scholarly journals Evidence-Based Psychodynamic Therapies for the Treatment of Patients With Borderline Personality Disorder

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Svenja Taubner ◽  
Jana Volkert
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Evidence Base ◽  
Borderline Personality ◽  
Drop Out ◽  
Evidence Based ◽  
Differential Indication ◽  
Psychoanalytic Treatment ◽  
Drop Out Rates ◽  
Psychodynamic Therapies

Borderline Personality Disorder (BPD) is a serious health issue associated with a high burden for the individual and society. Among the “Big Four” of evidence-based treatments for patients with BPD are two psychodynamic therapies that have evolved from classic psychoanalytic treatment with a change of setting and change of focus: Transference-Focused Psychotherapy (TFP) and Mentalization-Based Treatment (MBT). This overview provides a comparison of the two treatments in terms of stance, clinical concepts, costs and key interventions. Furthermore, the current literature on the efficacy of both treatments is reviewed. While TFP focuses on the content of disintegrated representations of self and other, MBT focuses on the processing of mental states. Both treatments diverge in their clinical concepts and interventions for the treatment of BPD. Although both treatments are regarded as effective in treating BPD, no direct comparison of both treatments has been made so far. Future studies are needed to investigate mechanisms of change and derive recommendations for a differential indication. Specialized therapies for BPD have favorable drop-out rates and outcome compared to non-specialized ones. MBT and TFP have very diverse clinical concepts and interventions for the treatment of BPD. Both, MBT and TFP show efficacy in RCTs. No trial has directly compared MBT and TFP; there is no evidence base for differential indication. Specialized therapies for BPD have favorable drop-out rates and outcome compared to non-specialized ones. MBT and TFP have very diverse clinical concepts and interventions for the treatment of BPD. Both, MBT and TFP show efficacy in RCTs. No trial has directly compared MBT and TFP; there is no evidence base for differential indication.

Personality Disorders

2018 ◽  
Author(s):  
Carla Sharp ◽  
Jared D. Michonski
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Dialectical Behavior Therapy ◽  
Evidence Base ◽  
Borderline Personality ◽  
Evidence Based ◽  
Assessment And Treatment ◽  
Literature Base ◽  
Vantage Points ◽  
Robust Evidence

The current chapter considers personality disorder in adolescents. In keeping with the evidence-based approach taken in this volume, the focus is on adolescent borderline personality disorder (BPD), as BPD currently has the most robust evidence base in terms of assessment and treatment in adolescents. While understudied relative to other disorders of childhood and adolescents, the current chapter summarizes the nascent, but rapidly growing, literature base for the definition, prevalence, assessment, and intervention of BPD in adolescents. Assessment and intervention are considered from the vantage points of both the leading treatment approaches to BPD, namely, dialectical behavior therapy and mentalization-based treatment. The chapter concludes with a discussion of the next frontier for BPD research in adolescents.

scholarly journals Evidence-based psychological interventions for borderline personality disorder in the United Kingdom—who falls through the gaps?

2021 ◽  
Vol 5 (2) ◽  
pp. 148-167
Author(s):  
Kirsten Barnicot
Keyword(s):  
United Kingdom ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Evidence Base ◽  
Borderline Personality ◽  
Psychological Interventions ◽  
Evidence Based ◽  
Post Traumatic Stress ◽  
Treatment Pathways ◽  
The United Kingdom

