May, 2019. For some time, there has been a widely endorsed view that patients with borderline personality disorder (BPD) should only be hospitalized when it is essential for patient safety, and that hospitalization, when necessary, should be as brief as possible. A patient with self-acknowledged BPD, for example, provided the following advice to clinicians: “Do not hospitalize a
person with BPD for any more than 48 hours.”1 A chorus of experts has aligned with this advice, arguing that regression and deterioration would predictably occur if patients with BPD remained in the hospital for more than a couple of weeks at most. I believe that this advice is well-intended and, in general, well-founded based on the experience and wisdom of clinical experts. Deriving from the days many years ago when patients with
BPD were hospitalized for a year or more, concern about the regressive impact of extended hospitalization became widespread. And with the development of evidence-based psychotherapies for patients with BPD, such as dialectical behavior therapy (DBT), mentalization-based therapy (MBT), and transference-focused psychotherapy (TFP), promising progress has been made that does not involve lengthy inpatient care. The American Psychiatric Association’s (APA)
Practice Guideline for the Treatment of Borderline Personality Disorder2 recommends psychotherapy as the primary, or core, treatment for BPD, as do subsequently published practice guidelines for BPD that have been developed in a number of countries throughout the world. But what can we do for those patients with BPD who have other comorbid psychiatric disorders and who have
not been able to get better? The APA Guideline advises that, for BPD patients with complex illnesses who are high risk and whose functioning is severely impaired, nonbrief inpatient care may be indicated. A group of colleagues and I at the Menninger Clinic recently published a study3 that considers this question, comparing 245 inpatients with BPD with a matched sample of 220 inpatients without
BPD. The average length of stay for the combined groups was 41 days, and both groups received intensive treatment. Contrary to common predictions, clinical deterioration was rare in both groups, and patients with BPD showed improvement with a large effect size, with comparable change scores in the comparison group without BPD. In this issue of the Journal, Probst and colleagues present results of a study of a 5-week inpatient DBT treatment program for patients with BPD. They
found that BPD symptoms and self-reported emotion dysregulation were significantly reduced at the end of the 5-week program. Although this was an effectiveness study without a control group, its results were consistent with those reported in other recent studies4 that had similar results utilizing more rigorous methodology that included controls. Also in this issue, Savard and coauthors report on the effectiveness of a 6-week day hospital treatment
program for patients with personality disorders, 68% of whom were diagnosed with BPD. Their results showed that, at the end of the 6-week program, patients showed reductions in “symptom distress,” and improved quality of interpersonal relationships and social role functioning. There will never be a “one size fits all” algorithm or formula for the treatment of patients with BPD. But continued efforts like those described above advance our knowledge about potentially effective
treatment options for patients with this highly disabling condition. John M. Oldham, MD REFERENCES1. Williams L. A “classic” case of borderline personality disorder. Psychiatr Serv. 1998;49:173–174. 2. Oldham JM, Gabbard GO, Goin MK, et al. Practice guideline for the treatment of borderline personality disorder. Am J Psychiatry. 2001;158:1–52. 3. Fowler JC, Clapp JD, Madan A, et al. A naturalistic longitudinal study of extended inpatient treatment for adults with borderline personality disorder: an examination of treatment response, remission and deterioration. J Affect Disord. 2018;235:323–331. 4. Bohus M, Haaf B, Simms T, et al. Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behav Res Ther. 2004;42:487–499. Types of BPD treatment offered at Sierra TucsonAs an internationally known and respected treatment provider of medical, therapeutic, and experiential services, our center is pleased to offer state of the art treatment for a wide range of behavioral health concerns. Through the integration of evidence-based practices and integrative therapies, our treatment center prides itself on being a leading provider of services that are effective in treating addictions and other behavioral health problems. Holistic and individualized treatment is cornerstone to the best care offered at our center, and is provided by a staff of qualified and experienced. At Sierra Tucson, a premier BPD treatment center, our primary goal is to deliver services in such a manner that all who come to us for treatment will benefit from our services and resume the pursuit of a healthy and productive future. Our BPD treatment center includes our 15-bed behavioral health inpatient unit, and