What are the best medications for borderline personality disorder?
Recent findings: 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 (DBT), and the adaptation of DBT treatment to manage post-traumatic stress disorder (PTSD) and BPD. Studies on pharmacological …
What medications treat borderline personality disorder?
There is evidence that long-term psychotherapy can be a useful form of treatment in those with BPD [ Zanarini, 2009; Davidson et al. 2006 ], and it is often preferred to pharmacological treatment due to reports of the limited efficacy of drug therapy [ Zanarini, 2004 ].
How to deal with a person with borderline personality disorder?
Purpose of the Review This review summarizes advances in treatments for adults with borderline personality disorder (BPD) in the last 5 years. Recent Findings 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 …
How to fix borderline personality disorder?
Nov 20, 2012 · Psychotherapy is the most important component in the treatment of borderline personality disorder, leading to large reductions in symptoms that persist over time. Over the past 2 decades, many forms of psychotherapy have been developed specifically to treat the disorder.
How many studies have been published on borderline personality disorder?
The Cochrane review of psychological therapies for borderline personality disorder, which analyzed 28 studies published until 2011, is among the most significant additions to the literature on treatments for BPD in the last 5 years [ 5 ]. The major randomized controlled studies can be characterized in four major waves (Table 1 ). The first wave of studies compared specialized therapies for BPD to TAU. In this first wave of studies, DBT and MBT were established as EBTs [ 1, 9, 10, 11 ]. Additionally, a short-term group therapy, 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 ].
What is the best EBT for BPD?
The most well-known, well researched, and widely available EBT for BPD is DBT [ 39, 40 ]. 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 formulates the problems of BPD as a result of the transaction between individuals born with high emotional sensitivity and “invalidating environments” that is, people or systems (i.e., families, schools, treatment settings, workplaces) that cannot perceive, understand, and respond effectively to their vulnerabilities.
How does DBT help with BPD?
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, 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.
What is evidence based treatment for BPD?
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 (DBT), and 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.
Why is BPD important?
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.
What are the co-morbidities of BPD?
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. Efforts to target BPD with its co-morbid disorders simultaneously have been developed and studies of their feasibility and effectiveness have been published in the last 5 years [ 15 •, 32, 33, 36, 37, 38 ].
What is a GPM?
GPM is based on a case management model, where interventions rely on common sense and are learned easily by generalist clinicians. Inherent in the case management approach is a focus on the patient’s life outside of therapy. GPM prioritizes the attainment of stable vocational functioning over romantic relationships, as well as improvement in social functioning over specific symptom improvement. Diagnostic disclosure with a discussion of the disorder’s symptoms should be the first step in psychoeducation for patients and their families, followed by information about the disorder’s etiology and positive prognosis. 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. Its mechanism of change is to facilitate the natural course of the disorder’s improvement with specific attention to promoting functioning in endeavors outside of treatment.
What is the best medication for BPD?
Antipsychotics are widely used in BPD, as they are believed to be effective in improving impulsivity, aggression, anxiety and psychotic symptoms [Nose et al.2006; American Psychiatric Association, 2001]. Evidence supports their use in the treatment of cognitive-perceptual symptoms [Herpertz et al.2007]. However, the common occurrence of adverse side effects in this class of medications means that they are often preferred for the treatment of acute relapses only [Díaz-Marsá et al.2008; Newton-Howes and Tyrer, 2003; Benedetti et al.1998; Teicher et al.1989]. The most commonly studied antipsycho tic, olanzapine, has been found to reduce impulsivity, hostility, affective instability and psychotic symptoms in BPD [Lieb et al.2010; Soler et al.2005; Zanarini et al.2004; Bogenschutz and Nurnberg, 2004; Hallmayer, 2003], although it is associated with metabolic side effects, which may limit its tolerability [Reynolds and Kirk, 2010; Kantrowitz and Citrome, 2008]. A more limited literature supports the use of aripiprazole and haloperidol in BPD, the latter especially for symptoms of anger [Lieb et al.2010].
