Management of borderline personality disorder

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The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.

Contents

Psychotherapy

There has traditionally been skepticism about the psychological treatment of personality disorders, but several specific types of psychotherapy for BPD have developed in recent years. There is growing evidence for the role of psychotherapy in the treatment of people with BPD, with indications that both comprehensive and non-comprehensive psychotherapeutic interventions may have a beneficial effect. [1] Supportive therapy alone may enhance self-esteem and mobilize the existing strengths of individuals with BPD. [2] Specific psychotherapies may involve sessions over several months or, as is particularly common for personality disorders, several years. Psychotherapy can often be conducted either with individuals or with groups. Group therapy can aid the learning and practice of interpersonal skills and self-awareness by individuals with BPD, [3] though drop-out rates may be problematic. [4]

Dialectical behavioral therapy

University of Washington psychology professor Marsha Linehan is credited with developing the first empirically supported standard treatment for BPD, termed dialectical behavioral therapy (DBT). DBT grew dramatically in popularity among mental health professionals following the publication of Linehan's treatment manuals for DBT in 1993. DBT was originally developed as an intervention for patients who meet criteria for BPD and particularly those who are highly suicidal. [5]

DBT draws its principles from behavioral science (including cognitive-behavioral techniques), dialectical philosophy and Zen practice. The treatment emphasizes balancing acceptance and change (hence dialectic), with the overall goal of helping patients not just survive but build a life worth living. Treatment is delivered in four stages, with self-harm and other life-threatening issues taking priority. In the second stage, patients are encouraged to experience the painful emotions that they have been avoiding. Stage three addresses problems of living such as career and marital problems. Finally, stage four focuses on helping clients feel complete and reducing feelings of emptiness and boredom.

DBT encompasses four modes of therapy:

The goal of all DBT treatment approaches is to reduce the ineffective action tendencies linked to dysregulated emotions. DBT is based on a biosocial theory of personality functioning in which the core problem is seen as the breakdown of the patient's cognitive, behavioral and emotional regulation systems when experiencing intense emotions. The etiology of BPD is seen as a biological predisposition toward emotional dysregulation combined with a perceived invalidating social environment. [8]

DBT can be based on a biosocial theory of personality functioning in which BPD is seen as a biological disorder of emotional regulation in a social environment experienced as invalidating by the borderline patient. [9]

Several random controlled trials comparing DBT to other forms of cognitive-behavioral treatments have favored the use of DBT to treat borderline patients. Specifically, DBT has been found to significantly reduce self-injury, suicidal behavior, impulsivity, self-rated anger and the use of crisis services among borderline patients. These reductions have been found even when controlling for other treatment factors such as therapist experience, affordability of treatment, gender of therapist and the number of hours spent in individual therapy. [10] [11] In a meta-analysis it was found that DBT was moderately effective. However, none of the studied therapies (including CBT) "fulfilled the criteria for empirically supported treatment." [12] The additional efficacy in the overall treatment of BPD is less clear; future research is needed to isolate the specific components of DBT that are most effective in treating BPD. Furthermore, little research has examined the efficacy of DBT in treating male and minority patients with BPD. Training nurses in the use of DBT has been found to replace a therapeutic pessimism with a more optimistic understanding and outlook. [13]

Schema therapy

Schema therapy (also called schema-focused therapy) is an integrative approach based on cognitive-behavioral or skills-based techniques along with object relations and gestalt approaches. It directly targets deeper aspects of emotion, personality and schemas (fundamental ways of categorizing and reacting to the world). The treatment also focuses on the relationship with the therapist (including a process of "limited re-parenting"), daily life outside of therapy and traumatic childhood experiences. It was developed by Jeffrey Young and became established in the 1990s. Limited recent research suggests it is significantly more effective than transference-focused psychotherapy, with half of individuals with borderline personality disorder assessed as having achieved full recovery after four years, with two-thirds showing clinically significant improvement. [14] [15] [ unreliable source? ] Another very small trial has also suggested efficacy. [16]

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is the most widely used and established psychological treatment for mental disorders, but has appeared less successful in BPD, due partly to difficulties in developing a therapeutic relationship and treatment adherence. Approaches such as DBT and schema-focused therapy developed partly as an attempt to expand and add to traditional CBT, which uses a limited number of sessions to target specific maladaptive patterns of thought, perception and behavior. A recent study did find a number of sustained benefits of CBT, in addition to treatment as usual, after an average of 16 sessions over one year. [17]

Psychoanalysis

It is in the DSM-IV that the term took two orientations: one psychiatric, and the other behavioral, included in a psychoanalytic psychopathology. According to this split, the diagnosis takes on, or a character of symptoms to be eradicated, or a particular type of patient of psychoanalysts. [18] [19] [20]

