Jun 15, · Borderline Personality Disorder (BPD) is a pervasive pattern of emotional dysregulation, impulsiveness, unstable sense of identity and difficult interpersonal relationships [].The prevalence rates of BPD are between –% in the general community, 15–25% among psychiatric inpatients and 10% of all psychiatric outpatients [2, 3].Among the different Dec 06, · Research literature reviews and meta-analyses have shown that in some domains of psychopathology, a greater percentage of individuals are more accurately characterized as having these types of diagnoses than meet the criteria for any specific disorder in the domain (e.g., Thomas, Vartanian, & Brownell, , for eating disorder; Verheul For example, people with borderline personality disorder (BPD)--the most commonly treated personality disorder--quit treatment programs about 70 percent of the time. However, hope is on the horizon as researchers begin the search for effective treatments, says Lynch. So far, the bulk of research has focused on BPD, he notes
Mistrustful and Misunderstood: A Review of Paranoid Personality Disorder
Try out PMC Labs and tell us what you think. Learn More. This review summarizes advances in treatments for adults with borderline personality disorder BPD in the last 5 years. Evidence-based advances in the treatment of BPD include a delineation of generalist models of care in contrast to specialist treatments, identification of essential effective elements of dialectical behavioral therapy DBTresearch papers on borderline personality disorder the adaptation of DBT treatment to manage post-traumatic stress disorder PTSD and BPD.
Studies on pharmacological interventions remain limited and have not provided evidence that any specific medications can provide stand-alone treatment.
The research on treatment in BPD is leading to a distillation of intensive packages of treatment to be more broadly and practically implemented in most treatment environments through generalist care models and pared down forms of intensive treatments e. Evidence-based integrations of DBT and exposure therapy for PTSD provide support for changing practices to simultaneously treat PTSD and BPD.
Once thought to be an untreatable condition, borderline personality disorder BPD is now effectively treated by a growing number of evidence based psychotherapeutic treatments. Since then, over 13 manualized psychotherapies for BPD have been tested. Five major treatments—DBT, mentalization-based treatment MBT [ 1 ], schema-focused therapy SFT [ 2 ], transference-focused psychotherapy TFP [ 3 ], and systems training for emotional predictability and problem solving STEPPS [ 4 ]—have been established as evidence based treatments EBTs for BPD [ 5 ].
This review will summarize major findings of what works in treatments for BPD, with a special emphasis on developments in the last 5 years. The Cochrane review of psychological therapies for borderline personality disorder, which analyzed 28 studies published untilis among the most significant additions to the literature on treatments for BPD in the last 5 years [ 5 ].
The first wave of studies compared specialized therapies for BPD to TAU. In research papers on borderline personality disorder first wave of studies, DBT and MBT were established as EBTs [ 19 — 11 ].
Additionally, a short-term group therapy, research papers on borderline personality disorder, STEPPS, was added to TAU and found to be more effective than TAU alone in reducing symptoms of BPD, negative mood states, and impulsivity while increasing functioning [ 4 ].
Responding to criticisms that treatments lead by experts had an obvious advantage to TAU, investigators in subsequent trials in the second wave compared specialized BPD treatments, such as DBT and TFP, to treatment by expert therapists in the community, known for their willingness and interest in patients with BPD [ 2122 ]. DBT again showed higher reduction in suicidal behavior and self-injury, inpatient hospitalization, and treatment drop out than treatment by other experts in the community [ 21 ].
Similarly, in the trial comparing TFP to treatment by community experts, TFP yielded greater improvements in not only suicide attempts, inpatient hospitalization, and treatment drop out, but also in borderline symptoms, psychosocial functioning, and personality functioning [ 22 ]. Treatment by experts was as effective as specialty treatments in reducing depressive symptoms, and in the DBT trial, treatment by experts was effective in reducing suicidality, but not to the degree achieved in DBT [ 2122 ].
