Borderline Personality Disorder – Dilemmas and Therapeutic Challenges

2017 ◽  
Vol 41 (S1) ◽  
pp. s783-s784
Author(s):  
G. Tasic ◽  
S. Anakiev
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Continuous Learning ◽  
Defence Mechanisms ◽  
Special Challenge ◽  
Competing Interest ◽  
Otto Kernberg

Treatment of borderline personality disorder has some specifics relative to other disorders, which are deriving from nature and structure of those people. Treatment is very slow, often with interruptions, and it presents a special challenge for contratransferal feelings but at the same time offers a possibility of continuous learning, for the patient and the therapist. Main characteristics of this personality disorder are the diffusion of identity, primitive defence mechanisms concentrated around the cleft and relatively preserved ability to rest reality. As classical psychoanalysis and psychoanalytical psychotherapy did not give results in therapy of this disorder, Otto Kernberg took its basic techniques but used them adjusted for borderline personality disorder, developing so called transfer focused psychotherapy. This paper will present the main principles of this modification, applied in practice.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Do Mood Stabilizers Help in Borderline Personality Disorder?

2017 ◽  
Vol 41 (S1) ◽  
pp. S47-S47
Author(s):  
B. Völlm ◽  
J. Stoffers-Winterling ◽  
J. Mattivi ◽  
E. Simonson ◽  
O.J. Storebø ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Evidence Base ◽  
Borderline Personality ◽  
Mood Stabilizers ◽  
Beneficial Effects ◽  
Drug Classes ◽  
Competing Interest

BackgroundDespite the relatively weak evidence base, individuals with borderline personality disorder are often treated with pharmacological interventions. Amongst the drugs, which have shown most promise, are mood stabilizers, which were one of the two drug classes with the most beneficial effects in a previous cochrane review though the robustness of findings was described as low (Stoffers et al., 2010). Here we present data on the latest evidence for mood stabilizers based on an updated cochrane review currently underway.MethodsA systematic review and meta-analysis of randomized controlled trials was conducted. All randomized comparisons of drug vs. placebo, drug vs. drug, or drug vs. a combination of drugs in adult BPD patients were eligible for inclusion. Outcomes comprised BPD core pathology as depicted by DSM criteria, associated pathology, i.e., depression and anxiety, general measures of overall psychopathology severity, tolerability, and adverse effects. Two researchers selected trials, assessed quality and extracted data independently.ResultsOnly a limited number of additional trials using mood stabilizers was identified since the publication of the last cochrane review, mainly utilizing Sodium Valproate. This added to the evidence base for mood stabilizers though the overall evidence remains very limited.ConclusionMood stabilizers show some initial evidence for their effectiveness in borderline personality disorder. However, these have to be replicated before wider conclusions can be drawn for clinical practice.Disclosure of interestThe authors declare that they have no competing interest.

Cognitive analytic therapy: A bibliometric review

2016 ◽  
Vol 33 (S1) ◽  
pp. s233-s233
Author(s):  
E. Gimeno ◽  
C. Chiclana
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Meta Analysis ◽  
Borderline Personality ◽  
Theoretical Concepts ◽  
Wide Range ◽  
Bibliometric Review ◽  
Analytic Therapy ◽  
Competing Interest ◽  
Cognitive Analytic Therapy

IntroductionCognitive Analytic Therapy (CAT) has emerged as an integrative new approach with promising results in the treatment of personality-disordered patients, particularly in borderline personality disorder. Although this approach has already demonstrated its effectiveness in adults, increasingly studies try to validate it in young population, which has meant a turning point in research.Aim and objectivesThe goal of this study is to know the whole production about CAT in a double way:–articles that describes the main theoretical concepts underlying CAT theory;–articles with evidence supporting its effectiveness in different mental disorders.MethodsA bibliometric review of 397 scientific articles extracted from research databases including Dialnet, EBSCO, PUBMED, Unika and Scholar Google was conducted.ResultsThe results indicate an exponential growth in published studies on CAT, from first publications in the late 1960s, particularly strong in the last two decades and reaching its peak in 2008. Total research includes 247 literature reviews, 109 clinical studies, 47 case studies, 17 letters and comments from authors, 4 studies on diagnostic tests and 1 meta-analysis. Most research has focused on borderline personality disorder or other personality disorders (35% and 12% respectively) and eating disorders (11%). Studies have been conducted with adults (49%) the same as children and adolescents (46%) whereas only the 4% has been developed for elderly population.ConclusionsCognitive analytic therapy represents a well-documented psychotherapy with a proven efficacy in a wide range of clinical contexts.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Impact of dialectical behavior therapy on incidence of suicidal attempts and non-suicidal self injury among a sample of Egyptian borderline personality disorder patients