What mood stabilizers are used for BPD?
Stronger evidence exists for the use of the mood stabilizers topiramate, lamotrigine and valproate semisodium in BPD. Topiramate and lamotrigine have both been shown in small RCTs to be effective in the treatment of symptoms of aggression in BPD [Nickel et al.2005, 2004; Tritt et al.2005]. In addition, there is evidence from one placebo-controlled trial of a broader effect of topiramate in treating other symptoms of BPD, including interpersonal problems and anxiety [Loew et al.2006]. Two small RCTs have demonstrated efficacy for divalproex sodium in the treatment of BPD [Hollander et al.2001], or BPD with comorbid bipolar II disorder [Frankenberg and Zanarini, 2002]. Improvements were seen in these studies on global function [Hollander et al.2001], and measures of interpersonal sensitivity and hostility and aggression [Frankenberg and Zanarini, 2002].
What is borderline personality disorder?
Borderline personality disorder (BPD) is a common and disabling psychiatric condition. Epidemiological studies suggest that 2% of the general population have BPD, and the condition is diagnosed in up to 15% of psychiatric inpati-ents and 50% of inpatients with a diagnosis of personality disorder [Torgersen et al.2001; Widiger and Weismann, 1991]. BPD is a clinically heterogeneous condition, encompassing disturbances of affective regulation and impulsivity [Links et al.1999], with symptom clusters of impulse-behavioural dyscontrol, cognitive perceptual symptoms and disturbed interpersonal interrelatedness [Skodol et al.2002; American Psychiatric Association, 2001], as well as associated affective states including depression, anxiety, anger and tension [Coid, 1993]. Research on the management of BPD has been challenging; the multifaceted nature of the disorder [Clarkin et al.1983] and comorbid diagnoses [Zanarini et al.1998a, 1998b], mitigate against homogeneity in patient cohorts. In addition, heterogeneity in outcome measures and methodology across clinical trials mean that treatment efficacy is often difficult to assess [Mercer et al.2009; Binks et al.2006].
Is BPD a comorbidity?
There is strong evidence that depressive symptoms are common in individuals meeting criteria for BPD. Previous studies have reported comorbidity rates between BPD and major depressive disorder of up to 61% [Comtois et al.1999], with this figure rising to as high as 98% in hospitalized inpatients prior to treatment [Zanarini et al.2003]. The suggestion that BPD is an atypical form of affective disorder led researchers to investigate the use of therapies aimed at treating the mood disorder in BPD [Kroll and Ogata, 1987]. The use of antidepressants in the management of BPD has been investigated for decades, and evidence supporting their effectiveness in treating BPD has ranged from case reviews [Pinto and Akiskal, 1998] to double-blind, randomized and controlled trials [Simpson et al.2004; Rinne et al.2002; Coccaro and Kavoussi, 1997; Soloff et al.1993; Parsons et al.1989; Cowdry and Gardner, 1988].
Does vasopressin affect BPD?
It has been suggested that, in the context of close interpersonal relationships, the predisposition towards enhanced irritability and aggression in BPD patients is partially explained by increased vaso pressin concentrations [Stanley and Siever, 2010]. As such, vasopressin antagonists may be helpful in the management of BPD, as has been proposed previously for major depressive disorder [Schüle et al.2009].
Is carmazepine safe for BPD?
Trials that have investigated the efficacy of car-bamazepine have yielded mixed results. Although a relatively early placebo-controlled trial in 16 BPD patients reported a significant decrease of impulsivity measures [Cowdry and Gardner, 1988], no significant positive effects of carbamazepine was reported in a more recent, similarly designed trial of 20 patients [De la Fuente and Lotstra, 1994]. Overall, therefore, the present findings do not support the use of carbamazepine in BPD [Lieb et al.2010].
Is lithium safe for BPD?