The third wave of studies staged head-to-head trials between specialist treatments i. DBT [ 3 ]; SFT vs. The evidence suggested a variety of systematic and well-informed manualized psychotherapies were effective at treating BPD and little was to be gained at horseracing to determine the superiority of any of them [ 27 ], research papers on borderline personality disorder. It incorporated a systematic, manualized supportive therapy as a third comparison treatment to TFP and DBT.
All three treatments, which were systematic and supervised, yielded improvements in depression, anxiety, and functioning [ 3 ], research papers on borderline personality disorder. While the supportive therapy arm failed to match reductions in suicidality yielded by both DBT and TFP, it proved effective enough to be an alternative to treating BPD patients in the absence of DBT and TFP treatments.
The other fourth wave of studies compared specialist therapies to systematic and well-informed generalist approaches to managing BPD. These studies aimed to show that the core ingredients to the specialist treatments provided increased gains in treatment, apart from the well research papers on borderline personality disorder and well-informed aspects of the clinical approach [ 3 ].
Unexpectedly, these enhanced, structured, and well-informed generalist treatment approaches performed as well in most ways to their already established specialized counterparts. Additionally, research papers on borderline personality disorder, supportive therapy, when delivered in a systematic way [ 3 ] or by experienced clinicians in a group format [ 26 ], proved comparable in outcomes to TFP and MBT.
While generalist approaches to BPD could widen access to evidence-based care, research dismantling differing aspects of research papers on borderline personality disorder, but complex and intensive treatments, can clarify their essential elements, research papers on borderline personality disorder. Generalist care, with the addition of targeted short-term adjunctive interventions in group formats or aimed at suicidality [ 4research papers on borderline personality disorder, 1831 ] may complement supportive or generalist approaches to yield good outcomes, with the investment of fewer clinical resources.
Investigators have also adapted the established evidence based treatments for BPD to manage the usual complex co-morbidities of BPD including substance use disorders substance use disorders SUDs [ 32 ], eating disorders EDs [ 33 ], and post-traumatic stress disorder PTSD [ 34 ]. BPD patients who present with acutely symptomatic co-morbidities of these types are often challenging to manage with strictly BPD oriented treatments [ 35 ].
Conversely, in SUD and ED treatments, individuals with co-morbid BPD may also present with problems that are difficult to manage in those treatment environments. The remainder of this review will describe the prevailing evidence-based psychotherapies for BPD, the newer generalist management approaches for BPD, dismantling studies of evidence-based treatments EBTs for BPD, adaptations of EBTs for complex co-morbidities, and the current state of knowledge on research papers on borderline personality disorder interventions for BPD.
This overview will demonstrate trends to paring down treatments to what essentially works for BPD, that most clinical settings can consider implementing as a more clear and feasible standard of care. The most well-known, well researched, and widely available EBT for BPD is DBT [ 3940 ]. Informed by clinical experience with suicidal personality disordered patients who did not improve with standard cognitive behavioral therapy intervention, Linehan developed DBT by incorporating the concept of dialectics and the strategy of validation into a treatment focused on skills acquisition and behavioral shaping.
DBT proposes that individuals with BPD can become more effective in managing their sensitivities and interactions with others through acquisition of skills that enhance mindfulness and enable them to better tolerate distress, regulate their emotions, and manage relationships. The full empirically validated package of DBT includes 1 h of weekly individual therapy, research papers on borderline personality disorder, a 2-h group skills training session, out-of-session paging, and consultation team for the therapist.
The intensity and structure of DBT, which is organized in an explicit, comprehensive set of manuals with instruction to therapists as well as hundreds of skills worksheets, provides an instant foundation for practitioners of any discipline or level of experience. DBT is designed for teams of clinicians and is among the most time intensive modalities for patients and clinicians. Its major mechanism of change occurs via acquisition and generalization of skills to be more emotionally regulated, mindful, and effective in the face of individual sensitivities.
