Psychotherapy still recommended as primary therapy for borderline personality disorder

The American Psychiatric Association has issued an updated version of its Practice Guideline for the Treatment of Patients with Borderline Personality Disorder. The 2005 update to the guidelines addressed the possibility of redefining the diagnostic cut-off point, or the minimum number of criteria that must be met

The guideline includes new data made available since the 2001 release of the previous version. Studies that have evaluated the utility of the five-factor model — through which patients must present with five of nine criteria in order to be diagnosed with borderline personality disorder (BPD) — now are included. According to recent studies, the use of this model may result in disparities among BPD populations. The 2005 update to the guidelines addressed the possibility of redefining the diagnostic cut-off point, or the minimum number of criteria that must be met.

The update also discussed the proliferation of studies that have suggested an overlap between BPD and bipolar II disorder, particularly given the benefit of mood-stabilizing medications to some BPD patients. The guideline concluded, however, that while these conditions may coexist, the bulk of current evidence indicates that BPD is a discrete diagnosis and not a milder form of a mood disorder.

In addition, while history of trauma is common in patients with BPD, the guideline states that BPD should be considered distinct from posttraumatic stress disorder. Potential associations between childhood ADHD and adult BPD diagnosis continue to be of interest, according to the guideline. While it is a commonly held belief that BPD is more prevalent in women, the updated guideline cited published studies suggesting that the condition is equally prevalent between sexes.

The updated guideline concurred with the 2001 version that psychotherapy remains the first-line treatment for this patient population. Adjunctive pharmacotherapy targeted to symptoms also is recommended. Dialectical behavior therapy (DBT) has been shown in some studies to be effective in treating BPD patients with comorbid substance abuse, although DBT does not appear to improve substance abuse.

Clinical trials have shown promise for several emerging psychotherapies in the treatment of BPD, including interpersonal therapy, cognitive therapy, cognitive analytic therapy (a combination of cognitive and psychodynamic treatments), and systems training for emotional predictability and problem solving. Transference-focused psychotherapy also has shown benefit vs. supportive psychotherapy in some ongoing studies.

Source: http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/bpd-watch.pdf