Psychodynamic psychotherapy generally

Psychodynamic psychotherapy (PP) are different types of psychotherapy derived from psychoanalysis. The duration of psychodynamic psychotherapy ranges from 10 to 25 sessions (short term psychodynamic psychotherapy) to over 200 sessions. The main emphasis of these measures are very different. Similar treatment principles mainly focus on one or several target problems by using the foundation of modern psychoanalytic theory. Results of meta-analysis show that psychodynamic psychotherapy has large effects in the treatment of personality disorders. The results indicate that psychodynamic psychotherapy causes long term changes in personality disorders. [21]

Transference-focused psychotherapy

Transference-focused psychotherapy (TFP) is a form of psychoanalytic therapy dating to the 1960s, rooted in the conceptions of Otto Kernberg on BPD and its underlying structure (borderline personality organization). Unlike in the case of traditional psychoanalysis, the therapist plays a very active role in TFP. In session the therapist works on the relationship between the patient and the therapist. The main focus is on the patient's emotions concerning their relationship with the therapist and the therapist's use of psychodynamic techniques (e.g., interpretation). [22] The therapist will try to explore and clarify aspects of this relationship so the underlying object relations dyads become clear. Some limited research on TFP suggests it may reduce some symptoms of BPD by affecting certain underlying processes, [23] and that TFP in comparison to dialectical behavioral therapy and supportive therapy results in increased reflective functioning (the ability to realistically think about how others think) and a more secure attachment style. [24] Furthermore, TFP has been shown to be as effective as DBT in improvement of suicidal behavior, and has been more effective than DBT in alleviating anger and in reducing verbal or direct assaultive behavior. [25] Limited research suggests that TFP appears to be less effective than schema-focused therapy, while being more effective than no treatment. [14]

Cognitive analytic therapy

Cognitive analytic therapy combines cognitive and psychoanalytic approaches and has been adapted for use with individuals with BPD with mixed results. [26]

Mentalization-based treatment

Mentalization-based treatment, developed by Peter Fonagy and Antony Bateman, rests on the assumption that people with BPD have a disturbance of attachment due to problems in the early childhood parent-child relationship. [27] Fonagy and Bateman hypothesize that inadequate parental mirroring and attunement in early childhood lead to a deficit in mentalization, "the capacity to think about mental states as separate from, yet potentially causing actions"; [28] in other words the capacity to intuitively understand the thoughts, intentions and motivations of others, and the connections between one's own thoughts, feelings and actions. Mentalization failure is thought to underlie BPD patients' problems with impulse control, mood instability and difficulties sustaining intimate relationships. Mentalization based treatment aims to develop patients' self-regulation capacity through a psychodynamically informed [29] multi-modal treatment program that incorporates group psychotherapy and individual psychotherapy in a therapeutic community, partial hospitalization or outpatient context. [30] In a randomized controlled trial, a group of BPD patients received 18 months of intensive partial-hospitalization MBT followed by 18 months of group psychotherapy, and were followed up over five years. The treatment group showed significant benefits across a range of measures including number of suicide attempts, reduced time in hospital and reduced use of medication. [31]

Marital or family therapy

Marital therapy can be helpful in stabilizing the marital relationship and in reducing marital conflict and stress that can worsen BPD symptoms. Family therapy or family psychoeducation can help educate family members regarding BPD, improve family communication and problem solving, and provide support to family members in dealing with their loved one's illness.[ citation needed ]

Two patterns of family involvement can help clinicians plan family interventions: overinvolvement and neglect. Borderline patients who are from overinvolved families are often actively struggling with a dependency issue by denial or by anger at their parents. [32]

Interest in the use of psychoeducation and skills training approaches for families with borderline members is growing. [3]

Medication

The UK's National Institute for Health and Clinical Excellence (NICE) in 2009 advises against the use of medication for treating borderline personality disorder, recommending that they only be considered for comorbid conditions. [33] A Cochrane review from 2006 arrived at the same conclusion, but a 2010 update found that some pharmacological interventions (second generation antipsychotics, mood stabilisers and dietary supplementation with omega 3 fatty acids) might provide beneficial effects. [34] However, the authors warned that total BPD severity is not significantly influenced by any drug and that the evidence generated by the review was based on single study effect estimates. No promising results were available for the core BPD symptoms of chronic feelings of emptiness, identity disturbance and abandonment.

Antidepressants

Selective serotonin reuptake inhibitor (SSRI) antidepressants have been shown in randomized controlled trials to improve the attendant symptoms of anxiety and depression, such as anger and hostility, associated with BPD in some patients. [35] According to Listening to Prozac [ unreliable medical source? ], it takes a higher dose of an SSRI to treat mood disorders associated with BPD than depression alone. It also takes about three months for benefit to appear, compared to the three to six weeks for depression.[ citation needed ]