Over the past fifteen years, access to evidence-based psychological interventions (EBPIs) for borderline personality disorder has dramatically increased in the United Kingdom. However, some patients continue to fall through the gaps. This article presents a novel analysis of evidence on patients who are currently unable to benefit from EBPIs and explores possible solutions, with particular reference to dialectical behaviour therapy and mentalization-based therapy. At one end of the spectrum, patients with less severe difficulties often do not meet the threshold for receiving EBPIs in dedicated personality disorder services. The nascent evidence base for a possible solution—implementation of streamlined versions of EBPIs in generic mental health or even primary care services—is reviewed. At the other end, a sizeable minority of patients receiving long-term EBPIs discontinue treatment prematurely and/or experience poor outcomes. This is a highly distressing experience with potential for iatrogenesis—yet the evidence base for what to do next is non-existent and follow-on treatment pathways in services are unclear. Difficulties in the therapeutic alliance, a failure to overcome epistemic hypervigilance, and therapist non-adherence to the model are reviewed as possible contributing factors. The importance of understanding the patient perspective on what happened, considering the role of both patient and therapist in contributing to difficulties, and offering patients a choice in specifying their onward treatment, is discussed. Finally, increasing access to trauma-focused EBPIs for post-traumatic stress disorder is recommended as an avenue for the future.

Assessing, Managing, and Resolving Suicide Risk in Borderline Personality Disorder

2017 ◽  
Author(s):  
Adam Carmel ◽  
Jeffrey Sung ◽  
Katherine Anne Comtois
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Suicide Risk ◽  
Treatment Strategies ◽  
Evidence Base ◽  
Borderline Personality ◽  
Evidence Based ◽  
Theoretical Approaches ◽  
Difficult Time ◽  
Suicidal Patients

The aim of this chapter is to aid the clinician in managing and resolving suicidality by providing an overview of different theoretical approaches to conceptualizing, assessing, managing, and treating suicidal behaviors in borderline personality disorder (BPD). After a brief introduction to the evidence base for these treatments, the suicide risk management and treatment strategies are examined for five evidence-based psychotherapies designed for BPD. Psychotherapies for suicidal patients in general (not specific to BPD) are also considered. Finally, conclusions drawn from comparing and contrasting these psychotherapies focus on key themes to improve clinicians’ approach to patients with BPD at their most difficult time.

Access to Evidence-Based Services for Individuals With Borderline Personality Disorder

2019 ◽  
pp. 155-176
Author(s):  
Peter King ◽  
Jennifer M. Martin
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Sexual Assault ◽  
Treatment Outcomes ◽  
Psychological Factors ◽  
Borderline Personality ◽  
Evidence Based ◽  
International Literature ◽  
High Prevalence ◽  
Key Features

This chapter outlines the key features of the diagnosis of borderline personality disorder. This is a diagnosis that has attracted significant levels of stigma and has generally been viewed as difficult to treat. This has resulted in often inadequate service responses for people experiencing high levels of distress. Increased understanding is facilitated by exploring precipitating factors leading to this diagnosis, including invalidating and often traumatizing environments. Available evidence from Australian and international literature is considered, with main treatments identified to inform improved treatment outcomes. The need for attention to biological, psychological factors is highlighted and in particular acknowledgment of the high prevalence of trauma, particularly childhood sexual assault, amongst the mostly women who are given this diagnosis.

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.

Generalist psychiatric treatments for borderline personality disorder: the evidence base and common factors

2015 ◽  
Author(s):  
Anthony W. Bateman ◽  
Roy Krawitz
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Clinical Management ◽  
Clinical Care ◽  
Relevant Literature ◽  
Common Factors ◽  
Evidence Base ◽  
Borderline Personality ◽  
Outcome Studies ◽  
Supportive Psychotherapy

Chapter 2 discusses generalist psychiatric treatments for borderline personality disorder (BPD). It introduces the rationale for seeking common factors in treatment and provide a brief overview of some relevant literature, outlines the four generalist treatments that have been shown to be effective (structured clinical management (SCM), general psychiatric management (GPM), good clinical care (GCC), and supportive psychotherapy (SP)), describes the outcome studies of the four treatments, and reviews commonalities of the treatments.

Naturalistic Outcomes of Evidence-Based Therapies for Borderline Personality Disorder at a University Clinic

2013 ◽  
Vol 61 (3) ◽  
pp. 578-584 ◽  
Author(s):  
Shilpa Sachdeva ◽  
Gregory Goldman ◽  
Georgian Mustata ◽  
Evan Deranja ◽  
Robert J. Gregory
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Evidence Based
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