Borderline Personality Disorder symptoms in university students
thesisposted on 02.03.2017, 04:14 by Meaney, Rebecca Isabella
Borderline Personality Disorder (BPD) is associated with significant distress and psychosocial dysfunction, and high-risk behaviours such as self-harm, suicide attempts and aggression toward others (Lieb et al, 2010). Protective factors such as formal qualifications, may preclude ongoing disability for people with BPD, however symptoms and behaviours associated with the disorder may pose a challenge within a tertiary environment. Symptoms such as aggression and suicide attempts may present a risk to both the student with BPD, and the broader university community, nevertheless considerations such as the prevalence, characteristics, treatment and management of BPD in university settings is unexplored in the literature. In this thesis four studies are presented, which were conducted with the aim of enhancing our understanding of the aforementioned considerations, and propose context appropriate forms of assistance for this population. Study 1 explored existing prevalence estimates of BPD in university students through a systematic review and meta-analysis. Meta-regression was employed to explore the influence of methodology on discrepancies in reported prevalence. Forty-three studies meeting inclusion criteria were identified. Across these studies an international pooled prevalence of 9.7% was calculated; heterogeneity was related to study methodology. Specifically, studies that provided anonymity in responses, offered course credit as an incentive, were focused on the topic of BPD, sampled postgraduates, and utilized the International Personality Disorder Examination to assess BPD (IPDE; Loranger et al., 1994), were associated with higher rates of BPD. The findings underscore the need for methodological consistency, in addition to suggesting an identifiable population of university students with BPD. Study 2 was a cross-sectional examination of demographic and cognitive factors that predicted dysregulated behaviours characteristic of BPD (e.g. self-harm) in 2261 Australian university students. The data was derived from self-report measures, and the relationships were explored using mediation and moderation analyses. Symptoms of BPD (distinct from the behaviours), stress, family psychological illness, and alexithymia each predicted behaviours associated with BPD. These symptoms also exerted indirect effects on behaviours through rumination, alexithymia and emotional dysregulation. Finally, the relationship between symptoms and dysregulated behaviours was conditional on level of rumination and alexithymia, such that the relationship between symptoms and behaviours was stronger at higher levels of rumination and alexithymia. Implications for early identification and treatment are proposed. Study 3 examined the efficacy of a pilot treatment program, aimed at treating university students with BPD, using short-term, modified group Dialectical Behavior Therapy within a University Counselling service setting. Seventeen university students aged 18 to 28 years, completed eight 2-hour group therapy sessions; levels of depression, anxiety, BPD traits, and coping strategies, were assessed at commencement and completion of the program. Upon program completion, there was a reduction in symptoms of depression and BPD traits, and an increase in adaptive coping skills, including problem solving, and constructive self-talk. There was no reduction in anxiety. The findings indicate promise for short-term treatment of college students with BPD. Implications and limitations are discussed with emphasis on replication with a control group. Study 4 represented a qualitative examination of the experience of peak episodes of symptom severity, referred to as a psychological crisis, from the perspectives of students who had experienced this event on campus, and staff that had provided assistance during this event. Drawing on a phenomenological approach, in-depth interviews were conducted with six university-based psychologists, six staff in student support roles, and six students. Students indicated they valued staff involvement, and staff embraced the helper role. Nonetheless, factors embedded in broader pedagogical, systemic, and fiscal considerations influenced the capacity of staff to assist students in crisis. Strategies and programs that may assist staff in supporting students in crisis are encouraged, and in turn, guidelines for staff to assist students in crisis were developed and presented in the subsequent chapter and the appendices. Evaluation of the guidelines is emphasised as future research. The research makes a unique contribution to the literature through systematic evaluation of prevalence of BPD across university student populations for the past 20 years, and factors that contribute to variance in prevalence across studies. In turn, the research proposed cognitive characteristics of the disorder in students through a test of Emotional Cascade Theory, and then evaluated a novel pilot treatment program for students with BPD held in a university counselling service. Finally, the research evaluated the experience of a psychological crisis from the perspective of students and staff, which formed the basis of proposed guidelines. Implications of the research are discussed.