Therein lies its mechanism of change. Attachment interactions become hyperactivated, feeding into distress and difficulty coping, rather than providing safety and security, rendering the therapeutic process with BPD difficult. Prioritizing the maintenance of mentalizing, MBT therapists support patients to think through hyperactivated states themselves, rather than providing prepackaged or intellectualized explanations, insights, or skills.
Outpatient MBT involves 50 min of weekly individual therapy, 75 min of group therapy, and a reflecting team meeting which serves to support clinical team members in their mentalization in the process of treatment [ 25 ]. Developed within the National Health Services NHS in the United Kingdom, MBT provides a tenable model for treating personality disordered patients settings where patients and clinicians face scarce resources.
Research papers on borderline personality disorder on the conceptualization of borderline personality organization introduced by Otto Kernberg in the s, transference-focused psychotherapy TFP is a manualized, psychoanalytically oriented psychotherapy.
Kernberg defined identity diffusion, research papers on borderline personality disorder, primitive defense mechanisms e. TFP involves two weekly individual therapy sessions, without group therapy.
Clinicians in TFP are encouraged to receive supervision. TFP is more compatible with treatments by individual clinicians, not working in teams. In twice weekly individual therapy sessions, research papers on borderline personality disorder, the clinician uses a variety of behavioral, cognitive, and experiential techniques that focus on the therapeutic relationship, daily life outside therapy, and past traumatic experiences.
Given the limitations of treatment models that require significant training and significant clinic resources, research papers on borderline personality disorder, there is a need to develop, test, and disseminate less intensive treatments.
GPM is based on a case management model, research papers on borderline personality disorder, where interventions rely on common sense and are learned easily by generalist clinicians. GPM prioritizes the attainment of stable vocational functioning over romantic relationships, as well as improvement in social functioning over specific symptom improvement.
This frames a discussion of treatment frequency and duration—treatment is only provided if it is helping the patient progress based on articulated goals. GPM rarely involves more than one weekly individual appointment. The treatment is multimodal in nature and provides guidance for psychopharmacological interventions, as well as the provision of group and family therapy and coordination across providers. What may be most specific to GPM is its central research papers on borderline personality disorder on an interpersonal hypersensitivity model of BPD [ 43 ].
In this model, the symptoms of BPD are understood as resulting from an emotional cascade that begins with an interpersonal stressor e. The therapist actively hypothesizes that any emotion dysregulation, impulsive or self-harming behavior, or hospitalization has resulted from an interpersonal problem, and works with the patient to better understand his or her sensitivities and responses.
In a randomized trial of GPM versus DBT, McMain et al. Results were consistent at 2-year follow-up [ 44 ]. Furthermore, this trial later demonstrated that of patients with high Axis 1 co-morbidity, those assigned to GPM had significantly lower dropout rates than their DBT counterparts [ 45 ]. For example, clinicians report feeling more hopeful, competent, and open to treat BPD [ 46 ].
These findings are particularly important given that BPD is a disorder for which significant stigma may introduce barriers to successful treatment.
The success of treatment dissemination depends in large part on whether clinicians are willing to use treatments and feel competent to do so. Compared to patients who received MBT, those who received SCM research papers on borderline personality disorder substantial improvements across an array of clinical outcomes.
Patients receiving MBT improved somewhat more quickly and continued to show greater benefit than SCM at month follow-ups. However, those who received SCM were as well at 6 months as those in the MBT group, and showed faster reductions in self-harm, research papers on borderline personality disorder.
This framework is guided by a number of generalist principles and is meant to make treatment understandable and predictable for patients. There is an emphasis on sharing the borderline diagnosis with patients, psychoeducation, alliance building that is based both on contractual e. Both GPM and SCM recommend intersession contact be used sparingly.
This may have more to do with differences in the legal climate of the UK versus the USA than with beliefs about the utility of intersession contact. Also, SCM includes specifically articulated weekly group therapy. Group therapy is open on a rolling basis for patients and includes psychoeducation and a framework focused on problem solving.