Antipsychotics

The newer atypical antipsychotics are claimed to have an improved adverse effect profile than the typical antipsychotics. Antipsychotics are also sometimes used to treat distortions in thinking or false perceptions. [36] [ unreliable medical source? ] One meta-analysis of two randomly controlled trials, four non-controlled open-label studies and eight case reports has suggested that several atypical antipsychotics, including olanzapine, clozapine, quetiapine and risperidone, may help BPD patients with psychotic-like, impulsive or suicidal symptoms. [37] However, there are numerous adverse effects of antipsychotics, notably tardive dyskinesia (TD). [38] Atypical antipsychotics are known for often causing considerable weight gain, with associated health complications. [39]

Mood stabilizers

Mood stabilizers are anticonvulsant drugs used for both epilepsy and reduction in mood variations in patients with excessive and often dangerous mood variabilities. Often, the goal of the anticonvulsants are to bring certain areas of the brain to equilibrium and control outbursts and seizures. Mood stabilizers (used primarily to treat bipolar disorder) such as lithium or lamotrigine may be of some use to help depressed or labile periods, as well as rapid changes in mood. [40] [ failed verification ] [41] [ unreliable medical source? ] A random controlled trial by Lieb (2010) found mood stabilizer valproate semisodium showed a significant decrease in interpersonal conflicts and depression. It was also found that topiramate showed a significant decrease in interpersonal issues and depression. Lamotrigine showed a significant decrease in impulsivity and anger-related behaviors. Carbamazepine showed no significant effects on patients with BPD. [42] Mood stabilizers are often used to treat comorbid disorders in BPD patients. There is currently no medicine with an overall significant effect on BPD as a whole. [43]

Services and recovery

Individuals with BPD sometimes use mental health services extensively. People with this diagnosis accounted for about 20 percent of psychiatric hospitalizations in one survey. [44] The majority of BPD patients continue to use outpatient treatment in a sustained manner for several years, but the number using the more restrictive and costly forms of treatment, such as inpatient admission, declines with time. [45] Experience of services varies. [46] Assessing suicide risk can be a challenge for mental health services (and patients themselves tend to underestimate the lethality of self-injurious behaviours) with typically a chronically elevated risk of suicide much above that of the general population and a history of multiple attempts when in crisis. [47]

Particular difficulties have been observed in the relationship between care providers and individuals diagnosed with BPD. A majority of psychiatric staff report finding individuals with BPD moderately to extremely difficult to work with, and more difficult than other client groups. [48] On the other hand, those with the diagnosis of BPD have reported that the term "BPD" felt like a pejorative label rather than a helpful diagnosis, that self-destructive behaviour was incorrectly perceived as manipulative, and that they had limited access to care. [49] Attempts are made to improve public and staff attitudes. [50] [51]

Combining pharmacotherapy and psychotherapy

In practice, psychotherapy and medication may often be combined, but there are limited data on clinical practice. [52] Efficacy studies often assess the effectiveness of interventions when added to "treatment as usual" (TAU), which may involve general psychiatric services, supportive counselling, medication and psychotherapy.

One small study, which excluded individuals with a comorbid Axis 1 disorder, has indicated that outpatients undergoing dialectical behavioral therapy and taking the antipsychotic olanzapine show significantly more improvement on some measures related to BPD, compared to those undergoing DBT and taking a placebo pill, [53] although they also experienced weight gain and raised cholesterol. Another small study found that patients who had undergone DBT and then took fluoxetine (Prozac) showed no significant improvements, whereas those who underwent DBT and then took a placebo pill did show significant improvements. [54]

Difficulties in therapy

There can be unique challenges in the treatment of BPD, such as hospital care. [55] In psychotherapy, a client may be unusually sensitive to rejection and abandonment and may react negatively (e.g., by harming themselves or withdrawing from treatment) if they sense this. In addition, clinicians may emotionally distance themselves from individuals with BPD for self-protection or due to the stigma associated with the diagnosis, leading to a self-fulfilling prophecy and a cycle of stigmatization to which both patient and therapist can contribute. [56]

Some psychotherapies, including DBT, were developed partly to overcome problems with interpersonal sensitivity and maintaining a therapeutic relationship. Adherence to medication regimens is also a problem, due in part to adverse effects, with drop-out rates of between 50 percent and 88 percent in medication trials. [57] Comorbid disorders, particularly substance use disorders, can complicate attempts to achieve remission. [58]

Other strategies

Psychotherapies and medications form a part of the overall context of mental health services and psychosocial needs related to BPD. The evidence base is limited for both, and some individuals may forego them or not benefit (enough) from them. It has been argued that diagnostic categorization can have limited utility in directing therapeutic work in this area, and that in some cases it is only with reference to past and current relationships that "borderline" behavior can be understood as partly adaptive and how people can best be helped. [59]

Numerous other strategies may be used, including alternative medicine techniques (see List of branches of alternative medicine); exercise and physical fitness, including team sports; occupational therapy techniques, including creative arts; having structure and routine to the days, particularly through employment - helping feelings of competence (e.g. self-efficacy), having a social role and being valued by others, boosting self-esteem.[ unreliable source? ] [60]

