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Reducing severe episodes of BPD

Mentalization-based and dialectical behavioral therapies show some success in

September 07, 2009|Shari Roan

The primary treatments for borderline personality disorder are behavioral strategies, such as dialectical behavioral therapy, which University of Washington psychologist Marsha Linehan devised almost two decades ago.

In this approach, the patients acknowledge that they have damaged their relationships while learning to regulate their emotions and change their most destructive behaviors. It takes time and effort.

"It's very active. It's not talk therapy," Linehan says. Instead of just talking about the fact that she is always arguing with people, for example, the patient has to try to find something to agree on with someone she is arguing with.

There are other successful therapies, such as mentalization-based therapy, which focuses on observing one's own emotions and those of other people in order to understand the impact of emotions, and transference-focused therapy, which centers on helping the patient develop new skills that overcome the tendency to see everything in extremes.

And studies show that these very specific behavioral therapies can reduce some of the most severe behaviors.

A 2006 study in the Archives of General Psychiatry showed that suicidal patients who were randomized to dialectical behavior therapy were half as likely to make future suicide attempts compared to patients who were treated with more conventional therapies.

A study published in May in the American Journal of Psychiatry showed that patients treated with mentalization-based therapy had sustained improvements in their symptoms compared to patients undergoing conventional treatment.

And research in the same journal, published in 2007, found that patients undergoing transference-focused therapies, dialectical behavior therapy and other supportive therapies showed improvements in depression, anxiety, daily functioning and social adjustment after one year of treatment.




BPD traits

Borderline personality disorder often can be difficult to distinguish from bipolar disorder, depression and anxiety. But the essential feature of BPD is a pattern of unstable personal relationships, self-image and emotions and impulsivity.

Traits (at least five of which must be present for a diagnosis) include:

* Efforts to avoid abandonment

* Unstable, intense interpersonal relationships

* Identity disturbance

* Impulsivity

* Suicidality

* Mood instability

* Chronic emptiness

* Inappropriate, intense anger

* Paranoid ideation or dissociation

-- Shari Roan

Source: Diagnostic and Statistical Manual, American Psychiatric Assn.

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