A Randomized Controlled Trial of Mentalization Based Therapy against Specialist Supportive Clinical Management in patients with both Eating Disorders and symptoms of Borderline Personality Disorder The NOURISHED Study
Research Project Team
- Dr Paul Robinson (Chief Investigator)
- Prof Anthony Bateman
- Prof Peter Fonagy
- Prof Ulrike Schmidt
- Dr Az Hakeem,
- Dr Barbara Barrett
- Ms Jennifer Hellier
Patients with eating disorders combined with symptoms of borderline personality disorder (BPD) present particular therapeutic challenges.
Their personality disorder symptoms lead them to engage in self harm (with use of acute psychiatric services), substance misuse and unstable relationships and can interfere with attempts at treatment of the eating disorder.
Treatment needs to address both the eating and personality disorders. BPD has been shown to respond to Mentalization Based Therapy (MBT) which targets deficits in self-reflectiveness (mentalizing) which are common in both BPD and eating disorders.
This project is a Feasibility/Pilot study in which information to guide the design of a larger, definitive study will be obtained.
- The primary aim of the project is to test the null hypothesis that treatment with MBT-ED is not superior to Specialist Supportive Clinical Management (SSCM-ED) in reducing symptoms of personality and eating disorder in those with eating disorders and BPD symptoms. If recruitment does not allow a definitive answer to this question, we will obtain information which will help plan a larger study.
- To examine the relative cost-effectiveness of MBT-ED and SSCM-ED
- Participants' experience of therapies will be examined. Mechanisms of change will be studied for both BPD symptoms, in which mentalizing capacity, measured as reflective function, is thought to be a key factor, and eating disorders in which personality characteristics are purported to be of aetiological importance.
- Changes in Object relations during therapy will be examined using the Object Relations Inventory,
Three Eating Disorders (ED) Services and two Personality Disorder services will be the source of referrals.
Patients will be screened for an ED combined with symptoms of BPD namely self harm and at least two impulsive behaviours.
Patients will be assessed for symptoms of both ED and BPD, use of services, reflective function and personality attributes and the intervention group randomised to intensive outpatient MBT-ED (MBT modified for patients with Eating Disorders) will receive a weekly individual and group session for 12 months.
Therapy will be supervised and therapist adherence to model assessed. The control group will receive manualized SSCM-ED (Specialist Supportive Clinical Management, adapted for use with all eating disorders).
Both groups will receive dietetic counselling and out of hours crisis management from local services, Participants will be reassessed six monthly throughout treatment and at 18 months after randomisation.
Initial results will be available by 2015.