[Prevention and early intervention for borderline personality disorder]. / Preventie en vroege interventie bij borderlinepersoonlijkheidsstoornissen.

BACKGROUND: After a long period of borderline personality disorder (BPD) research focusing on adulthood solely, accumulating evidence calls for a developmental perspective on BPD.
AIM: To demonstrate translations from a developmental perspective to interventions during the earliest stages of the development of BPD.
METHOD: To describe the rationale of how a clinical staging model can serve as a guideline for the development of interventions in prevention and early intervention for BPD.
RESULTS: Increasing evidence shows clinically significant precursors of BPD. These findings underpin recommendations for prevention and early intervention purposes.
CONCLUSION: Prevention and early intervention can improve assessment and treatment of BPD. This has implications for future health care management for people at risk for BPD. Tijdschrift voor Psychiatrie 63(2021)2, 138-141.

Parenting in Patients with Borderline Personality Disorder, Sequelae for the Offspring and Approaches to Treatment and Prevention.

PURPOSE OF REVIEW: We review recent findings concerning the implications of borderline personality disorder (BPD) on parenting behaviors, the parent-child relationships, and parental and child outcomes. We focus on self-report and interview data characterizing parents with BPD and their children as well as on observational paradigms investigating parent-child relationships and the quality of dyadic interactions. Novel treatment approaches are discussed. RECENT FINDINGS: Parents with BPD suffer from increased parenting stress and display characteristic behavioral patterns towards their children, impeding the formation of a healthy parent-child relationship and disrupting offspring emotional development. Offspring are at greater risk of maltreatment and developing BPD themselves, with parental affective instability playing a substantial mediating role. Mothers with BPD face a meaningful burden in their parenting role. Mechanisms of the transmission of BPD pathology onto the following generation are beginning to be understood. Targeted interventions have been devised recently, with preliminary testing producing encouraging results.

¿Trastorno límite de personalidad, trastorno por inestabilidad emocional o trastorno por desequilibrio emocional?: una actualización para la Atención Primaria de Salud / Is it a borderline personality disorder, an emotional instability disorder or an emotional imbalance disorder? An update for Primary Health Care / Trastorn límit de la personalitat, trastorn per inestabilitat emocional o trastorn per desequilibri emocional?

El trastorno límite de personalidad es uno de los trastornos más debatidos de la psiquiatría y la psicopatología contemporáneas. Además, es un problema que en atención primaria manifiesta una prevalencia y una frecuentación mayor y más grave que otros muchos tipos de problemas, tanto orgánicos como emocionales. Sin embargo, es uno de los cuadros de la psicopatología actual que resulta más urgente replantearse, al menos desde las perspectivas teóricas, etiopatogénicas y terapéuticas

The borderline personality disorder is one of the most debated disorders in contemporary psychiatry and psychopathology. In addition, in primary care, it represents a more severe problem, with higher and more frequent prevalence compared to other types of problems, both organic and emotional. However, it is one of the icons of the current psychopathology that is most urgent to reconsider, at least from the theoretical, etiopathogenic and therapeutic perspectives

El trastorn límit de la personalitat és un dels trastorns més debatuts de la psiquiatria i la psicopatologia contem-porànies. A més, és un problema que a l'atenció primária manifesta una prevalença i una freqüentació més gran i més greu que molts altres tipus de problemes, tant orgánics com emocionals. No obstant, és un dels quadres de la psicopatologia actual que resulta més urgent replantejar-se, almenys des de les perspectives teóriques, etiopatogéniques i terapéutiques

[Clinical staging and early intervention for borderline personality disorder]. / Klinische stadiëring en vroege interventie bij borderline-persoonlijkheidsstoornissen.

BACKGROUND: Within the accumulating evidence for a life span perspective on borderline personality disorder (BPD), the key factor is a developmental perspective.
AIM: To demonstrate that the lessons learnt from early intervention in somatic medicine and psychosis should be used to improve the diagnosis and treatment of BPD.
METHOD: We describe the rationale for early detection and intervention and present a staging model which can serve as a guideline for the development and selection of interventions for BPD.
RESULTS: There is increasing evidence that BPD first manifests itself in adolescence and that BPD symptoms can already be distinguished from normative adolescent development. BPD tends to develop gradually and to have a progressive, social and professional impact. Inadequate treatment can lead to iatrogenic damage, whereas adequate treatment shows promising results in adolescents with emerging BPD. These findings may underpin an early intervention paradigm for BPD.
CONCLUSION: Early intervention and clinical staging can improve the assessment and treatment of severe forms of psychopathology, such as BPD. This has implications for research, mental health care policy and society.

