RESUMO
OBJECTIVE: To describe and evaluate a full dialectical behavior therapy (DBT) program for people with comorbid eating disorder and borderline personality disorder. The program included a novel skills training module written especially for eating-disordered patients. METHOD: The program was run for 18 months. Days in hospital and major acts of self-harm were counted for the 18 months before and after DBT. RESULTS: There were no dropouts from the program. The patients seemed to benefit. Most patients were neither eating disordered nor self-harming at follow-up. DISCUSSION: Full DBT is an expensive and demanding treatment but deserves consideration for patients with an eating disorder and co-morbid borderline personality disorder and self-harm. There is a need for a more systematic and thorough evaluation.
Assuntos
Terapia Comportamental , Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/terapia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Adolescente , Adulto , Transtorno da Personalidade Borderline/complicações , Comorbidade , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Feminino , Humanos , Comportamento Autodestrutivo , Resultado do TratamentoRESUMO
BACKGROUND: There is great potential demand for treatment of bulimia nervosa and binge eating disorder. Skilled therapists are in short supply. Self-help and guided self-help based upon books have shown some promise as an economical alternative to full therapy in some cases. AIMS: To investigate the efficacy and effectiveness of self-help with and without guidance in a specialist secondary service. METHOD: A randomised controlled trial comparing three forms of self-help over 4 months with a waiting-list comparison group and measurement of service consumption over the subsequent 8 months. RESULTS: Self-help delivered with four sessions of face-to-face guidance led to improved outcome over 4 months. There is also some evidence to support the use of telephone guidance. A minority of participants achieved lasting remission of their disorder in relation to self-help, but there was no significant difference in final outcome between the groups after they had progressed through the stepped care programme. Patients initially offered guided self-help had a lower long-term drop-out rate. CONCLUSIONS: Guided self-help is a worthwhile initial response to bulimia nervosa and binge eating disorder. It is a treatment that could be delivered in primary care and in other non-specialist settings.
