Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies

World Psychiatry, Journal Year: 2024, Volume and Issue: 23(1), P. 4 - 25

Published: Jan. 12, 2024

Borderline personality disorder (BPD) was introduced in the DSM‐III 1980. From to DSM‐5, no major changes have occurred its defining criteria. The is characterized by instability of self‐image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings emptiness, strong abandonment fears, suicidal or self‐mutilation behavior, transient stress‐related paranoid ideation severe dissociative symptoms. There evidence that BPD can be reliably diagnosed differentiated from other mental disorders semi‐structured interviews. associated with considerable functional impairment, intensive treatment utilization, high societal costs. risk suicide high. In general adult population, lifetime prevalence has been reported 0.7 2.7%, while about 12% outpatient 22% inpatient psychiatric services. significantly disorders, including depressive substance use post‐traumatic stress disorder, attention‐deficit/hyperactivity bipolar bulimia nervosa, disorders. convincing suggest interaction between genetic factors adverse childhood experiences plays a central role etiology BPD. spite research, neurobiological underpinnings remain clarified. Psychotherapy choice for Various approaches empirically supported randomized controlled trials, dialectical behavior therapy, mentalization‐based transference‐focused schema therapy. No approach proved superior others. Compared as usual, psychotherapy more efficacious, effect sizes 0.50 0.65 regard core symptom severity. However, almost half patients do not respond sufficiently psychotherapy, further research this area warranted. It clear whether some may benefit one psychotherapeutic than available consistently showing any psychoactive medication efficacious features For discrete comorbid anxiety psychotic‐like features, pharmacotherapy useful. Early diagnosis reduce individual suffering high‐quality studies are required, both adolescents adults. This review provides comprehensive update clinical characterization, factors, neurobiology, cognition, management. also discusses current controversies concerning highlights areas which needed.

Language: Английский

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The (un)learning of social functions and its significance for mental health

Clinical Psychology Review, Journal Year: 2022, Volume and Issue: 98, P. 102204 - 102204

Published: Sept. 28, 2022

Social interactions are dynamic, context-dependent, and reciprocal events that influence prospective strategies require constant practice adaptation. This complexity of social creates several research challenges. We propose a new framework encouraging future to investigate not only individual differences in capacities relevant for functioning their underlying mechanisms, but also the flexibility adapt or update one's abilities. suggest three key functioning: (1) perception, (2) sharing emotions empathizing, (3) mentalizing. elaborate on how adaptations these may be investigated behavioral neural levels. Research flexible behavior is needed specify humans actually "learn social". Learning implies plasticity brain networks involved processes, indicating abilities malleable different contexts. To quantify such measures, researchers need find ways learning through dynamic changes adaptable paradigms examine factors influencing within aformentioned capacities. furthers insight concerning differences, provides holistic approach functioning, improve interventions ameliorating patients.

Language: Английский

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Childhood maltreatment, dissociation and borderline personality disorder: Preliminary data on the mediational role of mentalizing in complex post‐traumatic stress disorder

Psychology and Psychotherapy Theory Research and Practice, Journal Year: 2023, Volume and Issue: 97(S1), P. 58 - 74

Published: Dec. 18, 2023

Treatments for borderline personality disorder (BPD) and post-traumatic stress (PTSD) are less effective patients with co-occurring symptoms of both disorders, who considered to have complex PTSD (cPTSD), compared either condition alone. Evidence suggests that co-occurrence indicates greater impairment in mentalizing. This study examines evidence targeting mentalizing when treating individuals symptoms, irrespective their exposure developmental trauma and, the first time, investigates mediational role associations between BPD symptomatology cPTSD.

Language: Английский

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Impact of clinical severity on treatment response in a randomized controlled trial comparing day hospital and intensive outpatient mentalization‐based treatment for borderline personality disorder

Personality and Mental Health, Journal Year: 2024, Volume and Issue: 18(2), P. 148 - 156

Published: Jan. 31, 2024

This study examined the impact of clinical severity on treatment outcome in two programs that differ markedly intensity: day hospital mentalization-based (MBT-DH) and intensive outpatient (MBT-IOP) for borderline personality disorder (BPD). A multicenter randomized controlled trial was conducted. Participants include full intention-to-treat sample original N = 114 BPD patients (MBT-DH n 70, MBT-IOP 44), who were assessed at baseline subsequently every 6 up to 36 months after start treatment. Outcomes general symptom severity, features, interpersonal functioning. Clinical terms BPD, comorbid disorders, cluster C features. None measures related or differentially predicted MBT-DH MBT-IOP, with exception a single moderating effect co morbid disorders indicating less improvement more disorders. Overall, varying levels benefited equally from may not be useful criterion differentiate intensity.

Language: Английский

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Breaking the cycle with trauma-focused mentalization-based treatment: theory and practice of a trauma-focused group intervention

Frontiers in Psychology, Journal Year: 2024, Volume and Issue: 15

Published: Sept. 13, 2024

Trauma-Focused mentalization-based treatment (MBT-TF) is an adaptation of (MBT) specifically developed for patients suffering from attachment or complex trauma, with the possibility co-occurring borderline personality pathology. The creation MBT-TF was driven by previous research and observations that interventions centered on mentalizing could be significantly improved directly addressing impact trauma. aims to mitigate symptoms arise post-trauma, such as hyperarousal, hypervigilance, intrusions, flashbacks, avoidance behaviors, dissociative experiences, negative perceptions self others, ensuing relational difficulties. Implemented a group intervention, typically spans 6-12 months. From perspective, particularly leads failure in processing effects trauma through others. Stress behavioral systems are disrupted, which undermines capacity epistemic trust, impairs abilities. This paper offers concise summary reasoning MBT-TF's creation, its theoretical underpinnings, clinical strategy adverse impacts It further details phases, their main goals, interventions, supplemented case examples underscore distinctive attributes frequent hurdles.

