Corrective Experiences to Enhance Trust: Clinical Wisdom From Good (Enough) Psychiatric Management.

Unstable trust within social interchange underlies the symptom constellation of borderline personality disorder (BPD), resulting in preoccupation with intense dyadic relationships, limited capacity for social collaboration, and constricted social networks. Good Psychiatric Management (GPM) provides a distilled formulation of how interpersonal hypersensitivities drive the engine of BPD's symptomatic oscillations in both affect and attachment. The authors summarize clinically relevant conclusions from the empirical literature on trust in BPD, synthesize it with selected ideas from other empirically supported interventions, and distill a formulation of how the GPM approach can address problems of trust in BPD with strategies most clinicians can use to improve their work with patients. GPM's clinical management approach utilizes common factors in psychotherapy to structure collaboration with patients to be accountable partners in treatment, rely on themselves more to diminish unrealistic demands on others, and function more effectively in arenas that expand and stabilize their social network.

Destigmatizing Borderline Personality Disorder: A Call to Action for Psychological Science.

Despite recognition that borderline personality disorder (BPD) is one of the most stigmatized psychological disorders, destigmatization efforts have thus far focused on the views and actions of clinicians and the general public, neglecting the critical role that psychological science plays in perpetuating or mitigating stigma. This article was catalyzed by recent concerns about how research and editorial processes propagate stigma and thereby fail people with BPD and the scientists who study BPD. We provide a brief overview of the BPD diagnosis and its history. We then review how BPD has been stigmatized in psychological science, the gendered nature of BPD stigma, and the consequences of this stigmatization. Finally, we offer specific recommendations for researchers, reviewers, and editors who wish to use science to advance our understanding of BPD without perpetuating pejorative views of the disorder. These recommendations constitute a call to action to use psychological science in the service of the public good.

Effects of Group Psychotherapy for Nonsuicidal Self-Injury: A Meta-Analysis.

Nonsuicidal self-injury (NSSI) is prevalent and concerning among adolescents and adults. Although prior meta-analytic work has considered the efficacy of individual psychotherapy for reducing NSSI, the efficacy of group psychotherapy remains unclear. We conducted a systematic meta-analysis of group psychotherapy studies with NSSI measures. We identified a total of eight studies, including published articles (n = 6) or dissertations (n = 2) with 10 total effect sizes for group interventions. Overall, random-effects meta-analysis suggests that group psychotherapies have a significant small effect on NSSI. However, when corrected for publication bias, the effect is no longer significant. This meta-analysis cautiously suggests that group psychotherapies, which are cost-effective and efficient, hold promise for attenuating NSSI. The field would benefit from further study and treatment refinement, including consideration of what works for whom.

Boredom in Borderline Personality Disorder: A Lost Criterion Reconsidered.

Difficulty with boredom was eliminated from the formal diagnostic criteria for borderline personality disorder (BPD) in 1994 based on significantly limited, unpublished data. However, it is apparent in clinical practice that boredom remains relevant to BPD. This review synthesizes empirical research, with consideration of theoretical accounts, to critically examine the relevance of boredom to BPD. We first briefly review issues in defining and measuring boredom and offer an expanded conceptualization for BPD, which includes the notion of boredom reactivity, before turning to boredom's differentiation from and overlap with feelings of emptiness, with which it was paired prior to its removal from the DSM. We then discuss perspectives on boredom's significance in BPD, briefly touching on its relevance in other personality disorders. We propose a Boredom Cascade Model that articulates how boredom and boredom reactivity interact with identity disturbance and chronic emptiness to create escalating patterns of behavioral dysregulation and make recommendations for research and treatment.

When Trust Does Not Come Easily: Negative Emotional Information Unduly Influences Trustworthiness Appraisals for Individuals With Borderline Personality Features.

Individuals with borderline personality disorder and subclinical borderline features perceive others as untrustworthy (e.g., Fertuck, Grinband, & Stanley, 2013). Trust difficulties may be influenced by emotional state and are formally articulated in the diagnostic criteria for the disorder as temporary state-dependent paranoia. The current study examines the influence of emotional information on trustworthiness appraisals. Seventy-seven community adults, ranging in age from 18 to 70 (M = 31.53, SD = 14.01), with three or more borderline personality disorder symptoms (n = 30) or two or fewer symptoms (n = 47), completed an affective priming paradigm. They were exposed to negative, neutral, or positive information before rating the trustworthiness of unfamiliar faces. Individuals with borderline pathology made more untrusting appraisals regardless of prime, and they were more greatly influenced by negative primes relative to the control group. Findings suggest that biased trustworthiness appraisal is a replicable and consistent finding for individuals with borderline pathology, and that emotional context, even if unrelated to the appraisal at hand, has undue influence.