a 124-bed behavioral health residential treatment center, both of which are situated on the same campus. Residents who require immediate stabilization due to the presence of psychiatric concerns, such as those associated with borderline personality disorder or those in need of medical detoxification can receive these services prior to engaging in our treatment center’s residential care. The behavioral health residential treatment supplied by our BPD center is designed to elicit the most favorable treatment outcomes for all residents. With five distinct treatment options offered within the residential treatment center, residents can expect to receive the beneficial services they need in order to truly heal. For those who are trying to overcome the debilitating symptoms of anxiety, our treatment center’s Mood and Anxiety Program allows our residents to heal the mind, body, and spirit through integrative and comprehensive treatment. This intensive treatment incorporates both cognitive behavioral therapy and dialectic behavior therapy workshops and continues to provide psychodynamic therapy through their primary process group and individual therapies. The types of services you receive will be determined by your treatment team. Once an initial assessment has determined that a resident’s needs will be best met through this treatment, they can learn healthy ways of coping with the symptoms of borderline personality disorder and begin to prepare themselves for reintegration into their communities. Additional treatment methods offered in a resident’s treatment plan include: Medication management: Residents engaged in the Mood and Anxiety Program are seen by a psychiatrist or attending physician at our treatment center on a weekly basis to determine the need for medication, monitor medication, and adjust any medication prescribed in order to ensure optimal alleviation of mental health symptoms, including those associated with borderline personality disorder. Registered nurses and clinical technicians also assist in monitoring a resident’s medication needs. Individual therapy: Upon entering the Mood and Anxiety treatment plan, each resident is assigned a primary therapist at our BPD treatment whom they will meet with at least once a week. All individual sessions are conducted by master’s level clinicians and licensed psychologists. Group therapy: In addition to being assigned a primary therapist, each residents is also assigned a small group of peers at our treatment center with whom they will meet four times per week with a primary therapist. In addition to the peer group, other groups are supplied by this treatment plan and may include topics such as:
Therapeutic Recreational Activities: In order to help residents build a stronger sense of self and confidence, our center offers a Therapeutic Recreational Activities Program. This treatment plan includes the following therapeutic activities, which are conducted daily or on a weekly basis to stress the importance of getting physical activity:
Additional services for purchase: In order to best care for the needs of those in the Mood and Anxiety treatment plan, our BPD treatment center offers a number of additional services that have proven effectiveness in helping people manage the symptoms of their anxiety or mood disorder. The following services are those offered within this innovative treatment:
Should a resident require stabilization services while engaged in our center’s residential treatment, they are able to partake in the services supplied by our inpatient program before returning to residential treatment. The staff of professionals conducts an ongoing assessment of each resident’s progress and needs and offers assistance in making this a seamless transition so as to continue the process of healing with as little disruption as possible. What is the most successful treatment approach for borderline personality disorder?Borderline personality disorder is mainly treated using psychotherapy, but medication may be added. Your doctor also may recommend hospitalization if your safety is at risk. Treatment can help you learn skills to manage and cope with your condition.
What is the gold standard treatment for borderline personality disorder?Born from the randomized controlled trial by Linehan and colleagues in 1991, dialectical behavior therapy (DBT) has become the gold standard for treatment of individuals who are suicidal and have borderline personality disorder.
What treatments are available for BPD?Research has shown that several types of psychotherapy are effective in reducing the symptoms of BPD,2 including:. Dialectical Behavior Therapy (DBT). Schema-Focused Therapy.. Mentalization-Based Therapy.. Transference-Focused Psychotherapy.. What is the best mood stabilizer for borderline personality disorder?Divalproex sodium and valproate
Divalproex sodium is among the mood stabilizers, which are comprehensively studied in patients with BPD [52].
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Residential treatment programs for borderline personality disorder
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