Language: Английский

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Genetic Influences on Outcomes of Psychotherapy in Borderline Personality Disorder: A Narrative Review of Implications for Personalized Treatment

Cureus, Journal Year: 2023, Volume and Issue: unknown

Published: Aug. 18, 2023

Borderline personality disorder (BPD) manifests as instability in mood, relationships, self-image, and behavior, representing a challenging mental health issue. This review scrutinizes genetic factors influencing BPD the corresponding treatment outcomes. The primary objective of this narrative is to illuminate association between outcomes, discussing potential testing for personalized therapy. derived from observational experimental studies on BPD, factors, psychotherapy 2000 2023, sourced primarily through PubMed. Reviews meta-analyses were excluded. Our suggests that account 40-60% variation, with significant roles played by epigenetic alterations like DNA methylation microRNAs, particularly context childhood trauma. Gene-environment interactions are also vital BPD's development. Treatments such dialectical behavior therapy, mentalization-based schema therapy have shown efficacy, success variability possibly linked factors. However, existing research constrained recall bias, diverse methodologies, limited sample sizes. Future necessitates long-term follow-up, populations, controlled variables enhance our comprehension outcomes' foundations. underlines promise medicine treatment, driven insights.

Language: Английский

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Adverse childhood experiences and psychological maladjustment in adolescence: The protective role of epistemic trust, mentalized affectivity, and reflective functioning

Journal of Clinical Psychology, Journal Year: 2024, Volume and Issue: unknown

Published: Aug. 5, 2024

Abstract Introduction Adverse childhood experiences (ACEs) are psychosocial factors acknowledged as significant contributors to health consequences later in adolescence, including psychological maladjustment. The research suggests that, at a transdiagnostic and transtheoretical level, working on restoring epistemic trust (ET), mentalized affectivity (MA), reflective functioning (RF) adolescents with ACEs assumes central role the therapeutic process. However, there still few studies that attempted investigate specific of these sociocognitive detrimental positive association between levels experienced during maladjustment nonclinical adolescents. Methods A community sample 306 Italian cisgender (61.4% assigned females birth; age range 13–19 years old; M = 16.1, SD 1.64) self‐reported (Childhood Trauma Questionnaire‐Short Form), (Strengths Difficulties Questionnaire), ET (Epistemic Trust, Mistrust Credulity MA (Brief‐Mentalized Affectivity Scale for Adolescence), RF (Reflective Functioning Questionnaire). multiple mediation regression analysis has been performed explore through interaction socio‐cognitive factors. Results predictors adolescence. Regardless gender differences, mistrust credulity, processing expressing emotions, uncertainty about mental states mediated this association, while trust, identifying certainty did not configure mediators. Conclusion Findings suggest disruptions deficits risk factors, is protective factor within link These links help specify development problems who have exposed adverse childhood.

Language: Английский

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Mentalizing the patient–Patient experiences with short-term mentalization-based therapy for borderline personality disorder: A qualitative study

Frontiers in Psychiatry, Journal Year: 2022, Volume and Issue: 13

Published: Dec. 22, 2022

Background Mentalization-based therapy (MBT) is an evidence-supported psychotherapy approach for borderline personality disorder (BPD) that has been implemented in mental health services worldwide. Originally, MBT was developed as 18-months program BPD. However, a short-term (5 months) developed. Research into patient experiences with long-term BPD scarce, and no studies have investigated experience Objective The objective of this study to explore the Danish services. Methods Semi-structured qualitative interviews were conducted 12 outpatients diagnosed BPD, who attended 5 months. verbatim transcribed analyzed using thematic analysis double coding. Results resulted four subordinate themes: (1) Treatment duration – too short or appropriately short? , (2) group “safe space ,” (3) Bad impacted treatment negatively (4) My life changed better. Conclusion results suggest most patients overall satisfied MBT, which they experienced having positive impact on their lives. subgroup wanted more therapy. This highlighted strengths limitations by patients, points barriers developing service-user informed options

Language: Английский

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Mentalisation-based treatment for borderline personality disorder: a narrative review of recent process and outcome findings

Psychodynamic Practice, Journal Year: 2024, Volume and Issue: 30(4), P. 381 - 399

Published: May 3, 2024

This article presents a narrative review of recent process and outcome studies mentalisation-based treatment (MBT) for borderline personality disorder (BPD). The author introduces the theoretical origins mentalisation, its role in BPD, therapeutic approach MBT. Quantitative qualitative findings are then reviewed critically appraised their methodological strengths limitations. finds that BPD patients benefit from multicomponent structure active ingredients Finally, practical implications discussed directions future research proposed.

Language: Английский

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Personality disorders and their association with adverse childhood events

Current Opinion in Psychiatry, Journal Year: 2024, Volume and Issue: unknown

Published: Aug. 5, 2024

Purpose of review Theoretical models personality disorders (PDs) highlight the role adverse childhood experiences (ACEs) in development and maintenance pathology. This presents recent studies on associations between adversity PDs, while discussing mechanisms factors that impact these relationships. Recent findings Studies point to small moderate cluster A, B C some research suggests could be a predictor for onset Most focuses borderline PD, other PDs is limited. Some explain have been proposed, with literature investigating emotion dysregulation, dissociation, avoidance or psychosocial dysfunction as mediators. Summary The consistent ACEs seems transdiagnostic risk factor but warrants further prospective investigations causal conclusions, calls future investigate potential mediators moderators more thoroughly.

Language: Английский

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