Treatments for Borderline Personality Disorder

Individuals with Borderline Personality Disorder (BPD) often receive mental health treatment with the benefits shown for the use of psychotherapy (NCCMH, 2009; Peris, 2009; NHMRC, 2012) and to a lesser degree psychoeducation (Zanarini & Frankenburg, 2008). Although receiving treatment, not all individuals with BPD presenting to health services receive the benefit of psychotherapy or psychoeducation due to a number of extenuating circumstances. The complexity of BPD, suicide risk, BPD stigma, under resourced mental health services, limited access to specialised training for mental health professionals and a lack of consensus in the mental health sector as to where and how to best provide treatment can impede access to focused and effective psychological interventions.

Dialectical Behaviour Therapy (Van den Bosch et al., 2005; Linehan et al., 2006; Clarkin et al., 2007) is an evidence-based, cognitive-behavioural treatment that has been empirically proven to be effective in helping people to regulate emotions and improving interpersonal effectiveness and distress tolerance skills. Other psychological interventions to have shown improvement, in individuals with BPD, when applied include: Cognitive Behavioural Therapy (Blum et al., 2008; Davidson et al., 2011), Metallization-Based Treatment (Bateman & Fonagy, 2008; Bateman & Fonagy, 2009), Cognitive Analytic Therapy (Thompson et al., 2008), Group Therapy (Husband et al., 2007), Schema-Focused Therapy (Ball et al., 2011) and Psychotherapies (De Maat, De Jonghe, Schoevers & Dekker, 2009; Doering et al., 2010).

The Australian DBT Institute provides leadership to the mental health sector in the application of DBT and modified DBT programs for specific populations that include youth, Indigenous Australians, correctional settings and psychiatric emergency settings. The Australian DBT Institute gives consumers & carers the confidence that accredited DBT programs apply treatment in an evidence-based manner that emphasises clinical outcomes and results.

References:

Ball, S.A., MacCarelli, L.M., Lapaglia, D.M., & Ostrowski, M.J. (2011). Randomized trial of dual-focused vs. single-focused individual therapy for personality disorders and substance dependence. Journal of Nervous and Mental Disease, 199, 319-328.

Bateman, A., & Fonagy, P. (2008). 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. American Journal of Psychiatry, 165, 631-638.

Bateman, A., & Fonagy, P. (2009). Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. American Journal of Psychiatry, 166, 1355-1364.

Blum, N., St John, D., Pfohl, B., Stuart, S., McCormick, B. et al. (2008). Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up. American Journal of Psychiatry, 165, 468-478. 

Clarkin, J.F., Levy, K.N., Lenzenweger, M.F., & Kernberg, O.F. (2007). Evaluating three treatments for borderline personality disorder: a multiwave study. The American Journal of Psychiatry, 164, 922-928.

de Maat, S., de Jonghe, F., Schoevers, R., & Dekker, J. (2009). The effectiveness of long-term psychoanalytic therapy: a systematic review of empirical studies. Harvard Review Psychiatry, 17, 1-23.

Doering, S., Horz, S., Rentrop, M., Fischer-Kern, M., Schuster, P. et al. (2010). Transferencefocused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. British Journal of Psychiatry, 196, 389-395

Huband, N., Duggan, C., Evans, C., et al (2007) Social problem-solving plus psychoeducation for adults with personality disorder. Pragmatic randomised controlled trial. British Journal of Psychiatry, 190, 307– 313.

Krawitz, R., & Watson, C. (2000). Borderline personality. Foundations of treatment. Henley Beach, Australia: Seaview Press.

Lenzenweger, M., Lane, M., Loranger, A., & Kessler, R. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62, 553-564.

Linehan, M.M., Comtois, K.A., Murray, A.M., Brown, M.Z., Gallop, R.J. et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry, 63, 757-766.

National Collaborating Centre for Mental Health (2009). Borderline personality disorder: treatment and management. National clinical practice guideline number 78. Leicester: The British Psychological Society and The Royal College of Psychiatrists.

National Health and Medical Research Council (2012). Clinical practice guideline for the management of borderline personality disorder in Australia: Public Consultation Draft. Melbourne: National Health and Medical Research Council. Retrieved May 1, 2012 from http://consultations.nhmrc.gov.au/files/consultations/drafts/draftclinicalpracticeguidelineforthemanagementofborderlinepersonalitydisorder.pdf

Paris, J. (2009). The treatment of borderline personality disorder: implications of research on diagnosis, etiology, and outcome. Annual Review of Clinical Psychology, 5, 277.

Thompson, A.R., Donnison, J., Warnock-Parkes, E., Turpin, G., Turner, J., & Kerr , I.B. (2008). Multidisciplinary community mental health team staff’s experience of a ‘skills level’ training course in cognitive analytic therapy. International Journal of Mental Health Nursing, 17, 131-137.

Zanarini, M.C., & Frankenburg, F.R. (2008). A preliminary, randomized trial of psychoeducation for women with borderline personality disorder. Journal of Personality Disorders, 22, 284.

van den Bosch, L.M., Koeter, M.W., Stijnen, T., Verheul, R., & van den Brink, W. (2005) Sustained efficacy of dialectical behaviour therapy for borderline personality disorder. Behav Res Ther, 43(9), 1231-41.