scholarly journals Metacognitive Reflection and Insight Therapy (MERIT): Application to a Long-Term Therapy Case of Borderline Personality Disorder

2018 ◽  
Vol 71 (4) ◽  
pp. 145-154 ◽  
Author(s):  
Kelly D. Buck ◽  
Mary Vertinski ◽  
Marina Kukla
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Term Therapy ◽  
Metacognitive Reflection ◽  
Long Term Therapy

Treatment and management of personality disorder

2020 ◽  
pp. 1247-1254
Author(s):  
Giles Newton-Howes ◽  
Roger Mulder
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Borderline Personality ◽  
Mood Stabilizers ◽  
Dopamine Antagonists ◽  
Term Therapy ◽  
Short Term ◽  
Long Term Therapy

The management of personality disorders remains a complex and challenging area, in which significant advances have been made to our understanding over the last two decades. As an increasing understanding of the diagnosis of personality disorder is recognized, our ability to understand what interventions could be of value continues to develop. The diagnosis of borderline personality disorder is where the most significant understanding has occurred. It is now clear that these disorders can be recognized early in development and treatment should be primarily psychological. Cognitive, dynamic, and educational approaches have been trialled and found to be effective. Further, pharmacotherapy is best considered for short-term, symptom-focused use, as opposed to long-term therapy. The evidence suggests dopamine antagonists and mood stabilizers are the drugs of choice. Identifying the needs and developing strategies to meet these provide greater benefit than focusing on risk.

Treatment selection in borderline personality disorder between dialectical behavior therapy and psychodynamic psychiatric management

2020 ◽  
pp. 1-9 ◽  
Author(s):  
John R. Keefe ◽  
Thomas T. Kim ◽  
Robert J. DeRubeis ◽  
David L. Streiner ◽  
Paul S. Links ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Behavior Therapy ◽  
Dialectical Behavior Therapy ◽  
Social Adjustment ◽  
Symptom Relief ◽  
Borderline Personality ◽  
Optimal Treatment ◽  
Long Term Outcomes

Abstract Background No evidence-based therapy for borderline personality disorder (BPD) exhibits a clear superiority. However, BPD is highly heterogeneous, and different patients may specifically benefit from the interventions of a particular treatment. Methods From a randomized trial comparing a year of dialectical behavior therapy (DBT) to general psychiatric management (GPM) for BPD, long-term (2-year-post) outcome data and patient baseline variables (n = 156) were used to examine individual and combined patient-level moderators of differential treatment response. A two-step bootstrapped and partially cross-validated moderator identification process was employed for 20 baseline variables. For identified moderators, 10-fold bootstrapped cross-validated models estimated response to each therapy, and long-term outcomes were compared for patients randomized to their model-predicted optimal v. non-optimal treatment. Results Significant moderators surviving the two-step process included psychiatric symptom severity, BPD impulsivity symptoms (both GPM > DBT), dependent personality traits, childhood emotional abuse, and social adjustment (all DBT > GPM). Patients randomized to their model-predicted optimal treatment had significantly better long-term outcomes (d = 0.36, p = 0.028), especially if the model had a relatively stronger (top 60%) prediction for that patient (d = 0.61, p = 0.004). Among patients with a stronger prediction, this advantage held even when applying a conservative statistical check (d = 0.46, p = 0.043). Conclusions Patient characteristics influence the degree to which they respond to two treatments for BPD. Combining information from multiple moderators may help inform providers and patients as to which treatment is the most likely to lead to long-term symptom relief. Further research on personalized medicine in BPD is needed.

scholarly journals Cognitive therapy v. usual treatment for borderline personality disorder: prospective 6-year follow-up

2010 ◽  
Vol 197 (6) ◽  
pp. 456-462 ◽  
Author(s):  
Kate M. Davidson ◽  
Peter Tyrer ◽  
John Norrie ◽  
Stephen J. Palmer ◽  
Helen Tyrer
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Repeated Measures ◽  
Linear Models ◽  
Randomised Trial ◽  
Behavioural Therapy ◽  
Borderline Personality ◽  
Treatment As Usual

BackgroundLonger-term follow-up of patients with borderline personality disorder have found favourable clinical outcomes, with long-term reduction in symptoms and diagnosis.AimsWe examined the 6-year outcome of patients with borderline personality disorder who were randomised to 1 year of cognitive–behavioural therapy for personality disorders (CBT–PD) or treatment as usual (TAU) in the BOSCOT trial, in three centres across the UK (trial registration: ISRCTN86177428).MethodIn total, 106 participants met criteria for borderline personality disorder in the original trial. Patients were interviewed at follow-up by research assistants masked to the patient's original treatment group, CBT–PD or TAU, using the same measures as in the original randomised trial. Statistical analyses of data for the group as a whole are based on generalised linear models with repeated measures analysis of variance type models to examine group differences.ResultsFollow-up data were obtained for 82% of patients at 6 years. Over half the patients meeting criteria for borderline personality disorder at entry into the study no longer did so 6 years later. The gains of CBT–PD over TAU in reduction of suicidal behaviour seen after 1-year follow-up were maintained. Length of hospitalisation and cost of services were lower in the CBT–PD group compared with the TAU group.ConclusionsAlthough the use of CBT–PD did not demonstrate a statistically significant cost-effective advantage, the findings indicate the potential for continued long-term cost-offsets that accrue following the initial provision of 1 year of CBT–PD. However, the quality of life and affective disturbance remained poor.

