American Psychiatric Association Updates Guidelines For Borderline Personality Disorder Treatment
The American Psychiatric Association has updated its Practice Guideline for the Treatment of Patients with Borderline Personality Disorder to include more recent data and improved treatment strategies implemented since the 2001 release of the previous version.
Recent findings have shown that the five-factor model – through which patients must present with five of nine criteria in order to be diagnosed with borderline personality disorder (BPD) – could potentially lead to disparities among BPD populations. Therefore, the newest version of the guideline addresses the possibility of redefining the diagnostic cut-off point, or the minimum number of criteria that must be met.
The new guidelines also touch on a evidence suggesting an overlap between borderline personality disorder and bipolar II disorder, specifically given the benefit of mood-stabilizing medications to some BPD patients. Nonetheless, the guideline concludes that, while these conditions may coexist, the vast majority of evidence indicates BPD is a discrete diagnosis and not a milder form of a mood disorder.
The guidelines also states that BPD should be considered unique for post-traumatic stress disorder (PTSD), despite a history of trauma being common in patients with BPD. 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.
Much from the previous iteration of the guidelines stays the same, including statements that psychotherapy remains the first-line treatment for those with borderline personality disorder. 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.