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      What Works in the Treatment of Borderline Personality Disorder

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          Abstract

          Purpose of the Review

          This review summarizes advances in treatments for adults with borderline personality disorder (BPD) in the last 5 years.

          Recent Findings

          Evidence-based advances in the treatment of BPD include a delineation of generalist models of care in contrast to specialist treatments, identification of essential effective elements of dialectical behavioral therapy (DBT), and the adaptation of DBT treatment to manage post-traumatic stress disorder (PTSD) and BPD. Studies on pharmacological interventions remain limited and have not provided evidence that any specific medications can provide stand-alone treatment.

          Summary

          The research on treatment in BPD is leading to a distillation of intensive packages of treatment to be more broadly and practically implemented in most treatment environments through generalist care models and pared down forms of intensive treatments (e.g., informed case management plus DBT skills training groups). Evidence-based integrations of DBT and exposure therapy for PTSD provide support for changing practices to simultaneously treat PTSD and BPD.

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          Most cited references31

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          Borderline personality organization.

          O Kernberg (1967)
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            Dialectical behavior therapy for binge eating disorder.

            This study evaluated the use of dialectical behavior therapy (DBT) adapted for binge eating disorder (BED). Women with BED (N = 44) were randomly assigned to group DBT or to a wait-list control condition and were administered the Eating Disorder Examination in addition to measures of weight, mood, and affect regulation at baseline and posttreatment. Treated women evidenced significant improvement on measures of binge eating and eating pathology compared with controls, and 89% of the women receiving DBT had stopped binge eating by the end of treatment. Abstinence rates were reduced to 56% at the 6-month follow-up. Overall, the findings on the measures of weight, mood, and affect regulation were not significant. These results support further research into DBT as a treatment for BED.
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              BPD's interpersonal hypersensitivity phenotype: a gene-environment-developmental model.

              This paper explores the development of BPD as it might emerge in the child's early interpersonal reactions and how such reactions might evolve into the interpersonal pattern that typifies BPD. It begins to bridge the relevant bodies of clinical literature on the borderline's prototypic interpersonal problems with the concurrently expanding relevant literature on early child development. We will start by considering how a psychobiological disposition to BPD is likely to include a constitutional diathesis for relational reactivity, that is, for hypersensitivity to interpersonal stressors. Data relevant to this disposition's manifestations in adult clinical samples and to its heritability and neurobiology will be reviewed. We then consider how such a psychobiological disposition for interpersonal reactivity might contribute to the development of a disorganized-ambivalent form of attachment, noting especially the likely contributions of both the predisposed child and of parents who are themselves predisposed to maladaptive responses, leading to an escalation of problematic transactions. Evidence concerning both the genetics and the developmental pathways associated with disorganized attachments will be considered. Emerging links between such developmental pathways and adult BPD will be described, in particular the potential appearance by early- to middle-childhood of controlling-caregiving or controlling-punitive interpersonal strategies. Some implications from this gene-environment interactional theory for a better developmental understanding of BPD's etiology are discussed.
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                Author and article information

                Contributors
                lchoikain@partners.org
                Journal
                Curr Behav Neurosci Rep
                Curr Behav Neurosci Rep
                Current Behavioral Neuroscience Reports
                Springer International Publishing (Cham )
                2196-2979
                3 February 2017
                3 February 2017
                2017
                : 4
                : 1
                : 21-30
                Affiliations
                [1 ]ISNI 0000 0000 8795 072X, GRID grid.240206.2, Harvard Medical School, , McLean Hospital, ; 115 Mill St., Mail Stop 312, Belmont, MA 02478 USA
                [2 ]ISNI 0000 0000 8795 072X, GRID grid.240206.2, Massachusetts General Hospital, , McLean Hospital, ; Belmont, MA 02478 USA
                Article
                103
                10.1007/s40473-017-0103-z
                5340835
                28331780
                9157fd79-8a3e-473c-a4fe-58bad5efc126
                © The Author(s) 2017

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Categories
                Personality and Impulse Control Disorders (R Lee, Section Editor)
                Custom metadata
                © Springer International Publishing AG 2017

                borderline personality disorder,psychotherapy,general psychiatric management,dialectical behavior therapy,mentalization-based treatment,transference-focused psychotherapy,schema-focused therapy

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