Guideline Watch: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder

Abstract

Since the 2001 publication of APA's Practice Guideline for the Treatment of Patients With Borderline Personality Disorder (1), more studies have been published on borderline personality disorder (BPD) than on any other personality disorder (2, 3). New analyses of the validity of the DSM-IV-TR criteria-defined construct of BPD have been published, new data on the prevalence of BPD are available, risk factors for and biological characteristics of BPD are being elucidated, and new studies on the treatment of BPD have been carried out. This guideline watch highlights the most important of these developments. DEFINITION, DIAGNOSTIC STABILITY, AND LONGITUDINAL COURSE Definition With an eye toward DSM-V, careful examination of axis II is occurring. This has, in part, included comparing the relative merits of categorical systems such as DSM-IV-TR and dimensional systems such as the five-factor model (4). This debate is as yet unresolved. However, recent studies have analyzed the nine DSM-IV criteria that define BPD and have concluded that, as defined, BPD appears to reflect a statistically coherent construct (5, 6). Utilization of a polythetic system requiring five out of nine criteria to make a categorical BPD diagnosis inevitably results in extensive heterogeneity within and between BPD populations being treated The American Psychiatric Association (APA) practice guidelines are developed by expert work groups using an explicit methodology that includes rigorous review of available evidence, broad peer review of iterative drafts, and formal approval by the APA Assembly and Board of Trustees. APA practice guidelines are intended to assist psychiatrists in clinical decision making. They are not intended to be a standard of care. The ultimate judgment regarding a particular clinical procedure or treatment plan must be made by the psychiatrist in light of the clinical data presented by the patient and the diagnostic and treatment options available. Guideline watches summarize significant developments in practice since publication of an APA practice guideline. Watches may be authored and reviewed by experts associated with the original guideline development effort and are approved for publication by APA's Executive Committee on Practice Guidelines. Thus, watches represent opinion of the authors and approval of the Executive Committee but not policy of the APA. This guideline watch was published in March 2005.

Combined therapy with interpersonal psychotherapy adapted for borderline personality disorder: A two-years follow-up

“…In accordance with the results of systematic reviews and treatment guidelines for the management of BPD, options to treat this disorder include both pharmacotherapy and psychotherapy (American Psychiatric Association, 2001;Oldham, 2005;NICE, 2009;NHMRC, 2012;Stoffers et al, 2012) and combination of them can be considered a valid approach in treating this clinical population (American Psychiatric Association, 2001;Oldham, 2005). Some authors suggested that psychotherapy may enhance pharmacotherapy effects, although it remains unclear how this treatments actually interact (Lieb et al, 2010).…”

A Comprehensive Approach in Dissemination of Evidence-Based Care for PTSD

“…A similar set of self-assessment tools for the treatment of depression among adults was published earlier (39), guided by recommendations from the APA Practice Guideline for the Treatment of Patients with Major Depressive Disorder (40).…”

“…The Healthcare Effectiveness Data and Information Set (HEDIS) measures of the National Committee for Quality Assurance (NCQA) (40) are a commonly used group of quality indicators that measure health organization performance. anti-manic agent such as valproate or lithium."…”

Recent approaches to pharmacotherapy of personality disorders

“…APA guidelines and fol lowing updates [1,66] recommended to choose antidepressant agents (SSRIs and MAOIs) and mood stabilizers as first and secondline inter ventions for affective dysregulation, SSRIs and mood stabilizers for impulsivebehavioral dys control, and antipsychotics as firstline therapy for cognitiveperceptual symptoms.…”