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Borderline Personality Disorder (BPD)

Treatments

Pharmacological Therapy/Psychotherapy

Treatment Summary: Because Borderline is such a difficult personality disorder to treat and often comorbid with other personality disorders which also makes proper diagnosis difficult a variety of methods have been explored in order to treat this disorder. It has been found through many trials that drugs are only moderately effective on their own. Many therapeutic models and techniques have been employed in order to treat BPD. In the Harvard Mental Health Letter (2010) the authors name four methods of therapy that are proving to be effective with this particularly difficult disorder.

  • Reference: The Treatment of Borderline Personality Disorder. Harvard Mental Health Letter; Jun 2010, Vol. 26 Issue 12, p1-3, 3p © 2010 Harvard University
  • Submitter: N/A

Dialectical therapy

Treatment Summary: The focus here is problem solving and relaxations techniques

  • Reference: The Treatment of Borderline Personality Disorder. Harvard Mental Health Letter; Jun 2010, Vol. 26 Issue 12, p1-3, 3p © 2010 Harvard University
  • Submitter: N/A

Schema-Focused Therapy

Treatment Summary: The belief is that the patient has bpd because they hold to faulty "schemas." The goal here is to redirect their cognitive focus to a healthy "schema."

  • Reference: The Treatment of Borderline Personality Disorder. Harvard Mental Health Letter; Jun 2010, Vol. 26 Issue 12, p1-3, 3p © 2010 Harvard University
  • Submitter: N/A

Transference-Focused Therapy:

Treatment Summary: Using aspects of psycho-dynamic theories of transference/counter-transference the therapist and patient seek to understand dynamics of past relationships and associated emotions.

  • Reference: The Treatment of Borderline Personality Disorder. Harvard Mental Health Letter; Jun 2010, Vol. 26 Issue 12, p1-3, 3p © 2010 Harvard University
  • Submitter: N/A

Mentalization-Based Treatment (MBT):

Treatment Summary: MBT or structured clinical management showed positive results in reducing the psychotic (including suicidal gesture/attempt) behavior in patients.

  • Reference: The Treatment of Borderline Personality Disorder. Harvard Mental Health Letter; Jun 2010, Vol. 26 Issue 12, p1-3, 3p © 2010 Harvard University
  • Submitter: N/A

Dynamic Deconstructive Psychotherapy (DDP)

Treatment Summary: DDP emphasizes growth in three neurocognitive skills: Association. Association is the ability to comprehend emotional experiences and to differentiate one emotion from another. DDP requires the client reflect on an interpersonal exchange and to organize his or her emotions into a narrative. The narrative includes their intent for the conversation, the replies received from others, their response to replies, and emotions felt. The client reads back their narrative to the therapist; this leads to reflection and a better understanding of their emotions (Goldman and Gregory, 2010). Attribution. Attribution is the ability to grasp the complexity of emotions, intentions, and motivations. Clients with BPD normally struggle with ambiguity and see things as "black and white." Attribution is increased when the client repeats their narrative to the therapist who challenges assumptions of "black and white" thinking (Goldman and Gregory, 2010). Alterity. Alterity is the ability to view one's actions objectively. Initially the therapist adopts an "ideal other" posture, agreeing with the client's conclusions about interpersonal actions. Gradually, the therapist becomes a "real other" who interprets the client's actions objectively. By modeling alterity, the client gains insight into how to interpret and challenge their assumptions (Goldman and Gregory, 2010). By increasing association, attribution, and alterity the client will learn how to rethink and revise the actions they choose and the conclusions that they draw.

  • Reference: Goldman, G., & Gregory, R. (2010). Relationships Between Techniques and Outcomes for Borderline Personality Disorder. American Journal of Psychotherapy, 64, 359-371
  • Submitter: Donald Ehrke

Dialectical behavior therapy (DBT)

Treatment Summary: It is interesting to note that Borderline Personality is a bit of a misnomer because it was originally called that because of the thinking that it is on the edge between psychosis and neurosis. This has been re-evaluated and the understanding is that basically BPD is the instability in emotions in interpersonal relationships and is sometimes called Emotionally unstable personality disorder. According to Grohol (2014) Dialectical behavior therapy (DBT) was developed by Marsha Linehan and is described as the approach that gets the best results in treatment for BPD. Gill and Warburton (2014) say that DBT is based on the Biosocial model of Borderline Personality Disorder, which states that there is a strong connection between how one is raised by parents and his/her emotional make-up as a child. The disruption from this connection leads to traits for borderline behavior to develop. Gill and Warburton (2014) tested this theory to see if there was really a correlation between these two forces. They stated that the results were less than conclusive in proving that parenting that is not affirming to a child and the child's uncertain emotional state leads to abnormal emotional development. In this treatment the person with this disorder is taught to get a handle on his/her life by learning to control emotions, knowing more about himself/herself and rearranging thought processes. It is often used in group therapies to attain the results that are necessary in dealing with BPD.