Initial placebo-controlled trials of lithium in patients with emotionally unstable character disorder provided evidence of improvement in global functioning and mood [Rifkin et al.1972], although subsequent studies in BPD failed to demonstrate the therapeutic efficacy of lithium use [Links et al.1990]. The pharmacological profile of lithium also prevents it being used in first-line management, with a high risk of toxicity on overdose.
Why should borderline personality disorder patients be referred to a therapist?
In areas where specialized treatments are available, patients with borderline personality disorder should be referred to these services because data consistently have shown them to be superior to usual treatment.
What is the most important component of borderline personality disorder?
Psychotherapy is the most important component in the treatment of borderline personality disorder, leading to large reductions in symptoms that persist over time. Over the past 2 decades, many forms of psychotherapy have been developed specifically to treat the disorder.
What is mentalization based therapy?
Mentalization-based treatment is the second psychotherapy technique developed specifically for the treatment of borderline personality disorder. It has roots in attachment theory,35and its goal is to improve the patient’s ability to “mentalize” —that is, to understand his or her own and others’ mental states.36The treatment uses weekly individual therapy sessions and group sessions over 18 months. It has the advantage of having much shorter training periods and requirements than those for other treatments.18
What is dialectical behavior therapy?
Dialectical behaviour therapy was the first psychotherapy shown to be effective specifically in the treatment of borderline personality disorder.23This manualized therapy combines cognitive behavioural therapy with Eastern philosophy and traditions. It has a strict hierarchy of treatment targets, with life-threatening behaviours at the top of the list. One of the key dialectics in the treatment is the balance that the therapist must achieve in validating the experiences and behaviours of the patient while promoting change.10The therapy includes weekly individual sessions and weekly life-skills group sessions that teach skills in 4 domains: mindfulness, distress tolerance, regulation of emotions and interpersonal effectiveness. Phone consultation with the therapist is available at all hours, and team consultation meetings play an important role.10The therapy is designed to last at least 1 year; subsequent phases have been suggested but not thoroughly described.10
What is the most recent Cochrane review of psychotherapy for borderline personality disorder?
The most recent Cochrane review of psychotherapy for borderline personality disorder, although it included only studies published to 2003, found support for dialectical behaviour therapy and mentalization-based treatment,22and recent findings strengthen this conclusion. Dialectical behaviour therapy.
How long does a pharmacotherapy trial last?
First, many of the pharmacotherapy trials were short, often lasting between 6 and 12 weeks. Because the condition is, by definition, a longstanding disorder, it is unclear whether changes that occurred during treatment persisted over time. Second, the sample sizes were small in most of the trials. This was compounded by high dropout rates. The third limitation is the choice of outcome measures. Many studies reported changes in self-reported ratings of depression, anxiety or general psychiatric symptoms, but these measures are not meant to assess changes in symptoms of borderline personality disorder. Changes attributed to the study medication could therefore have been due to treatment of comorbid disorders or subsyndromal pathology, even if treatment of comorbid depression is more difficult in these patients.40The use of validated measures to assess the effect of treatment on specific symptoms of borderline personality disorder such as self-harm, suicidality or impulsivity would be helpful. The fourth limitation is the number of exclusion criteria. Most patients with borderline personality disorder frequently experience suicidality and often have multiple comorbidities.41Therefore, trials with long lists of exclusions that included suicidal ideation and depression have samples that likely have less severe borderline personality disorder and are less representative of patients seen in practice. The final limitation is the lack of replication. Except for olanzapine, most medications only have 1 or 2 small trials showing their effects. When multiple trials do exist, the studies have often been conducted by the same group of researchers.
What is borderline personality disorder?
Borderline personality disorder is characterized by intense, rapidly fluctuating moods combined with impulsivity and interpersonal difficulties. Patients with the disorder are frequently encountered in clinical practice, despite a prevalence in the community of 1%–2%.1Up to 10% of patients seen in outpatient psychiatry clinics2,3and 6% of those seen in a family medicine clinic4meet criteria on diagnostic interviews, although rates are much higher and more varied when self-report measures are used.5,6In general, patients show a gradual improvement in symptoms with age,7although functioning remains impaired.8One long-term community-based follow-up study found a 10% suicide rate.9
What is the borderline personality disorder guideline?
