From Research to Treatment: Advancing the Agenda Saturday – October 6, 2007

Borderline Personality Disorder:
From Research to Treatment: Advancing the Agenda

Saturday, October 6, 2007
Fort Worth Botanic Garden

Moderator for the Day:
Peter Kowalski, MD
Diplomate, American Board of Psychiatry and Neurology
General, Child and Adolescent Psychiatry
Fort Worth, Texas

Perry D. Hoffman, PhD
President, National Education Alliance for Borderline Personality Disorder
Rye, New York


John Oldham, MD, MS
Senior Vice President & Chief of Staff, The Menninger Clinic
Executive Vice Chair for Clinical Affairs and Development
Professor, Menninger Department of Psychiatry and Behavioral Sciences,
Baylor College of Medicine, Houston, Texas

  • A dimensional approach to defining BPD
  • Latest information about evidence-based treatment of BPD
  • The longitudinal course of this disorder

Borderline Personality Disorder (BPD) has emerged into widespread recognition as a highly disabling condition that is prevalent in clinical populations. An evidence-based practice guideline has been developed for treatment of patients with BPD, and research is clarifying the neurobiology and phenomenology of the disorder. Heritable endophenotypes such as affective instability and impulsive aggression may underlie an array of symptom patterns, a dimensional trait-based approach that could lead to enhanced understanding of this disorder. Psychotherapy itself, the evidence-based primary recommended treatment, is now known to be correlated with biological changes in the brain at the neuromolecular level, shedding light on the mechanism of action of this therapeutic form of learning and memory. Longitudinal studies have clarified that our current defining criteria of BPD may need to be unpacked and segregated into at least two categories: relatively stable traits, and episodic self-injurious behaviors or symptoms that are sensitive to environmental circumstances.

Glen Gabbard, MD
Brown Foundation Professor of Psychoanalysis
Director, Baylor Psychiatry Clinic, Houston, Texas

  • Participants will gain knowledge about the evidence-based psychotherapies that have been shown to be efficacious in the treatment of borderline personality disorder.
  • Participants will be able to develop an algorithm of pharmacotherapy agents for the treatment of borderline personality disorder.

The American Psychiatric Association Practice Guidelines issued in 2001 suggested that a combination of psychotherapy and medication would be the optimal treatment approach to borderline personality disorder. In the last six years since the appearance of the Guidelines, much greater information is available to guide clinicians in the implementation of a treatment plan. Data demonstrating efficacy from randomized controlled trials suggest that several psychotherapeutic strategies are useful: 1) Dialectical Behavior Therapy, 2) Mentalization-Based Therapy, 3) Transference-Focused Psychotherapy, 4) Schema-Focused Therapy, and 5) Supportive Psychotherapy. These psychotherapies will be outlined and discussed in terms of clinical usefulness, and the data stemming from the studies will be critiqued. A number of medications have been shown to be efficacious in placebo-controlled randomized trials. These medications can be applied according to symptom clusters and algorithms, and will be illustrated and discussed.

Anthony W. Bateman, MA, MD, FRCPsych
Consultant Psychiatrist in Psychotherapy
Visiting Professor, University College, London, England
Visiting Professor Consultant, Menninger Clinic,
Baylor College of Medicine, Houston, Texas
Mentalization is the process by which we implicitly and explicitly interpret the actions of ourselves and others as meaningful on the basis of intentional mental states (e.g., desires, needs, feelings, beliefs, & reasons). We mentalize interactively and emotionally when with others. Each person has the other person’s mind in mind (as well as their own) leading to self-awareness and other awareness. We have to be able to continue to do this in the midst of emotional states but borderline personality disorder is characterised by a loss of capacity to mentalize when emotionally charged attachment relationships are stimulated. The aim of MBT is to increase this capacity in order to ensure better regulation of affective states and to increase interpersonal and social function. Therapy has been shown to be more effective than treatment as usual in the context of a partial hospital programme both at the end of treatment and at 8 year follow-up. Some results from this long term follow-up will be presented. With the support of a grant from the Borderline Personality Disorder Research Foundation (BPDRF), a randomised controlled trial of MBT in an out-patient setting has also been completed. Some preliminary results will be presented. Finally some clinical examples of mentalizing interventions will be given as well as a rationale of why some commonly used therapeutic interventions might be harmful in BPD.Objectives of presentation
Following the presentation participants should be able:

  • To understand mentalization
  • To appraise the evidence for its effectiveness in treatment of BPD
  • To recognise mentalizing and non-mentalizing interventions
Anthony Bateman, MD
Glen Gabbard, MD
John Oldham, MS, MD