  • Reference: Gill, D. & Warburton, W. (2014). An Investigation of the Biosocial Model of Borderline Personality Disorder. Journal Of Clinical Psychology, 70(9), 866-873. Grohol, J., (2014). Borderline personality disorder treatment. In Psych Central. Retrieved from http://psychcentral.com/lib/borderline-personality-disorder treatment/0001065
  • Submitter: Ben Ray

Cognitive Therapy

Treatment Summary: Patients with Borderline Personality Disorder, BPD, are characterized by dysfunctional beliefs and distorted perceptions that appear to be inflexable such as extreme emotional and behavioral reactions, angry outbursts, impulsive behavior, and/or severe and sudden symptoms of anxiety and depression. Cognitive Therapy, CT, gives the patient tools to identify and evaluate these distorted perceptions in hopes that a realistic appraisal of one's circumstances will reduce the severity of the patient's distress. A change in the dysfunctional belief is the target of the cognitive therapy associated with BPD.

  • Reference: Wenzel, A., Chapman, J. E., Newman, C. F., Beck, A. T., & Brown, G. K. (2006). Hypothesized mechanisms of change in cognitive therapy for borderline personality disorder. Journal of Clinical Psychology, 62(4), 503-516.
  • Submitter: N/A

Mentalization-based Treatment

Treatment Summary: Borderline personality disorder (BPD) is a challenge to treat not only because it is complicated and stigmatized, but also because its symptoms reflect ingrained patterns of thinking and behavior. Although it is heterogeneous in nature, causing different clusters of symptoms in different people, the disorder has three major clinical components: a fragile sense of self that impairs relationships with other people, impulsiveness, and emotional volatility. Many patients with BPD also have other mental health problems, such as a mood disorder or post-traumatic stress disorder. Drugs may be moderately helpful at reducing particular symptoms, such as depression or anxiety, but they do not address core personality traits and behaviors. As such, psychotherapy remains the mainstay of treatment for patients with BPD, although there is no "one-size-fits-all" treatment. Dialectical behavior therapy is probably the most common psychotherapy used for BPD, but other options have emerged over the past decade. A review of four psychotherapies concluded that all were equally effective overall, but that each had specific advantages. As such, clinicians and patients can decide on an individual basis which treatment is most appropriate. The impact of BPD extends well beyond the individual patient, causing suffering in family members as well. Loved ones like, therapists, may struggle with how to respond constructively to a patient's volatile moods and demands. For that reason, family members may also benefit from psychotherapy. Mentalization-based treatment: This therapy, developed by Drs. Peter Fonagy and Anthony Bateman, psychologists at the University of London, is based on the premise that patients with BPD suffer from difficulties in their ability to "mentalize" or develop a mental picture of the emotions, feelings, or beliefs of themselves and others. A long-term study reported that mentalization-based treatment reduced antipsychotic use and the number of suicide attempts, and increased chances of recovery five years after completing treatment (see Harvard Mental Health Letter, April 2009). Because the investigators conducted their initial research in a partial hospital setting, they conducted a separate study in an outpatient setting. In an 18-month study, they randomly assigned 134 patients with BPD to mentalization-based treatment or structured clinical management (consisting of case management, supportive counseling, and problem-solving sessions). Although patients in both interventions improved significantly (as measured by a decrease in suicide attempts, hospitalizations, and other crisis events), those assigned to mentalization-based treatment improved substantially more than those receiving structured clinical management.

  • Reference: Borderline personality disorder: Origins and symptoms. (cover story). (2006). Harvard Mental Health Letter, 22(12), 1-3. Retrieved February 25, 2011, from https://zeus.tarleton.edu Treating borderline personality disorder. (2010). Harvard Mental Health Letter, 26(12), 1. Retrieved February 25, 2011, from https://zeus.tarleton.edu
  • Submitter: Roderick D. Swanson