The primary focus is on adults, but the guideline looks at emerging characteristics of borderline personality disorder in younger people. The guideline also considers the needs of those with learning disabilities and contains a useful overview of borderline personality disorder.
Is borderline personality disorder a functional impairment?
Personality disorder now accounts for a substantial portion of the workload of most community mental health teams in the UK and borderline personality disorder is associated with significant functional impairments for the individual. The NICE guideline takes the first comprehensive view of the disorder and is an important resource for healthcare professionals to improve people’s long-term outcomes.
What is the treatment for borderline personality disorder?
Dialectical behavior therapy as treatment for borderline personality disorder
What are the symptoms of BPD?
These components work together to teach behavioral skills that target common symptoms of BPD, including an unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity such as self-injurious behaviors.
What is dialectical behavior therapy?
The term “dialectical” means the interaction of conflicting ideas. Within DBT, “dialectical” refers to the integration of both acceptance and change as necessities for improvement .6Dialectical behavior therapy aims to address the symptoms of BPD by replacing maladaptive behaviors with healthier coping skills, such as mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. It is currently the only empirically supported treatment for BPD as demonstrated by the Cochrane Collaborative Review.7Research has also shown it be effective in treatment of substance use disorders, mood disorders, posttraumatic stress disorder (PTSD), and eating disorders in both adults and adolescents.8Given the often comorbid psychiatric symptoms with BPD in patients participating in DBT, psychopharmacologic interventions are oftentimes considered appropriate adjunctive care. This article aims to outline the basic principles of DBT as well as comment on the role of pharmacotherapy as adjunctive treatment for the symptoms of BPD.
What is behavioral therapy?
Dialectical behavior therapy is based on cognitive-behavioral principles and is currently the only empirically supported treatment for BPD. Randomized controlled trials have shown the efficacy of DBT not only in BPD but also in other psychiatric disorders, such as substance use disorders, mood disorders, posttraumatic stress disorder, and eating disorders. Traditional DBT is structured into 4 components, including skills training group, individual psychotherapy, telephone consultation, and therapist consultation team. These components work together to teach behavioral skills that target common symptoms of BPD, including an unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity such as self-injurious behaviors. The skills include mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Given the often comorbid psychiatric symptoms with BPD in patients participating in DBT, psychopharmacologic interventions are oftentimes considered appropriate adjunctive care. This article aims to outline the basic principles of DBT as well as comment on the role of pharmacotherapy as adjunctive treatment for the symptoms of BPD.
How does Linehan's DBT work?
Linehan's DBT manual explains that the skills training group is designed to target behavioral skill deficits that are common to patients with BPD, including an unstable sense of self, chaotic relationships, fear of abandonment, emotional lability, and impulsivity. The group focuses on teaching psychosocial skills that target these deficits through 4 skills training modules: core mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. The group typically meets weekly for approximately 2 hours, and it takes about 6 months to complete all of the modules. Individuals can choose to repeat the modules, and it is recommended that patients who are new to DBT stay in the skills training group for at least 1 year. Patients are assigned homework to reinforce skills and given diary cards to keep track of how they are using the skills outside of the group. Although patients can discuss with the group how they are using the skills, they are encouraged to process their diary cards primarily with their individual therapists.6
How long does it take to complete DBT?
The group typically meets weekly for approximately 2 hours, and it takes about 6 months to complete all of the modules. Individuals can choose to repeat the modules, and it is recommended that patients who are new to DBT stay in the skills training group for at least 1 year.
What are the components of DBT?
Traditional DBT consists of 4 components: skills training group, individual psychotherapy, telephone consultation, and therapist consultation team. This treatment structure was used in the RCTs validating its effectiveness; however, DBT can be modified or shortened to accommodate any treatment setting, including solo private practices or inpatient facilities.1,6
What is schema focused therapy?
