Grant: Operating Grant

Borderline personality disorder (BPD) is a serious psychiatric disorder that affects 2 to 6% of the population. Patients with BPD often harm themselves: 84% intentionally injure themselves at least one time, and many attempt suicide, with estimates of completed suicides ranging from 9 to 33%. People who self-harm (suicide attempts or non suicidal behaviours) are heavy users of health care services, making BPD one of the most expensive psychiatric disorders to treat. There is an effective treatment, called Dialectical Behaviour Therapy (DBT), which has been well tested and is successful in reducing suicide attempts, other self-harm behaviours, use of health care services, and in improving quality of life. However, DBT programs are in short supply, and there are long wait lists to get into them. A standard course of DBT treatment is 1 year long and includes 4 components: individual therapy sessions, skills training group sessions, phone calls with the therapist, and regular discussions among the therapists. Because DBT lasts a year and has four components, it is costly. It is unknown whether DBT works as well if delivered in a shorter format. In practice, DBT is often reduced in length or intensity. This allows more people to be served, but it is not known how well a shorter form of DBT works and whether it is cost-effective. Finding an answer to this question would be of great importance. In our study, 240 self harming BPD patients will be assigned randomly (by chance) to get either 1 year or 6 months of DBT. After their initial assessment, participants will be assessed every 3 months. Follow-up assessments will occur during treatment (6 or 12 months) and after treatment for a total of 9 assessments over 2 years. Rates of suicidal and self-harm behaviours, use of health care and general psychological functioning will be examined. The results will help therapists in planning treatment, and decision-makers in determining how best to direct limited treatment resources.