Maltrato en la infancia y la adolescencia: características y psicopatología asociada en un Centro de Salud Mental Infanto-Juvenil / Maltreatment in Childhood and Adolescence: characteristics and associated psychopathology in a Children and Adolescent Mental Health Centre / Maltractament alainfànciai al’adolescència: característiques i psicopatologia associada en un Centre de Sa­lut Mental Infantil i Juvenil

Multitud de estudios han demostrado los efectos psicopatológicos que el maltrato tiene en niños y adolescentes, que en muchos casos persisten en la edad adulta. En este trabajo se describen las características de una muestra de pacientes de Salud Mental Infanto-juvenil con situaciones de maltrato (N = 150). La sintomatología más prevalente tiene que ver con dificultades de relación, síntomas ansioso-depresivos, alteraciones de conducta y problemas de rendimiento escolar. Resulta fundamental detectar e intervenir sobre casos de maltrato, previniendo la aparición de trastornos clínicos. Tricotilomanía: tratamiento psicodinámico de un caso

Multiple studies have shown the psychopathological effects of child and adolescent maltreatment, which frequently persist into adulthood. This work describes the characteristics of a sample of a Child and Adolescent Mental Health Service patients with experience of previous or current maltreatment situations (N =150). The most prevailing symptoms are relationship difficulties, anxiety and depressive symptoms, behavioural problems and academic performance difficulties. It is fundamental to detect and intervene in maltreatment cases in order to prevent the onset of clinical disorders

Molts estudis han demostrat els efectes psicopatològics que el maltractament té en nens i adolescents, que en molts casos persisteixen a l’edat adulta. En aquest treball es descriuen les característiques d’una mostra de pacients de Salut Mental Infantil i Juvenil amb situacions de maltractament (N=150). La simptomatologia més prevalent té a veure amb dificultats de relació, símptomes ansiosos i depressius, alteracions de la conducta i problemes de rendiment escolar. Resulta fonamental detectar i intervenir sobre casos de maltractament, per prevenir l’aparició de trastorns clínics

Métodos de Psicoterapia Focalizada en la Transferencia en niños con organización límite de la personalidad / Methods of transference focused psychotherapy in children with borderline personality organization / Mètodes de psicoteràpia focalitzada en la transferència en nens amb organització límit de la personalitat

La autora describe cómo trabaja con las estrategias principales de la psicoterapia focalizada en la transferencia (TFP) en el tratamiento de niños con organización límite de la personalidad. Los niños, al igual que los adultos y los adolescentes con esta organización, no son capaces de desarrollar un self y unas representaciones de objeto de forma integrada. Las representaciones agresivas y libidinales están separadas a través de mecanismos de disociación combinados con identificación proyectiva y otros mecanismos de defensa primitivos. En este sentido, los pacientes pueden proteger sus representaciones libidinales frágiles de las agresivas dominantes. En primer lugar, la autora da ejemplos de formas típicas en las cuales estos niños juegan o hacen actuaciones. Así es como muestran sus díadas dominantes de relaciones de objeto y sus mecanismos de defensa en la transferencia. A continuación, la autora muestra sus intentos para desarrollar intervenciones basadas en la TFP apropiadas para la edad. En conclusión, la autora propone indicaciones para el desarrollo hacia la integración de las representaciones escindidas

The author describes her work with the strategic principles of transference focused psychotherapy (TFP) in the treatment of children with borderline personality organization. Children, much like adults and adolescents with this organization, are unable to develop an integrated self and integrated object representations. Aggressive and libidinous representations are separated through a process of splitting, along with projective identification and other primitive defense mechanisms. In this way patients are able to protect their fragile libidinous representations from dominant aggressive representations. The author begins by citing examples of typical ways in which these children play or perform. This is how they show their dominant object relations dyads and defense mechanisms in the transference. Then the author describes her attempts to develop age-appropriate and TFP-based interventions. Finally, she offers some suggestions of ways to move toward integration of the split off representations