Schema-focused therapy (SFT) is an integrative cognitivetherapy focused on generating structural changes to a patient’spersonality. In twice weekly individual therapy sessions, theclinician uses a variety of behavioral, cognitive, and experien-tial techniques that focus on the therapeutic relationship, dailylife outside therapy, and past traumatic experiences. Unlikethe more neutral stances of other therapies, SFT encouragesan attachment between therapist and client, a process de-scribed as “limited re-parenting”. Therapy focuses on fourschema modes of BPD: detached protector, punitive parent,abandoned/abused child, and angry/impulsive child. Its mech-anism of change occurs through changing negative patterns ofthinking, feeling, and behaving and developing healthier al-ternatives to replace them so that these dysfunctional schemasno longer control a patient’slife.
What is structured clinical management?
Structured clinical management (SCM) was developed in theUK, similar to GPM, reflects “best general psychiatric treat-ment” that is feasible for use by“generalist mental healthclinicians” with minimal additional training [47, p. 57]. Itwas developed based on“expert consensus”about what gen-eral practices work best for treating BPD, and has been testedprimarily in the context of RCTs evaluating the effectivenessof MBT [25]. Compared to patients who received MBT, thosewho received SCM showed substantial improvements acrossan array of clinical outcomes. Patients receiving MBT im-proved somewhat more quickly and continued to show greaterbenefit than SCM at 18-month follow-ups. However, thosewho received SCM were as well at 6 months as those in theMBT group, and showed faster reductions in self-harm.Like GPM, SCM provides a structured framework forapproaching treatment for BPD (see Table2for compari-sons). This framework is guided by a number of generalistprinciples and is meant to make treatment understandableand predictable for patients. There is an emphasis on sharingthe borderline diagnosis with patients, psychoeducation, al-liance building that is based both on contractual (e.g., goalagreement) and relational factors (e.g., trust, reliability, lik-ing), encouragement of family involvement, limited reliance
What is borderline personality disorder?
Borderline personality disorder (BPD) is a condition first formally described in the 20th century ( Gunderson 2009 ). Historically, the term BPD was coined by Adolph Stern to describe a condition in the 'borderland' between psychosis and neurosis ( Stern 1938 ). Subsequent psychoanalytic contributions (especially that of Kernberg 1975) have reaffirmed this distinction, emphasising that the capacity to test reality remains grossly intact but is subject to subtle distortions, especially under stress. The current evidence supports a biopsychological model of the aetiological factors in BPD, all of which may contribute. It is assumed that there is an interaction between the experience of adverse effects during childhood (like neglect, emotional or sexual abuse), and genetic or biological factors. Relevant biological factors include neurobiological structures, such as reduced aymgdala volume, increased volume of the pituitary gland, reduced grey matter volume in the anterior cingulate gyrus, posterior cingulate gyrus or hippocampus, and reduction in size of the right parietal cortex ( Leichsenring 2011; Lieb 2004 ), and neurobiological dysfunctions (especially of the serotonergic system). In combination with psychosocial factors, personality traits (e.g. neuroticisms), personality functioning (self and interpersonal) and proneness to react highly emotionally may contribute to the core components of BPD, like affective and behavioural dysregulation, and disturbed relatedness ( Leichsenring 2011; Lieb 2004 ).
What is the psychological impact of BPD?
presentation to emergency clinics due to self‐harm or suicidal crises and repeated hospitalisations) and poor psychosocial functioning (e.g. inability to complete education or get/maintain a job). Consequently, identification of effective psychological therapies for BPD is important ( Stoffers‐Winterling 2012 ).
How many trials were excluded from the BPD study?
In total, we excluded 105 trials from 118 full‐text reports (see Characteristics of excluded studies tables). Of these, 70 trials included an ineligible patient population, 28 assessed ineligible interventions, 1 included an ineligible comparator, 2 had unclear numbers of participants with BPD included (we were unable to retrieve information), and 4 did not include any relevant outcomes (see Figure 1 ).