SCM has considerable similarity to GPM in terms of training requirements, structure, and general principles. However, descriptions of therapeutic techniques employed in SCM suggest that in some respects, it research papers on borderline personality disorder appear more similar to MBT than GPM in practice, research papers on borderline personality disorder.
GPM is less psychotherapeutically oriented than other evidence-based treatments for BPD [ 29 ]. The general therapeutic stance includes responsivity, appropriate self-disclosure, flexibility, and pragmatism. The nonspecific techniques and therapeutic stance employed in SCM are generally rooted in psychodynamic principles consistent with MBT. Now that several evidence-based treatments for BPD have been tested, their most essential ingredients can be discerned from dismantling studies.
DBT in its standard form involves an intensive package of weekly individual therapy, weekly two and a half hour skills training group, 1-h consultation team for the therapist, and paging for skills coaching available between sessions.
All packages of DBT demonstrated significant improvements in suicidality and reduction in use of crisis services.
While standard DBT showed greater improvement in frequency of self-harm, anxiety, and depression than the DBT-I condition, it did not show significant research papers on borderline personality disorder over DBT-S despite the significant difference in total hours of treatment average Designed to supplement ongoing treatments such as medication, individual therapy, research papers on borderline personality disorder case management, systems training for emotional predictability and problem solving STEPPS consists of cognitive behavioral elements, skills training, and a systems component.
The STEPPS program includes 20 weeks of 2-h seminar-like group sessions. Two co-facilitators lead the sessions by following detailed lesson plans that cover three main components of STEPPS. The second, emotion management skills trainings, teaches skills to better manage the effects of BPD including distancing, communicating, and problem management. The third, behavior management skills training, covers goal setting, healthy eating, sleep, and exercise habits, self-harm avoidance, and interpersonal effectiveness.
Participants are responsible for course materials and homework. The skills-based group sessions are supplemented by a single 2-h psychoeducation and skills training session for families which accounts for the systems component of STEPPS. More recently, a series of studies conducted by Black and colleagues [ 48 ] explored the effectiveness of STEPPS for BPD patients with co-morbid antisocial personality disorder ASPD in both university and correctional settings.
The findings indicate that subjects with co-morbid ASPD experienced similar or greater improvement in BPD symptoms, impulsiveness, and global symptoms than their non-ASPD counterparts and that STEPPS treatment is effective. These preliminary findings suggest that STEPPS has potential for treating a uniquely difficult to treat population: offenders with co-morbid BPD and ASPD. While depression is its most common co-morbidity, co-occurring with BPD in the majority of cases [ 50 ], evidence from RCTs presented here suggest it responds to specialist and generalist approaches, and tends to improve when BPD improves [ 51 ].
Other common co-morbidities such as substance use disorders SUDS [ 32 ], eating disorders EDs [ 33 ], and post-traumatic stress disorder PTSD [ 34 ] have been shown to lead to poorer treatment outcomes in some trials.
Psychiatric Interview: BPD (Borderline Personality Disorder) - Part 1 - Dr. Lois Choi-Kain
, time: 36:09Narcissistic personality disorder - Wikipedia
Understanding Personality Disorders. What causes personality disorders? Research suggests that genetics, abuse and other factors contribute to the development of obsessive-compulsive, narcissistic or other personality disorders. Ten Turtles on Tuesday. This is the story of an 11 year old girl with obsessive–compulsive disorder Jun 15, · Borderline Personality Disorder (BPD) is a pervasive pattern of emotional dysregulation, impulsiveness, unstable sense of identity and difficult interpersonal relationships [].The prevalence rates of BPD are between –% in the general community, 15–25% among psychiatric inpatients and 10% of all psychiatric outpatients [2, 3].Among the different Feb 03, · The Cochrane review of psychological therapies for borderline personality disorder, which analyzed 28 studies published until , is among the most significant additions to the literature on treatments for BPD in the last 5 years. The major randomized controlled studies can be characterized in four major waves (Table (Table1). 1). The first
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