2016 ◽  
Vol 33 (S1) ◽  
pp. s270-s270
Author(s):  
A. Abdelkarim ◽  
D. Nagui Rizk ◽  
M. Esmaiel ◽  
H. Helal
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Behavior Therapy ◽  
Dialectical Behavior Therapy ◽  
Borderline Personality ◽  
Language And Culture ◽  
Self Injury ◽  
Suicidal Attempts ◽  
Competing Interest ◽  
Almost All

IntroductionDialectical behavior therapy (DBT) is a comprehensive psycho-social treatment developed by Marsha Linehan and originally designed for persons meeting criteria for borderline personality disorder (BPD). DBT is considered as a standard evidence based treatment for suicidal BPD patients in most international guidelines. Although its effectiveness has been proved in multiple studies across different patient populations but almost all the research was conducted in North American or European countries. The current study was the first trial to apply DBT in Egypt with a different language and culture than where the treatment was originally developed.ObjectivesAssessment of incidence of suicidal attempts and non-suicidal self-injury (NSSI) among a sample of Egyptian BPD patients enrolled in an outpatient DBT program.AimThe aim of the current study was to estimate impact of comprehensive DBT on suicidal attempts and NSSI when applied to Egyptian BPD patients.MethodsTwenty-five BPD patients, 4 males and 21 females, were included in a comprehensive outpatient DBT program for one year and incidence of suicidal attempts and NSSI were calculated.ResultsFive patients only attempted suicide again with an incidence of 20% and a mean of one attempt/patient. Seven patients attempted NSSI with an incidence of 28%, an overall 22 incidents and a mean of 3 incidents/patient.ConclusionAlthough this was the first time to apply DBT in an Egyptian population, DBT proved to be an effective psycho-therapeutic intervention for suicidal BPD patients across regardless of different language or culture.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Borderline personality disorder and working memory: A systematic review

2016 ◽  
Vol 33 (S1) ◽  
pp. S211-S212
Author(s):  
S. Marini ◽  
C. Ranalli ◽  
C. Di Gregorio ◽  
E. Cinosi ◽  
M. Corbo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Working Memory ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Literature Search ◽  
Memory Load ◽  
Borderline Personality ◽  
The Third ◽  
Memory Functioning ◽  
Competing Interest

Purpose of the studyThe purpose of this study was to investigate cognitive functioning in Borderline Personality Disorder subjects, with particular reference to the Working Memory functioning. The Working Memory seems to be relate to core features of the disturb. The final aim was to better understand the disorder and to implement a cognitive training to improve the deficits.MethodsA literature search was conducted in April 2015. Pubmed and Scopus databases were used to find studies to include in the systematic review. The keywords used for the literature search were: “borderline personality disorder”, “borderline personality”, “working memory”, “executive functioning”. In each search, the keywords were used together with the logical operator “and”.SummaryThree studies were included in this systematic review (Table 1). In each study, the working memory was investigated using N-back test. In two of those studies significantly differences were found between patients and healthy group in N-back task. In the third study, which used more tests to investigate working memory domain, no differences were found between the two groups.ConclusionsBorderline personality disorder patients performed significantly worse on the N-back test compared to healthy controls and the impairment increased with increasing working memory load. In the third study the working memory domain was investigated using four different tests and single scores were not included therefore it was impossible to compare N-back data.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Digging out insights and behavioral correlates of false and true femininity in borderline personality disorder patients attending four-step integrative model group psychotherapy

2016 ◽  
Vol 33 (S1) ◽  
pp. s232-s232 ◽  
Author(s):  
M. Abdelhameed ◽  
R. Mahfouz ◽  
A. Kamal ◽  
M. Taha
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Group Psychotherapy ◽  
Borderline Personality ◽  
Integrative Model ◽  
Model Group ◽  
Behavioral Correlates ◽  
Dsm Iv ◽  
Competing Interest ◽  
Age Range