What is evidence based therapy?
Evidence‐based psychological therapies are based on assumptions about causality, core symptoms, and maintenance of the disorder ( Kazdin 2004; Livesley 2003; Livesley 2004 ). The various psychotherapeutic approaches to BPD claim different mechanisms of action according to their respective models of causation ( Gunderson 2018 ; Huprich 2015; Livesley 2004; Livesley 2016 ). However, they also contain a number of common elements that can account for why a number of seemingly different approaches appear to be effective in ameliorating BPD symptoms ( Bateman 2015; Fonagy 2014; Kongerslev 2015; Weinberg 2011 ), including: a clear and highly structured treatment framework; an explicit model of BPD symptomatology; a consistent focus on the therapeutic relationship, affect regulation, tolerance of emotional states, and biases in social cognition; a high priority given to self‐harm and suicidal behaviour; active therapists who deliver both support and validation as well as explorative and change‐oriented interventions; mix of treatment formats (e.g. includes both individual and group therapy); and therapist support in the form of supervision and regular meetings. The symptoms of BPD are addressed using the following therapeutic approaches. Following Weinberg 2011:
Is there any data available for BPD?
No data were available on any time point for BPD symptom severity, self‐harm, suicide‐related outcomes, and psychosocial functioning.
Is BPD a cut off for clinically meaningful improvement?
Our assessments showed beneficial effects on all primary outcomes in favour of BPD‐tailored psychotherapy compared with TAU. However, only the outcome of BPD severity reached the MIREDIF‐defined cut‐off for a clinically meaningful improvement. Subgroup analyses found no evidence of a difference in effect estimates between the different types of therapies (compared to TAU) .
Specialized Evidence-Based Treatments (Ebts) For BPD
- Dialectical Behavioral Therapy
The most well-known, well researched, and widely available EBT for BPD is DBT [39, 40]. 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 … - Mentalization-Based Treatment
Mentalization refers to the complex capacity human beings develop to imagine the thoughts and feelings in one’s own and other’s minds to understand interpersonal interactions [41]. Therein lies its mechanism of change. MBT proposes that BPD symptoms arise when a patient stops mental…
Generalist Approaches to BPD
- General Psychiatric Management
Given the limitations of treatment models that require significant training and significant clinic resources, there is a need to develop, test, and disseminate less intensive treatments. One of these new EBTs is general psychiatric management (GPM) [8•]. GPM is based on a case manag… - Structured Clinical Management
Structured clinical management (SCM) was developed in the UK, similar to GPM, reflects “best general psychiatric treatment” that is feasible for use by “generalist mental health clinicians” with minimal additional training [47, p. 57]. It was developed based on “expert consensus” about wha…
Dismantling Studies
- Now that several evidence-based treatments for BPD have been tested, their most essential ingredients can be discerned from dismantling studies. A major advance in the last 5 years for understanding what works in BPD treatment comes from Linehan’s dismantling study of DBT. DBT in its standard form involves an intensive package of weekly individual therapy, weekly two and …
Other Brief Cost-Effective Options
- Systems Training for Emotional Predictability and Problem Solving
Designed to supplement ongoing treatments such as medication, individual therapy, and case management, systems training for emotional predictability and problem solving (STEPPS) consists of cognitive behavioral elements, skills training, and a systems component. The STEPP…
Treatments For BPD and Major Co-Morbidities
- BPD’s usual complex pattern of co-morbidity [49, 50] is another challenging factor in its clinical management. 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-morbi…
Pharmacology
- Compared with the growing evidence base for effective psychological treatments, pharmacologic treatments for BPD remain less well-studied. To date, no medication has been approved by the FDA for BPD or proven to definitively manage its cardinal symptoms, interpersonal impairments, and functional difficulties. Clinical applicability of the available evidence is hampered by a limite…