Group-based psychological services encourage clients to socialize and participate in both solitary and group activities. These may be in day centers. Therapeutic communities are an example of this, particularly in Europe; although their usage has declined many have specialised in the treatment of severe personality disorder. [61]

Psychiatric rehabilitation services aimed at helping people with mental health problems reduce psychosocial disability, engage in meaningful activities and avoid stigma and social exclusion may be of value to people who have BPD. There are also many mutual-support or co-counseling groups run by and for individuals with BPD. Services, or individual goals, are increasingly based on a recovery model that supports and emphasizes an individual's personal journey and potential. [62]

Data indicate that the diagnosis of BPD is more variable over time than the DSM implies. Substantial percentages (for example around a third, depending on criteria) of people diagnosed with BPD achieve remission within a year or two. [63] A longitudinal study found that, six years after being diagnosed with BPD, 56 percent showed good psychosocial functioning, compared to 26 percent at baseline. Although vocational achievement was more limited even compared to those with other personality disorders, those whose symptoms had remitted were significantly more likely to have a good relationship with a spouse/partner and at least one parent, good work/school performance, a sustained work/school history, good global functioning and good psychosocial functioning. [64]

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

<span class="mw-page-title-main">Borderline personality disorder</span> Personality disorder of emotional instability

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, a distorted sense of self, and intense emotional responses. Individuals diagnosed with BPD frequently exhibit self-harming behaviours and engage in risky activities, primarily due to challenges in regulating emotional states to a healthy, stable baseline. Symptoms such as dissociation—a feeling of detachment from reality, a pervasive sense of emptiness, and an acute fear of abandonment are prevalent among those affected.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Cognitive analytic therapy (CAT) is a form of psychological therapy initially developed in the United Kingdom by Anthony Ryle. This time-limited therapy was developed in the context of the UK's National Health Service with the aim of providing effective and affordable psychological treatment which could be realistically provided in a resource constrained public health system. It is distinctive due to its intensive use of reformulation, its integration of cognitive and analytic practice and its collaborative nature, involving the patient very actively in their treatment.

Psychodynamic psychotherapy and psychoanalytic psychotherapy are two categories of psychological therapies. Their main purpose is revealing the unconscious content of a client's psyche in an effort to alleviate psychic tension, which is inner conflict within the mind that was created in a situation of extreme stress or emotional hardship, often in the state of distress. The terms "psychoanalytic psychotherapy" and "psychodynamic psychotherapy" are often used interchangeably, but a distinction can be made in practice: though psychodynamic psychotherapy largely relies on psychoanalytical theory, it employs substantially shorter treatment periods than traditional psychoanalytical therapies. Psychodynamic psychotherapy is evidence-based; the effectiveness of psychoanalysis and its relationship to facts is disputed.

Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behavior and psychopathology. Biopsychiatry is the branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.

Mental disorders are classified as a psychological condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. Individuals diagnosed with certain mental disorders can be unable to function normally in society. Mental disorders may consist of several affective, behavioral, cognitive and perceptual components. The acknowledgement and understanding of mental health conditions has changed over time and across cultures. There are still variations in the definition, classification, and treatment of mental disorders.

Marsha M. Linehan is an American psychologist and author. She is the creator of dialectical behavior therapy (DBT), a type of psychotherapy that combines cognitive restructuring with acceptance, mindfulness, and shaping.

<span class="mw-page-title-main">Psychological intervention</span>

In applied psychology, interventions are actions performed to bring about change in people. A wide range of intervention strategies exist and they are directed towards various types of issues. Most generally, it means any activities used to modify behavior, emotional state, or feelings. Psychological interventions have many different applications and the most common use is for the treatment of mental disorders, most commonly using psychotherapy. The ultimate goal behind these interventions is not only to alleviate symptoms but also to target the root cause of mental disorders.

Child psychotherapy, or mental health interventions for children refers to the psychological treatment of various mental disorders diagnosed in children and adolescents. The therapeutic techniques developed for younger age ranges specialize in prioritizing the relationship between the child and the therapist. The goal of maintaining positive therapist-client relationships is typically achieved using therapeutic conversations and can take place with the client alone, or through engagement with family members.

Therapy interfering behaviors or "TIBs" are, according to dialectical behavior therapy (DBT), things that get in the way of therapy. These are behaviors of either the patient or the therapist. More obvious examples include being late to sessions, not completing homework, cancelling sessions, and frequently contacting the therapist out-of-session. More subtle examples can include sobbing uncontrollably, venting, criticizing the therapist, threatening to quit therapy, shutting down, yelling, only reporting negative information, saying "I don't know" repeatedly, and pushing the therapist's limits. Behaviors that "burn out the therapist" are included, and thus, vary from therapist to therapist. These behaviors can occur in session, group, between sessions, and on the phone.