Changes in post-traumatic stress disorder symptoms during residential treatment for borderline personality disorder: a longitudinal cross-lagged study.

BACKGROUND: Symptoms of borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) commonly co-occur. Recent evidence supports the concomitant treatment of BPD and PTSD. METHODS: This study uses a longitudinal cross-lagged panel model to examine BPD and PTSD symptom response in a sample of 110 women undergoing residential treatment for BPD. The naturalistic treatment primarily followed a dialectical-behavior therapy protocol, with individualized integration of other major evidence-based treatments (EBTs) for BPD, including mentalization-based treatment, good psychiatric management, and transference-focused psychotherapy. RESULTS: A residentially-based integration of treatment approaches resulted in significant reductions in BPD (d = 0.71) and PTSD (d = 0.75) symptoms. Moreover, changes in BPD symptoms prospectively predicted changes in PTSD symptoms (constrained path b = 1.73), but the reverse was not true (constrained path b = 0.05). CONCLUSIONS: A naturalistic integration of EBTs for BPD may benefit both BPD and PTSD symptoms even in the absence of PTSD-oriented intervention. Additionally, the attenuation of BPD symptoms may have positive impact on PTSD symptoms.

A meta-analysis of treatment as usual for borderline personality disorder.

In the era of evidence-based medicine, "treatment as usual" (TAU) for borderline personality disorder (BPD) is often considered ineffective or even iatrogenic. To evaluate the effects of TAU, this meta-analysis examined published data from the TAU arms of randomized controlled trials of manualized psychotherapies for BPD. Studies were selected through a comprehensive bibliographic search. A total of 16 studies met inclusion criteria. Comprehensive Meta-analysis V3 software was used for computing and pooling effect sizes. For the primary outcome category of BPD symptoms, Hedges' g showed a small-to-moderate improvement for patients in TAU conditions (11 studies; g = 0.371; 95% confidence intervals [CI: 0.246, 0.495]). Secondary outcomes included general psychopathology, global functioning, and self-harm/suicidality. Hedges' g indicated small improvements in general psychopathology (14 studies; g = 0.119; 95% CI [0.025, 0.214]) and global functioning (10 studies; g = 0.254; 95% CI [0.123, 0.384]). No significant effect was found for changes in self-harm/suicidality (four studies; g = 0.003; 95% CI [-0.193, 0.199]). These findings question the notion that TAU for BPD is inherently iatrogenic. Thus, in the absence of specialized treatment for BPD, standard available care may be a practical option. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Is perceived criticism an independent construct? Evidence for divergent validity across two samples.

Perceived criticism (PC) is a predictor of poor outcomes across a range of psychological disorders. Yet what is being measured when people are asked to report on how critical a key individual is of them is far from clear. In two community-based studies, we examined the divergent validity of PC in relation to measures of personality, psychopathology, early experiences with parents, and other cognitive and affective variables. In Study 1, an unselected sample of participants completed measures in the laboratory. In Study 2, participants were required to be married or partnered, and measures were completed online. Across both studies, PC was not consistently or reliably related to any measure. This suggests that PC may not simply be a proxy for another variable. Rather, our findings suggest that PC may be an independent construct worthy of research and clinical attention in its own right. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

What Works in the Treatment of Borderline Personality Disorder.

PURPOSE OF THE REVIEW: This review summarizes advances in treatments for adults with borderline personality disorder (BPD) in the last 5 years. RECENT FINDINGS: Evidence-based advances in the treatment of BPD include a delineation of generalist models of care in contrast to specialist treatments, identification of essential effective elements of dialectical behavioral therapy (DBT), and the adaptation of DBT treatment to manage post-traumatic stress disorder (PTSD) and BPD. Studies on pharmacological interventions remain limited and have not provided evidence that any specific medications can provide stand-alone treatment. SUMMARY: The research on treatment in BPD is leading to a distillation of intensive packages of treatment to be more broadly and practically implemented in most treatment environments through generalist care models and pared down forms of intensive treatments (e.g., informed case management plus DBT skills training groups). Evidence-based integrations of DBT and exposure therapy for PTSD provide support for changing practices to simultaneously treat PTSD and BPD.