L’autora descriu com treballa amb les estratègies principals de la psicoteràpia focalitzada en la transferència (TFP) en el tractament de nens amb organització límit de la personalitat. Els nens, igual que els adults i els adolescents amb aquesta organització, no són capaços de desenvolupar un self i unes representacions d’objecte de manera integrada. Les representacions agressives i libidinals estan separades mitjançant mecanismes de dissociació combinats amb identificació projectiva i altres mecanismes de defensa primitius. En aquest sentit, els pacients poden protegir les seves representacions libidinals fràgils de les agressives dominants. En primer lloc, l’autora dóna exemples de formes típiques en les quals aquests nens juguen o fan actuacions. Així és com mostren les seves díades dominants de relacions d’objecte i els seus mecanismes de defensa en la transferència. Seguidament, l’autora mostra els seus intents per desenvolupar intervencions basades en la TFP apropiades per a l’edat. En conclusió, l’autora proposa indicacions per al desenvolupament cap a la integració de les representacions escindides

Tratamiento de adolescentes con trastorno límite en un hospital de día mediante técnicas de la psicoterapia focalizada en la transferencia (TFP) / Day clinic treatment of adolescent borderline patients using the techniques of the transference-focused psychotherapy (TFP) for adolescents / Estudi de prevalença de possible trastorn per dèficit d’atenció i hiperactivitat en nens preescolars

En este artículo se presenta un programa especializado de tratamiento en hospitales de día del Departamento de Psiquiatría Infantil y Juvenil de la Universidad de Colonia de adolescentes con trastorno límite basado en la terapia focalizada en la transferencia (TFP) de Kernberg. Este tratamiento se basa en la definición e interpretación de las díadas de relaciones de objeto del paciente que se dan en la transferencia con el terapeuta, que constituyen la base de sus dificultades y síntomas. Una modificación del tratamiento con los jóvenes es la implicación de los padres, así como las particularidades incluidas en los acuerdos contractuales. Junto con consideraciones conceptuales, se debaten las primeras experiencias acumuladas en el tratamiento en hospitales de día

This paper introduces a specialized day-treatment program for borderline adolescents offered by the child and adolescent psychiatry department of the university clinic of Cologne, based on O. Kernberg‘s concept of transference-focused psychotherapy (TFP). TFP focuses on defining and interpreting the central object relation dyads of the adolescent that appear through transference on the therapist. These dyads are the basis of difficulties and symptoms in these juvenile borderline patients. Including the parents in treatment is one modification of TFP for youth that is presented, along with other modifications in the treatment contract. Conceptual considerations are discussed, and first experiences of the day clinic treatment are described

El nostre ob­jectiu és realitzar un estudi pilot clínic i epidemiològic de trastorn per dèficit d’atenció i hiperactivitat (TDAH) en la població escolar. El mètode emprat ha estat un estudi poblacional multicèntric. Vam avaluar 1.171 preescolars, el 4,1% dels quals corresponien a un possible cas de TDAH. Els possibles factors associats a una presència de sospita de TDAH han estat an­tecedents familiars de TDAH, consum de tabac en l’embaràs i antecedents de dificultats en el desenvolupament psicomotor. És important realitzar una detecció precoç del TDAH en l’època preescolar per iniciar de manera primerenca intervencions efectives

Aplicación de la Terapia Dialéctico-Conductual en el tratamiento del Trastorno Límite de la Personalidad y de la Patología Dual / The Application of Dialectical Behavior Therapy to the treatment of Borderline Personality Disorder and of Dual Disorder / Aplicació de laTeràpiaDialècticaConductual en el tractamentdel Trastorn Límitde laPersonalitati de laPatologiaDual

En este artículo, se introduce el modelo de hospitalización parcial de adolescentes de la Fundació Orienta (seguido en sus hospitales de día), así como las estrategias terapéuticas empleadas en patologías específicas. Se presenta la Terapia Dialéctico Conductual y se valora su idoneidad en el tratamiento de pacientes adolescentes con Trastorno Límite de Personalidad, así como con Patología Dual. Se describe finalmente la aplicación de dicha terapia en los hospitales de día de la Fundación

The Application of Dialectical Behavior Therapy to the treatment of Borderline Personality Disorder and of Dual Disorder. Fundació Orienta’s adolescent partial hospitalization model (employed in the foundation’s day hospitals) is introduced, as well as the program’s therapeutic strategies for specific pathologies. Dialectical Behavioral Therapy is presented, and its suitability in the treatment of adolescent patients with Borderline Personality Disorder and with Dual Disorder is assessed. Finally, the application of the treatment in Fundació Orienta day hospitals is described