Mentalization-based treatment (MBT) is an integrative form of psychotherapy, bringing together aspects of psychodynamic, cognitive-behavioral, systemic and ecological approaches. MBT was developed and manualised by Peter Fonagy and Anthony Bateman, designed for individuals with borderline personality disorder (BPD). Some of these individuals suffer from disorganized attachment and failed to develop a robust mentalization capacity. Fonagy and Bateman define mentalization as the process by which we implicitly and explicitly interpret the actions of oneself and others as meaningful on the basis of intentional mental states. The object of treatment is that patients with BPD increase their mentalization capacity, which should improve affect regulation, thereby reducing suicidality and self-harm, as well as strengthening interpersonal relationships.

Transference focused psychotherapy (TFP) is a highly structured, twice-weekly modified psychodynamic treatment based on Otto F. Kernberg's object relations model of borderline personality disorder. It views the individual with borderline personality organization (BPO) as holding unreconciled and contradictory internalized representations of self and significant others that are affectively charged. The defense against these contradictory internalized object relations leads to disturbed relationships with others and with self. The distorted perceptions of self, others, and associated affects are the focus of treatment as they emerge in the relationship with the therapist (transference). The treatment focuses on the integration of split off parts of self and object representations, and the consistent interpretation of these distorted perceptions is considered the mechanism of change.

<span class="mw-page-title-main">Peter Fonagy</span> British psychoanalyst & psychologist

Peter Fonagy, is a Hungarian-born British psychoanalyst and clinical psychologist. He studied clinical psychology at University College London. He is a Professor of Contemporary Psychoanalysis and Developmental Science Head of the Division of Psychology and Language Sciences at University College London, Chief Executive of the Anna Freud Centre, and a training and supervising analyst in the British Psycho-Analytical Society in child and adult analysis. His clinical interests center on issues of borderline psychopathology, violence, and early attachment relationships. His work attempts to integrate empirical research with psychoanalytic theory. He has published over 500 papers, and 270 chapters and has authored 19 and edited 17 books.

Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's culture. These patterns develop early, are inflexible, and are associated with significant distress or disability. The definitions vary by source and remain a matter of controversy. Official criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

Eating recovery refers to the full spectrum of care that acknowledges and treats the multiple etiologies of anorexia nervosa and bulimia, including the biological, psychological, social and emotional causes of the disorder, through a comprehensive, integrated treatment regimen. When successful, this regimen restores the individual to a healthy weight and arms them with the skills and resources needed to maintain a sustainable recovery. Although there are a variety of treatment options available to the eating disorders patient, the intensive and multi-faceted program followed in eating recovery is the appropriate option for individuals who require intensive support and are able to commit to treatment in an inpatient, residential or full-day hospital setting.

Supportive psychotherapy is a psychotherapeutic approach that integrates various therapeutic schools such as psychodynamic and cognitive-behavioral, as well as interpersonal conceptual models and techniques.

Dynamic deconstructive psychotherapy (DDP) is a manual-based treatment for borderline personality disorder.

