Developments in Diagnosis and Treatment of People With Borderline Personality Disorder

Sathya Rao; Parvaneh Heidari; Jillian H. Broadbear


Curr Opin Psychiatry. 2020;33(5):441-446. 

In This Article

National Treatment Guidelines

Treatment guidelines for BPD continue to be refined. An Australian[50] and five European[51] guidelines provide excellent contemporary guidance for the treatment of people diagnosed with BPD. All recommend psychotherapy as the treatment of first choice, although their advice differs in relation to diagnosis, duration and setting of treatment and use of pharmacotherapy.

The United Kingdom Royal College of Psychiatrists recently published an important position statement, 'Services for people diagnosable with personality disorder'.[52] This ambitious document articulates a comprehensive approach to personality disorders. Its vision is for improved services including more accurate diagnosis; an emphasis on engagement that does not rest solely with the patient; understanding presentation through formulation and narrative; offering high-quality and effective treatments; employment opportunities for people with lived-experience and acceptance of diagnostic framework as a key plank in the way that psychiatric practice is organized. The model of care articulated in the statement is arranged into four tiers according to severity and incorporates a stepped-care approach. The model identifies the patient group, therapy recommendations, the likely demand, current provision, specification and standards, providers and access. The statement also describes services required to provide high-quality treatment and care for individuals with personality disorder, informing health policy and recommendations on implementation.