scholarly journals Conceptual Development and Case Data for a Modular, Personality-Based Treatment for Borderline Personality Disorder

2021 ◽  
Author(s):  
Shannon Sauer-Zavala ◽  
Matthew W. Southward ◽  
Caitlyn O. Hood ◽  
Sohayla Elhusseini ◽  
Martina Fruhbauerova ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Conceptual Development ◽  
Modular Design ◽  
Theoretical Background ◽  
Borderline Personality ◽  
Conceptual Background ◽  
Pre Treatment ◽  
Case Data

Borderline personality disorder (BPD) is a heterogenous condition and variations in its presentation may be accounted for by individual differences in personality dimensions. Extant treatments for BPD are long-term and intensive; it is possible that prioritizing the personality-based difficulties that underlie an individual’s symptoms may improve the efficiency of care. This manuscript describes the conceptual background for the development of a novel, personality-based intervention for BPD (BPD Compass) informed by recent research on personality mechanisms maintaining this condition to address gaps left by existing treatments and be maximally efficient and disseminable. BPD Compass is a comprehensive, short-term package with a fully modular design that allows for personalization (e.g., all skills can be presented in isolation or in any order based on pre-treatment assessment). We discuss the theoretical background for its development, an overview of the skills included in the treatment, as well as preliminary efficacy data.

Missed diagnosis: The emerging crisis of borderline personality disorder in older people

2016 ◽  
Vol 50 (12) ◽  
pp. 1139-1145 ◽  
Author(s):  
Josephine Beatson ◽  
Jillian Helen Broadbear ◽  
Hemalatha Sivakumaran ◽  
Kuruvilla George ◽  
Eli Kotler ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Older People ◽  
Old Age ◽  
The Elderly ◽  
Aged Care ◽  
Borderline Personality ◽  
Long Term Follow Up ◽  
Maladaptive Behaviours

Objective: Clinical experience suggests a growing prevalence of borderline personality disorder in aged residential care and psychiatric facilities with attendant difficulties in their management. This paper reviews the literature concerning the prevalence, phenomenology and diagnosis of borderline personality disorder in old age. The aim is to elucidate the phenomenological differences in old age and thus improve identification of the disorder. Methods: A systematic search was conducted using MEDLINE, PubMed, EMBASE and PsycINFO databases, employing the search terms including ‘personality disorder’, ‘borderline personality disorder’, ‘aged care’, ‘gerontology’, ‘geriatric psychiatry’ and ‘life span’. The search included articles in English involving participants 65+ years. Long-term prospective studies of borderline personality disorder, long-term follow-up studies and studies involving older adults from 50+ years were also examined. Results: There is a paucity of literature on borderline personality disorder in the elderly. No diagnostic or rating instruments have been developed for borderline personality disorder in the elderly. The phenomenology of borderline personality disorder in the aged population differs in several respects from that seen in younger adults, causing some of the difficulties in reaching a diagnosis. Escalations of symptoms and maladaptive behaviours usually occur when the diagnosis of borderline personality disorder is either not made or delayed. Improved identification of borderline personality disorder in older patients, together with staff education concerning the phenomenology, aetiology and management of these patients, is urgently needed. Conclusion: Diagnostic instruments for borderline personality disorder in the elderly need to be developed. In the interim, suggestions are offered concerning patient symptoms and behaviours that could trigger psychiatric assessment and advice concerning management. A screening tool is proposed to assist in the timely diagnosis of borderline personality disorder in older people. Timely identification of these patients is needed so that they can receive the skilled help, understanding and treatment needed to alleviate suffering in the twilight of their lives.

“Abandonment Psychotherapy” for Suicidal Patients with Borderline Personality Disorder: Long-Term Outcome

2017 ◽  
Vol 86 (5) ◽  
pp. 311-313 ◽  
Author(s):  
Yvonne Burnand ◽  
Antonio Andreoli ◽  
Laura Frambati ◽  
Donna Manning ◽  
Alessandra Canuto ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Suicidal Patients

Low Vocational Outcome Among People Diagnosed With Borderline Personality Disorder During First Admission to Mental Health Services in Denmark: A Nationwide 9-Year Register-Based Study

2019 ◽  
Vol 33 (3) ◽  
pp. 326-340 ◽  
Author(s):  
Lene Halling Hastrup ◽  
Mickey T. Kongerslev ◽  
Erik Simonsen
Keyword(s):  
Mental Health ◽  
Labor Market ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mental Health Services ◽  
Health Services ◽  
Borderline Personality ◽  
Vocational Outcome ◽  
First Admission

Earlier studies report that although people with borderline personality disorder (BPD) experience symptom reduction in the long term, they continue to have difficulties in work recovery. This nationwide 9-year register-based study (N = 67,075) investigated the long-term labor-market attachment of all individuals diagnosed with BPD during first admission to Danish mental health services in comparison with other psychiatric disorders. Controlling for baseline characteristics and co-occurring secondary psychiatric diagnoses, the BPD group had 32% lower odds (OR = 0.68; 95% CI [0.61, 0.76]) of being in work/under education after 9 years. Individuals diagnosed with BPD also showed more impairment in long-term vocational outcome than other personality disorders, and lower labor-market attachment than other psychiatric disorders except for schizophrenia, schizotypal and delusional disorders, and mental and behavioral disorders due to psychoactive substance use. Intervention programs addressing social psychiatric aspects of BPD in terms of work functioning is henceforth an important area for future research.

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