References

  1. ↑ Stoffers, Jutta M.; Völlm, Birgit A.; Rücker, Gerta; Timmer, Antje; Huband, Nick; Lieb, Klaus (2012-08-15). "Psychological therapies for people with borderline personality disorder". The Cochrane Database of Systematic Reviews. 8 (8): CD005652. doi:10.1002/14651858.CD005652.pub2. ISSN   1469-493X. PMC   6481907 . PMID   22895952.
  2. ↑ Aviram RB, Hellerstein DJ, Gerson J, Stanley B (May 2004). "Adapting supportive psychotherapy for individuals with Borderline personality disorder who self-injure or attempt suicide". J Psychiatr Pract. 10 (3): 145–55. doi:10.1097/00131746-200405000-00002. PMID   15330220. S2CID   12403789.
  3. 1 2 Gunderson, J.G. MD (10 April 2006). ""Borderline Personality Disorder - Psychotherapies". American Medical Network. Retrieved on 23 September 2007.
  4. ↑ Hummelen B, Wilberg T, Karterud S (January 2007). "Interviews of female patients with borderline personality disorder who dropped out of group psychotherapy". Int J Group Psychother. 57 (1): 67–91. doi:10.1521/ijgp.2007.57.1.67. PMID   17266430. S2CID   7252379.
  5. ↑ Koerner K, Linehan MM (March 2000). "Research on dialectical behavior therapy for patients with borderline personality disorder". Psychiatr Clin North Am. 23 (1): 151–67. doi:10.1016/S0193-953X(05)70149-0. PMID   10729937.
  6. ↑ Holmes Paul; Georgescu Sandra; Liles Wendy (2005). "Further Delineating the Applicability of Acceptance and Change to Private Responses: The Example of Dialectical Behavior Therapy". The Behavior Analyst Today. 7 (3): 301–315.
  7. ↑ Sampl S. Wakai; Trestman R.; Keeney E.M. (2008). "Functional Analysis of Behavior in Corrections: Empowering Inmates in Skills Training Groups". Journal of Behavior Analysis of Offender and Victim: Treatment and Prevention. 1 (4): 42–51. doi:10.1037/h0100455.
  8. ↑ Lynch TR, Trost WT, Salsman N, Linehan MM (2007). "Dialectical Behavior Therapy for Borderline Personality Disorder". Annual Review of Clinical Psychology. 3: 181–205. doi:10.1146/annurev.clinpsy.2.022305.095229. PMID   17716053. S2CID   26494524.
  9. ↑ Murphy, E. T. PhD; J. Gunderson MD (January 1999). "A Promising TreatmentBorderline Personality Disorder". McLean Hospital Psychiatic Update. Retrieved on 23 September 2007.
  10. ↑ Verheul R, Van Den Bosch LM, Koeter MW, De Ridder MA, Stijnen T, Van Den Brink W (February 2003). "Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands". Br J Psychiatry. 182 (2): 135–40. doi: 10.1192/bjp.182.2.135 . PMID   12562741.
  11. ↑ Linehan MM, Comtois KA, Murray AM, et al. (July 2006). "Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder". Arch Gen Psychiatry. 63 (7): 757–66. doi: 10.1001/archpsyc.63.7.757 . PMID   16818865.
  12. ↑ Öst LG (2008). "Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis". Behaviour Research and Therapy. 46 (3): 296–321. doi:10.1016/j.brat.2007.12.005. PMID   18258216.
  13. ↑ Hazelton M, Rossiter R, Milner J (2006). "Managing the 'unmanageable': training staff in the use of dialectical behaviour therapy for borderline personality disorder". Contemporary Nurse. 21 (1): 120–30. doi:10.5172/conu.2006.21.1.120. PMID   16594889. S2CID   42925830. Archived from the original on 2010-08-17. Retrieved 2010-09-25.
  14. 1 2 Giesen-Bloo J, van Dyck R, Spinhoven P, et al. (June 2006). "Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy". Arch Gen Psychiatry. 63 (6): 649–58. doi: 10.1001/archpsyc.63.6.649 . PMID   16754838.
  15. ↑ Darden, M. (10 October 2006). "New hope for an 'untreatable' mental illness". EurekAlert! Retrieved on 23 September 2007.
  16. ↑ Nordahl H.M.; Nysaeter T.E. (2005). "Schema therapy for patients with borderline personality disorder: a single case series". J Behav Ther Exp Psychiatry. 36 (3): 254–64. doi:10.1016/j.jbtep.2005.05.007. PMID   15978543.
  17. ↑ Davidson K, Norrie J, Tyrer P, et al. (October 2006). "The Effectiveness of Cognitive Behavior Therapy for Borderline Personality Disorder: Results from the Borderline Personality Disorder Study of Cognitive Therapy (BOSCOT) Trial". J Pers Disord. 20 (5): 450–65. doi:10.1521/pedi.2006.20.5.450. PMC   1852259 . PMID   17032158.
  18. ↑ Searles, Harold F. (1994). My Work With Borderline Patients (Master Work) . Northvale, N.J.: Jason Aronson. ISBN   978-1-56821-401-6.
  19. ↑ Steiner, John F. (1993). Psychic retreats: pathological organizations in psychotic, neurotic and borderline patients. New York: Routledge. ISBN   978-0-415-09924-0.
  20. ↑ Bateman A, Fonagy P (January 2001). "Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up". Am J Psychiatry. 158 (1): 36–42. doi:10.1176/appi.ajp.158.1.36. PMID   11136631.
  21. ↑ Falk Leichsenring; Eric Leibing (July 2003). "The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders: A Meta-Analysis". Am J Psychiatry. 160 (7): 1223–1232. doi:10.1176/appi.ajp.160.7.1223. PMID   12832233. S2CID   39770553.
