Developments in Diagnosis and Treatment of People With Borderline Personality Disorder

Sathya Rao; Parvaneh Heidari; Jillian H. Broadbear

Disclosures

Curr Opin Psychiatry. 2020;33(5):441-446. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: Borderline personality disorder (BPD) attracts significant attention from clinicians and researchers alike. Despite increased recognition and willingness to diagnose BPD, most effective treatment approaches remain inaccessible to most. We consider recent developments in the diagnosis and treatment of BPD.

Recent Findings: A literature search of EMBASE and PsychINFO, using the search terms 'borderline personality disorder,' 'diagnosis' and 'treatment' for publications since October 2018, yielded over 300 articles and reviews. The literature highlights the increasing awareness of the diagnostic complexity of BPD as well as the emerging significance of 'common factors' and stepped care approaches for managing and treating the disorder.

Summary: Clinical practice is evolving to embrace more holistic diagnostic approaches, generalist treatment frameworks and stepped-care models that can be tailored to fit individual needs and service resources. The new frontiers in this field include expansion of timely treatment options, improved knowledge regarding the expression and management of BPD in men, adolescents and the elderly, and bridging cultural divides to create a worldwide population approach.

Introduction

Borderline personality disorder (BPD) is a complex and severe mental illness that causes significant distress to patients, families and communities. Clinicians treating BPD may also experience adverse emotional reactions. BPD, a highly stigmatized disorder, results in frequent utilization of health services and carries prominent risks of morbidity and mortality.

BPD may embody the Hysteria diagnosis of our times. Like hysteria, BPD is not a good 'fit' within current psychiatric nosology, defying diagnostic conceptualizations and epitomizing the challenges and dilemmas of contemporary psychiatry. It is notable that Hysteria shaped the origin of BPD, which debuted in diagnostic and statistical manual of mental disorders (DSM)-3 in 1980.

In recent decades, a small group of committed researchers has advanced the science of BPD. Their work has vastly improved our understanding of the disorder and led to the development of effective psychotherapeutic treatments, instilling hope amongst patients, inspiring many clinicians to treat BPD and researchers to investigate additional treatment approaches. The evidence shows that most patients with BPD can achieve symptom remission with BPD-specific psychological treatments; some achieve recovery. Pharmacological intervention for BPD is still in its infancy, focusing primarily on psychotropics indicated for other psychiatric disorders; no novel medications have been developed for treating BPD.

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