Locked up in freedom. Pilot Dialectical Behavioral Therapy and relation suicidal behaviour and quality of life in forensic female borderline patients.
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In the current study the effects of a pilot of the Dialectical Behavioral Therapy (DBT; Linehan, 1991) and the relation of suicidal behaviour and quality of life were investigated in female forensic inpatients at the Inforsa Clinic. This study was divided into two parts; study 1 was a descriptive and qualitative study, in which the characteristics of 6 forensic severly affected borderline patients were described and the effects of DBT on aggressive- and self-destructive behavior, self-esteem, locus of control, quality of life and coping were examined. Study 2 was a correlational study, in which the relationship between quality of life, suicidal behavior, locus of control and self-esteem were examined in 10 forensic patients, both borderline and non-borderline. All patients were hospitalized at a forensic psychiatric clinic, Inforsa. In study 1 we implemented a short version of DBT over a three-month period, administered questionnaires measuring borderline symptoms at the beginning and end of the treatment and performed in depth interviews with both patients and therapists. In study 2 we administered questionnaires measuring variables related to quality of life in both borderline and non-borderline female patients who were hospitalized at least six times in their life. Results of Study 1 show that the patients experience severe borderline symptoms. It also points to an interesting pattern in self-destructive and aggressive behaviors over a three-month period: with a high peak during the holidays. Evaluation interviews concerning the therapy and researlch led to the following conclusions: Patients (n =3), their personal case managers and therapists were positive about the DBT pilot and all were in favor of continuing with the full version of the therapy. Study 2 showed a significant relationship between quality of life, suicidal behavior and self-esteem. Quality of life had a positive relationship with self-esteem and both had a negative relationship with suicidal behavior. This study shows that DBT can be effective (qualitatively) even for patients with severe borderline personality disorder. It also shows that quality of life may be improved and suicidal cognitions reduced if treatment focuses on self-esteem. Thus this study demonstrates that we might be able to help patients who are currently considered untreatable.