  22. ↑ Biskin, R.S., & Paris, J. (November 2012). "Management of borderline personality disorder". Canadian Medical Association Journal. 184 (17): 1897–1902. doi:10.1503/cmaj.112055. PMC   3503902 . PMID   23027916.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  23. ↑ Levy KN, Clarkin JF, Yeomans FE, Scott LN, Wasserman RH, Kernberg OF (April 2006). "The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy". J Clin Psychol. 62 (4): 481–501. doi:10.1002/jclp.20239. PMID   16470612. S2CID   9585382.
  24. ↑ Levy KN, Meehan KB, Kelly KM, et al. (December 2006). "Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder". J Consult Clin Psychol. 74 (6): 1027–40. doi:10.1037/0022-006X.74.6.1027. PMID   17154733. S2CID   16241020.
  25. ↑ Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF (June 2007). "Evaluating three treatments for borderline personality disorder: a multiwave study". Am J Psychiatry. 164 (6): 922–8. doi:10.1176/appi.ajp.164.6.922. PMID   17541052.
  26. ↑ Ryle A (February 2004). "The contribution of cognitive analytic therapy to the treatment of borderline personality disorder". J Pers Disord. 18 (1): 3–35. doi:10.1521/pedi.18.1.3.32773. PMID   15061342.
  27. ↑ Fonagy P, Gergely G, Target M (2007). "The parent-infant dyad and the construction of the subjective self". J Child Psychol Psychiatry. 48 (3–4): 288–328. CiteSeerX   10.1.1.613.134 . doi:10.1111/j.1469-7610.2007.01727.x. PMID   17355400.
  28. ↑ Bateman A and Fonagy P (2004) Psychotherapy for Borderline Personality Disorder: Mentalization based treatment. Oxford University Press p. 71
  29. ↑ Sugarman, A (2006). "Mentalization, insightfulness, and therapeutic action. The importance of mental organization". International Journal of Psychoanalysis . 87 (4): 965–87. doi:10.1516/6DGH-0KJT-PA40-REX9. PMID   16877247. S2CID   22720610.
  30. ↑ Bateman A and Fonagy P (2004) Psychotherapy for Borderline Personality Disorder: Mentalization based treatment. Oxford University Press Ch. 5
  31. ↑ Bateman A, Fonagy P (May 2008). "8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual". Am J Psychiatry. 165 (5): 631–8. doi:10.1176/appi.ajp.2007.07040636. PMID   18347003. S2CID   2738794.
  32. ↑ MPH, James Reich, M. D. (2013-01-11). Personality Disorders: Current Research and Treatments. Routledge. ISBN   9781135422158.{{cite book}}: CS1 maint: multiple names: authors list (link)
  33. ↑ "CG78 Borderline personality disorder (BPD): NICE guideline". Nice.org.uk. 28 January 2009. Retrieved 12 August 2009.
  34. ↑ Stoffers, J; Völlm, BA; Rücker, G; Timmer, A; Huband, N; Lieb, K (16 June 2010). "Pharmacological interventions for borderline personality disorder". The Cochrane Database of Systematic Reviews (6): CD005653. doi:10.1002/14651858.CD005653.pub2. PMC   4169794 . PMID   20556762.
  35. ↑ Herpertz, SC; Zanarini, M; Schulz, CS; Siever, L; Lieb, K; Möller, HJ; WFSBP Task Force on Personality, Disorders.; World Federation of Societies of Biological Psychiatry, (WFSBP). (2007). "World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of personality disorders". World Journal of Biological Psychiatry. 8 (4): 212–44. doi:10.1080/15622970701685224. PMID   17963189. S2CID   14077861.
  36. ↑ Siever, Larry J.; Koenigsberg, Harold W. (October 2000). "The frustrating no-man's-land of borderline personality disorder". Cerebrum, the Dana Forum on Brain Science. 2 (4).
  37. ↑ Grootens KP, Verkes RJ (January 2005). "Emerging evidence for the use of atypical antipsychotics in borderline personality disorder". Pharmacopsychiatry. 38 (1): 20–3. doi:10.1055/s-2005-837767. PMID   15706462. S2CID   21786004.
  38. ↑ Casey DE (1985). "Tardive Dyskinesia: Reversible and Irreversible". Dyskinesia. Psychopharmacology Supplementum. Vol. 2. pp. 88–97. doi:10.1007/978-3-642-70140-5_11. ISBN   978-3-642-70142-9. PMID   2860664.
  39. ↑ Ruetsch O, Viala A, Bardou H, Martin P, Vacheron MN (2005). "[Psychotropic drugs induced weight gain: a review of the literature concerning epidemiological data, mechanisms and management]" [Psychotropic drugs induced weight gain: a review of the literature concerning epidemiological data, mechanisms and management]. L'Encéphale (in French). 31 (4 Pt 1): 507–16. doi:10.1016/S0013-7006(05)82412-1. PMID   16389718.
  40. ↑ "NIMH · Borderline Personality Disorder". Nimh.nih.gov. Retrieved 12 August 2009.
  41. ↑ "Borderline Personality Disorder Medications - Learn More About Borderline Personality Disorder Medications". Bpd.about.com. Archived from the original on 4 August 2009. Retrieved 12 August 2009.
  42. ↑ Lieb, Klaus; Völlm, Birgit; Rücker, Gerta; Timmer, Antje; Stoffers, Jutta M. (2010). "Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials". The British Journal of Psychiatry. 196 (1): 4–12. doi: 10.1192/bjp.bp.108.062984 . ISSN   0007-1250. PMID   20044651. S2CID   4680308.
