Abstract

Borderline Personality Disorder (BPD) has emerged into widespread recognition as a highly disabling condition that is prevalent in clinical populations. An evidence-based practice guideline has been developed for treatment of patients with BPD, and research is clarifying the neurobiology and phenomenology of the disorder. Heritable endophenotypes such as affective instability and impulsive aggression may underlie an array of symptom patterns, a dimensional trait-based approach that could lead to enhanced understanding of this disorder.  Psychotherapy itself, the evidence-based primary recommended treatment, is now known to be correlated with biological changes in the brain at the neuromolecular level, shedding light on the mechanism of action of this therapeutic form of learning and memory. Longitudinal studies have clarified that our current defining criteria of BPD may need to be unpacked and segregated into at least two categories: relatively stable traits, and episodic self-injurious behaviors or symptoms that are sensitive to environmental circumstances.

Abstract

The American Psychiatric Association Practice Guidelines issued in 2001 suggested that a combination of psychotherapy and medication would be the optimal treatment approach to borderline personality disorder. In the last six years since the appearance of the Guidelines, much greater information is available to guide clinicians in the implementation of a treatment plan. Data demonstrating efficacy from randomized controlled trials suggest that several psychotherapeutic strategies are useful: 1) Dialectical Behavior Therapy, 2) Mentalization-Based Therapy, 3) Transference-Focused Psychotherapy, 4) Schema-Focused Therapy, and 5) Supportive Psychotherapy. These psychotherapies will be outlined and discussed in terms of clinical usefulness, and the data stemming from the studies will be critiqued. A number of medications have been shown to be efficacious in placebo-controlled randomized trials. These medications can be applied according to symptom clusters and algorithms, and will be illustrated and discussed.