En aquest article s’introdueix el model d’hospitalització parcial d’adolescents de la Fundació Orienta (seguit en els seus hospitals de dia), així com les estratègies terapèutiques utilitzades en patologies específiques. Es presenta la Teràpia Dialèctica Conductual i se’n valora la idoneïtat en el tractament de pacients adolescents amb Trastorn Límit de la Personalitat, així com de Patologia Dual. Es descriu finalment l’aplicació d’aquesta teràpia en els hospitals de dia de la Fundació

The impact of parental diagnosis of borderline personality disorder on offspring: learning from clinical practice.

The aim of this study was to explore mental health clinicians' opinions regarding the impact of a parental diagnosis of borderline personality disorder (BPD) on offspring and factors that may protect these children from developing emotional and/or behavioural difficulties. Expert opinions from 64 clinicians were collected through a voluntary and anonymous online qualitative survey. Thematic analysis of the data revealed five main themes relating to the impact of parental BPD symptoms on offspring. Children in these families were observed to develop behavioural, emotional and interpersonal difficulties, disturbances to cognitive processes and self dysfunction. A number of protective factors for offspring were also identified, such as supportive social networks, therapeutic intervention and child and parent characteristics. A model for the potential transgenerational transmission of emotional dysregulation from parent to child was proposed.

Borderline personality disorder in adolescence.

Borderline personality disorder (BPD) is a common and severe mental disorder that is associated with severe functional impairment and a high suicide rate. BPD is usually associated with other psychiatric and personality disorders, high burden on families and carers, continuing resource utilization, and high treatment costs. BPD has been a controversial diagnosis in adolescents, but this is no longer justified. Recent evidence demonstrates that BPD is as reliable and valid among adolescents as it is in adults and that adolescents with BPD can benefit from early intervention. Consequently, adolescent BPD is now recognized in psychiatric classification systems and in national treatment guidelines. This review aims to inform practitioners in the field of adolescent health about the nature of BPD in adolescence and the benefits of early detection and intervention. BPD diagnosis and treatment should be considered part of routine practice in adolescent mental health to improve these individuals' well-being and long-term prognosis.

Intervenciones psicoterapéuticas con el entorno de niños con problemas psiquiátricos graves desde un centro de día / Psychotherapeutic interventions with the environment of children with serious mental problems from a day care centre

A través de esta exposición y valiéndome de un caso clínico, me gustaría acercar el trabajo realizado con el entorno familiar de niños con problemas psiquiátricos graves en un centro terapéutico-educativo (AU)

Through this exhibition and availing myself of a clinical case, I would bring the work done with the family environment of children with serious psychiatric problems in a therapeutic-educational center (AU)

Reconsiderando la clasificación psicopatológica desde el punto de vista psicoanalítico-relacional. Lo histérico/ histriónico como modelo / The psychopathological classification revisited from the psychoanalytic-relational standpoint. The hysterical / histrionic as a model

En el momento presente la clasificación psicopatológica destaca por su gran complejidad y confusión, que da lugar a incontables debates. Realizamos una indagación en este terreno partiendo del concepto de "histeria" por tratarse de un diagnóstico proteico y esquivo, que en cierta medida se solapa con el más de moda, pero no menos confuso, "trastorno límite", y con otros trastornos, como la psicosis, lo que hace de él un caso paradigmático dentro de la discusión diagnóstica en general y psicoanalítica en particular. Su presentación multiforme posiblemente ha llevado, en tiempos de positivismo dominante, a su desprestigio y práctica eliminación de los sistemas de clasificación oficiales. Sin embargo, cuando hablamos de "diagnóstico" al referirnos a la personalidad no debemos entenderlo tanto en el sentido de agrupación de signos y síntomas sino como la valoración y descripción de esas pautas complejas de comportamiento cuyo nivel privilegiado de análisis es el de la relación interpersonal, relación que cuando se constituye como área principal de desadaptación permite hablar de "Trastornos de la personalidad". Concluimos que, a pesar de su complejidad, la personalidad histriónica (PH) es un patrón relacional que conserva una presencia muy importante en la clínica psicoterapéutica, en salud mental y en otros ámbitos de la salud, y que precisamente su adecuada valoración y diferenciación de otros patrones relacionales permitirá afinar los sistemas clasificatorios futuros (AU)

