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Need for treatment is high among patients with borderline personality disorder

Posted on 07-12-16 in Psychiatry, Research, Treatment

Need for treatment is high among patients with borderline personality disorder

People who have personality disorders such as borderline personality disorder (BPD) have an enduring pattern of thoughts, feelings and behaviors that influences the way that they cope with stress and adversity, feel and think about themselves, and relate to other people. About 1.6 percent of adults in the United States have BPD, a serious and pervasive mental health condition that is characterized by mood swings, emotional dysregulation, self-destructive behaviors (e.g., self-harm, suicidal ideation, substance abuse) and highly unstable interpersonal relationships.

Up to 80 percent of people who have BPD exhibit suicidal behaviors, while approximately 10 percent of these individuals eventually commit suicide, wrote Marsha M. Linehan, Ph.D., the developer of dialectical behavior therapy (DBT) and a professor at the University of Washington. Due to the severity and pervasiveness of BPD, as well as its high comorbidity with other mental health problems (e.g., depression, anxiety), BPD is notoriously difficult to diagnose and treat. While many people with BPD benefited from DBT skills groups, psychotherapy and other psychotherapeutic approaches, about 70 percent of those who do seek treatment end up dropping out early and many people do not seek treatment at all.

Specialized psychodynamic therapy for BPD

Transference focused psychotherapy (TFP) is an evidence-based psychodynamic treatment for patients with BPD and other severe personality disorders. Otto F. Kernberg, M.D., psychoanalyst and professor of psychiatry at Weill Cornell Medical College, and his colleagues reported that the use of TFP leads to significant improvements in the ability to regulate emotions and behaviors among patients with severe personality disorders or BPD.

Previous studies have found evidence for specific brain abnormalities present in individuals with BPD in the areas involved in emotional processing, aggression, impulsivity and behavioral inhibition. For example, one study found that individuals with BPD had less activity in areas of the ventromedial prefrontal cortex and heightened activity in the amygdala compared to controls. Other studies have found evidence for reductions in impulsivity, anger and suicidality as well as greater multisystem improvement among patients who received TFP compared to supportive psychotherapy and DBT.

TFP changes brain activity in BPD patients, study finds

As such, a recent study conducted by Emily Stern, M.D., a radiologist and functional neuroimaging researcher at Brigham and Women’s Hospital, and her colleagues examined the brain changes that occurred in 10 women with BPD who underwent functional magnetic resonance imaging (fMRI) scans before and after treatment with TFP. The researchers found that TFP led to changes in the prefrontal and limbic regions of the brain, which in turn produced clinical improvements in patients’ emotional regulation and affective lability.

Specifically, activity decreased in brain areas associated with emotional reactivity and semantic-based memory retrieval, and increased in regions associated with emotional and cognitive control. The findings of the study indicated that TFP may improve emotional and cognitive control through changes in brain activity in several important regions. Thus, while treatment options are relatively sparse for patients with BPD, recent studies indicate that making changes to these brain regions can lead to reductions in symptoms and distress for this population.

As part of our comprehensive, individualized behavioral health treatment services offered at Sovereign Health, patients with borderline personality disorder and other mental health conditions can receive evidence-based treatments such as cognitive behavioral therapy and DBT. For more information on the treatment programs offered at Sovereign Health, please contact our 24/7 helpline to speak to a member of our team.

About the author

Amanda Habermann is a writer for Sovereign Health. A graduate of California Lutheran University, she received her M.S. in clinical psychology with an emphasis in psychiatric rehabilitation. She brings to the team her background in research, testing and assessment, and recovery techniques. For more information and other inquiries about this article, contact the author at