IntroductionThe four-step integrative model of psychotherapy is concerned with individual's needs, wants, rights and decisions in that order. It may carry a promise for deep and changing vision for patients with borderline personality disorder (BPD).ObjectivesThe study of the illuminating and changing effect of dealing with BPD patients in view of their needs, wants, rights and decisions.AimsTo evaluate the effect of group work through the hierarchy of the four-step integrative model with BPD patients and to help them explore false and true elements of their femininity.MethodsForty-three female patients (age range: 19-37) diagnosed according to DSM-IV diagnostic criteria for BPD were enrolled in a dynamic psychotherapy group. Their progress was evaluated using Borderline evaluation of severity over time (BEST) and they wrote down detailed comments about their experience quarterly.ResultsResults of regular attendants for 2 years were included (35 = 81.4%). The results of BEST showed a significant reduction of BPD severity at the end of 1 and 2 years. During psychotherapy sessions and within their quarterly comments, patients expressed their change in terms of moving from a state of cunning, manipulation, aggression, arrogance, envy and rejection (as stemming from their false femininity) into wisdom, confrontation, patience, pride, healthy competition and containment respectively (as stemming from their true femininity).ConclusionsPatients with BPD may gain a better insight and genuine change as they realize what is false and what is true about their femininity in the context of attending four-step integrative model group psychotherapy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Borderline Personality Disorder in Adolescence. Prevention and Early Intervention From a Cognitive Analytic Approach

2016 ◽  
Vol 33 (S1) ◽  
pp. S505-S505
Author(s):  
E. Gimeno ◽  
C. Chiclana
Keyword(s):  
Risk Factors ◽  
Early Intervention ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Analytic Approach ◽  
Diagnostic Threshold ◽  
Potential Development ◽  
Axis I ◽  
Competing Interest

IntroductionBorderline personality disorder begins in adolescence, however, its diagnosis is subject to some controversy and tends to be underdiagnosed. Stigma associated with its diagnosis, comorbidity with other axis I disorders or the changeable sense of identity during adolescence are some of the elements that obscure the diagnosis. Increasingly, recent studies have shown the utility of prevention programs as well as instituting early intervention in adolescents, with very hopeful outcomes.ObjectivesThe aim of this study is to review the benefits derived from early prevention and intervention programs in adolescents with borderline symptoms from a cognitive analytic approach.MethodsA systematic review for scientific articles extracted from research databases including Dialnet, EBSCO, Pubmed, Unika and Scholar Google was conducted. Other high-impact studies in the field were also included.ResultsEvidence reported by reviewed articles supports Cognitive analytical therapy as one of the most successful approaches, the same as Mentalization based therapy, in the treatment of Borderline personality disorder. From this approach, prevention and early intervention have shown their effectiveness in reducing borderline symptoms and risk factors besides they contribute to interpersonal functioning improvement.ConclusionsPrevention and early intervention constitute the main pillars to prevent the potential development of Borderline personality disorder or its evolution in more complex and irreversible forms. But this intervention must be carried not only in young already diagnosed, but also in those who are on the diagnostic threshold, presenting risk factors for further development.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Short-term Psychological Interventions for Bordeline Personality Disorder–What Works?

2017 ◽  
Vol 41 (S1) ◽  
pp. S46-S46
Author(s):  
O.J. Storebø ◽  
J. Stoffers-Winterling ◽  
J. Mattivi ◽  
B. Völlm ◽  
M.L. Kielsholm ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Borderline Personality ◽  
Current Evidence ◽  
Psychological Interventions ◽  
Short Term ◽  
Psychotherapeutic Interventions ◽  
Competing Interest

