvarstein E,H, Zahl KE, Stänicke LI, et al. Vulnerability of personality disorder during the Covid-19 crises – a multicenter survey of mental and social distress among patients referred to treatment; Nordic J Psychiatry; 2021.

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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.