  43. ↑ Cattarinussi, Giulia; Delvecchio, Giuseppe; Prunas, Cecilia; Moltrasio, Chiara; Brambilla, Paolo (2021-06-01). "Effects of pharmacological treatments on emotional tasks in borderline personality disorder: A review of functional magnetic resonance imaging studies". Journal of Affective Disorders. 288: 50–57. doi:10.1016/j.jad.2021.03.088. ISSN   0165-0327. PMID   33839558. S2CID   233211413.
  44. ↑ Zanarini MC, Frankenburg FR, Khera GS, Bleichmar J (2001). "Treatment histories of borderline inpatients". Compr Psychiatry. 42 (2): 144–50. doi:10.1053/comp.2001.19749. PMID   11244151.
  45. ↑ Zanarini MC, Frankenburg FR, Hennen J, Silk KR (January 2004). "Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years". J Clin Psychiatry. 65 (1): 28–36. doi:10.4088/JCP.v65n0105. PMID   14744165.
  46. ↑ Fallon P (August 2003). "Travelling through the system: the lived experience of people with borderline personality disorder in contact with psychiatric services". J Psychiatr Ment Health Nurs. 10 (4): 393–401. doi:10.1046/j.1365-2850.2003.00617.x. PMID   12887630.
  47. ↑ Links, P.; Y. Bergmans, S. Warwar (July 1, 2004). "Assessing Suicide Risk in Patients With Borderline Personality Disorder". Psychiatric TimesXXI (8). Retrieved on 23 September 2007.
  48. ↑ Cleary M.; Siegfried N.; Walter G. (2002). "Experience, knowledge and attitudes of mental health staff regarding clients with a borderline personality disorder". Australian and New Zealand Journal of Ophthalmology. 11 (3): 186–191. doi:10.1046/j.1440-0979.2002.00246.x. PMID   12510596.
  49. ↑ Nehls N (1999). "Borderline personality disorder: the voice of patients". Res Nurs Health. 22 (4): 285–93. doi:10.1002/(SICI)1098-240X(199908)22:4<285::AID-NUR3>3.0.CO;2-R. PMID   10435546.
  50. ↑ Deans C.; Meocevic E. (2006). "Attitudes of registered psychiatric nurses towards patients diagnosed with borderline personality disorder". Contemporary Nurse. 21 (1): 1–7. doi:10.5172/conu.2006.21.1.43. hdl:1959.17/66356. PMID   16594881. S2CID   20500743. Archived from the original on 2008-04-11.
  51. ↑ Krawitz R (2004). "Borderline personality disorder: attitudinal change following training". Australian and New Zealand Journal of Psychiatry. 38 (7): 554–9. doi:10.1111/j.1440-1614.2004.01409.x. PMID   15255829.
  52. ↑ (2001). "Treatment of Patients With Borderline Personality Disorder". APA Practice Guidelines. Retrieved on 21 September 2007.
  53. ↑ Soler J, Pascual JC, Campins J, et al. (June 2005). "Double-blind, placebo-controlled study of dialectical behavior therapy plus olanzapine for borderline personality disorder". Am J Psychiatry. 162 (6): 1221–4. doi:10.1176/appi.ajp.162.6.1221. PMID   15930077.
  54. ↑ Simpson EB, Yen S, Costello E, et al. (March 2004). "Combined dialectical behavior therapy and fluoxetine in the treatment of borderline personality disorder". J Clin Psychiatry. 65 (3): 379–85. doi:10.4088/JCP.v65n0314. PMID   15096078.
  55. ↑ Kaplan CA (September 1986). "The challenge of working with patients diagnosed as having a borderline personality disorder". Nurs Clin North Am. 21 (3): 429–38. doi:10.1016/S0029-6465(22)01212-9. PMID   3638699. S2CID   40320645.
  56. ↑ Aviram, R.B.; B.S. Brodsky, B. Stanley (October 2006). "Borderline Personality Disorder, Stigma, and Treatment Implications [ permanent dead link ]". Harvard Review of Psychiatry14 (5). Retrieved on 23 September 2007.
  57. ↑ Gabbard, G. O. (October 2001). "Practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Association". Am J Psychiatry. 158 (10 Suppl): 1–52. doi:10.1176/appi.ajp.158.1.1. PMID   11665545. S2CID   20392111.
  58. ↑ Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR (November 2004). "Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission". Am J Psychiatry. 161 (11): 2108–14. doi:10.1176/appi.ajp.161.11.2108. PMID   15514413. S2CID   24240127.
  59. ↑ Warner S.; Wilkins T. (2004). "Between Subjugation and Survival: Women, Borderline Personality Disorder and High Security Mental Hospitals". Journal of Contemporary Psychotherapy. 34 (3): 1573–3564. doi:10.1023/B:JOCP.0000036634.36358.0e. S2CID   20396259.
  60. ↑ Flory, L. (2004). Understanding borderline personality disorder . London: Mind. Retrieved on 23 September 2007.
  61. ↑ Campling P (2001). "Therapeutic communities". Advances in Psychiatric Treatment. 7 (5): 365–372. doi: 10.1192/apt.7.5.365 .
  62. ↑ Michael T. Compton (2007) Recovery: Patients, Families, Communities Conference Report, Medscape Psychiatry & Mental Health, October 11–14, 2007
  63. ↑ Oldham J (2004). "Borderline Personality Disorder: An Overview". Psychiatric Times. XXI: 8.
  64. ↑ Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR (February 2005). "Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years" [Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years]. J Pers Disord. 19 (1): 19–29. doi:10.1521/pedi.19.1.19.62178. PMID   15899718.
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