IntroductionBorderline personality disorder (BPD) is a common and disabling personality disorder associated with difficulties in controlling emotions and impulses, self-injury, feelings of emptiness and abandonment. It is associated with problems in many areas of life, most notably relationships. Psychotherapy is the first-line treatment for people with borderline personality disorder widely used; however, the evidence is not thoroughly investigated. In addition, several specific short-term interventions have been developed during the last decades.ObjectivesWe are currently updating this cochrane collaboration review on psychological interventions for BPD. First findings on the up-to-date evidence relating to short-term psychological interventions will be presented.MethodsWe conducted a cochrane systematic review and meta-analysis of randomized controlled trials (RCTs). Any randomized comparisons of psychological interventions versus unspecific control interventions, waitlist or specific psychotherapeutic interventions in adult BPD patients were eligible. Primary outcomes were BPD core pathology as depicted by DSM criteria. Secondary outcomes included depression, anxiety, general psychopathology, dropouts and adverse events. Two independent researchers selected trials, assessed quality and extracted data independently.ResultsThe current evidence of short-term psychological interventions in general and the different types of interventions for which RCT evidence is currently available will be evaluated.Disclosure of interestThe authors declare that they have no competing interest.

Trauma-related dissociation: Psychological features and psycho-physiological responses to script-driven imagery in borderline personality disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S764-S764
Author(s):  
D. Bichescu-Burian ◽  
S. Jürgen ◽  
S. Tilman ◽  
T. Stefan
Keyword(s):  
Heart Rate ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Clinical Symptoms ◽  
Clinical Status ◽  
Traumatic Events ◽  
Borderline Personality ◽  
Skin Conductance Responses ◽  
History Of ◽  
Competing Interest

BackgroundDefense reactions to threatening situations are vital adaptations to stress that protect organisms from injury and ensure survival. We retrospectively investigated the role of peritraumatic dissociation (PD) in the occurrence of severe psychopathology and dissociative patterns of reactions in borderline personality disorder (BPD).MethodsWe recruited 28 patients with a clinical diagnosis of BPD and 15 healthy controls. The BPD group was divided according to the level of PD (low vs. high): BPD and PD (n = 15) and BPD only (n = 13). We conducted an extensive investigation of history of trauma, clinical status, and measurements of emotional and physiologic responses to recall of personalized aversive experiences.ResultsParticipants with BPD and high PD displayed highest degrees of trauma exposure and clinical symptoms. Their significant heart rate decline during the imagery of personal traumatic events was opposed to the heart rate increases exhibited by the other two groups and may indicate a dissociative reaction pattern. Skin conductance responses did not differentiate between groups. Several emotional responses to imagery provided also support of the idea that PD may play a role in memory processing of traumatic events and thus in the aggravation and maintenance of symptoms in particularly severe forms of BPD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Reasons for Acute Psychiatric Admissions and Psychological Interventions for Patients with Borderline Personality Disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S71-S71
Author(s):  
N.P. Lekka ◽  
G. Carr ◽  
T. Gilpin ◽  
B. Eyo
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Significant Risk ◽  
Borderline Personality ◽  
Psychological Interventions ◽  
Nice Guidance ◽  
Icd 10 ◽  
Psychosocial Difficulties ◽  
Relationship Breakdown ◽  
Competing Interest

IntroductionNICE guidelines advise to consider admission for patients with borderline personality disorder (BPD) for the management of crises involving significant risk to self or others. Furthermore, to consider structured psychological interventions of greater than three months’ duration and twice-weekly sessions according to patients’ needs and wishes.ObjectivesWe aimed to assess reasons for admission and access to psychological interventions in an acute inpatient BPD population.MethodsCase notes of patients with a diagnosis of BPD (ICD-10 F60.3 and F60.31), discharged from four acute general adult wards in Sheffield during a period of twelve months were studied retrospectively, using a structured questionnaire based on BPD NICE guidance.ResultsOf the 83 identified BPD patients, seventy-eight percent were female and 82% between 16–45 years old. Eleven patients had four or more admissions. Eighty percent reported suicidal ideation at admission, with 50% having acted on it (70% by overdose, 50% cutting, 10% hanging). Of this cohort, 58% reported they intended to die. Psychosocial factors at admission were identified in 59 cases, including relationship breakdown (47.5%), alcohol/drug use (30.5%) and accommodation issues (17%). Disturbed/aggressive behaviour was documented in 27.1% of these cases. Sixty-eight percent of patients had psychology input in the 5 years preadmission: 38% (21 patients) received structured therapy, whilst 62% received only one assessment or advise to teams.ConclusionsPatients were mainly admitted for risk management. A high proportion received unstructured psychological interventions. Services offering structured psychological interventions should be supported, as hospitalisations only temporarily address BPD patients’ suicidality and psychosocial difficulties.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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