Nowadays psychopathological classification is characterized by a great complexity and confusion, which produces innumerable debates. We make here an inquiry focusing on the concept of "hysteria" as starting point, for it is an elusive and protean diagnostic term, which overlaps to some extent to the more fashionable - but not less fuzzy - one of "borderline disorder", as well as to other disorders, the psychosis for instance, making it a paradigmatic case inside the general discussion in psychopathology and psychoanalysis. In these times of positivist thinking the multiform presentation of hysteria has led to its discredit and virtual elimination from the official classification systems. However, when we use the word "diagnostics" for the personality we should not take it as a mere aggregate of signs and symptoms but as the appraisal and description of those complex behavioral patterns whose privileged level of analysis is the interpersonal relationship. When the relationship is the main area of maladjustment constitutes just what is called "personality disorder". We reach the conclusion that histrionic personality is, in spite of its complexity, a relational pattern with a huge presence in the psychotherapeutic clinic, in mental health and in other domains of the health care system, and that its accurate assessment and differentiation from other patterns will improve future classification systems (AU)

Prevención del trastorno límite de la personalidad del adulto: tratamiento de los adolescentes con síntomas límites / Prevention of adult bordeline personality disorder: Treatment of adolescents with bordeline symtoms

EL TRASTORNO LÍMITE DE PERSONALIDAD (TLP) es un trastorno psiquiátrico grave y difícil de tratar de un modo adecuado en el adulto, dada su heterogeneidad clínica y la diversidad de necesidades que puede presentar. Se ha evidenciado que el diagnóstico y tratamiento precoz puede mejorar el pronóstico del TLP, al evitar las complicaciones que se asocian a los casos que han evolucionado a lo largo de la vida y que han sido diagnosticados tardíamente. Actualmente se considera el TLP como un trastorno ligado al desarrollo, existiendo un número importante de pacientes que manifiestan el trastorno completa o parcialmente ya en la adolescencia. Por todo ello, las estrategias de detección precoz durante esta etapa de la vida permitirían establecer tratamientos de menor complejidad y mayor eficiencia, evitando el desarrollo de formas más graves del trastorno en el adulto (AU)

Borderline Personality Disorder (BPD) is a serious psychiatric disorder, with a difficult treatment in the adulthood, related to its clinical heterogeneity and diversity of needs that patients can require. Evidence suggests that early diagnosis and treatment may improve BPD prognosis, to avoid complications associated with those cases that have evolved throughout life and have been diagnosed late. Nowadays, BPD is considered as a developmental disorder, existing a significant number of patients that exhibit the complete or partial disorder in the adolescence. Therefore, early detection strategies during this stage of life enable to establish treatments to reduce complexity and increase efficiency, avoiding the development of severe forms of this disorder in the adulthood (AU)

[Importance of neurobiology for modular psychotherapy]. / Bedeutung der Neurobiologie für die modulare Psychotherapie.

In the context of continuing education in psychiatry and psychotherapy, modular psychotherapy is of special importance. In modular psychotherapy, general interventions, e.g. for regulation of emotions, have an important function. In this review examples are given to describe the importance of neurobiology for the understanding and the improvement of these mechanisms. In addition, the use of neurobiological investigations within classical psychotherapy trials in the fields of borderline personality disorder and posttraumatic stress disorder will be depicted.

Prevention and early intervention for borderline personality disorder: current status and recent evidence.

Borderline personality disorder (BPD) is a leading candidate for developing empirically based prevention and early intervention programmes because it is common in clinical practice, it is among the most functionally disabling of all mental disorders, it is often associated with help-seeking, and it has been shown to respond to intervention, even in those with established disorder. Moreover, it can be reliably diagnosed in its early stages and it demarcates a group with high levels of current and future morbidity and mortality. Data also suggest considerable flexibility and malleability of BPD traits in youth, making this a key developmental period during which to intervene. Novel indicated prevention and early intervention programmes have shown that BPD in young people responds to intervention. Further work is required to develop appropriate universal and selective preventive interventions.

Trastorno límite de la personalidad y conductas autolíticas / Borderline personality disorder and self-harming behaviors

En este artículo se rastrean los factores de riesgo de suicidio en pacientes con diagnóstico de trastorno límite de la personalidad y se propone un abordaje de diagnóstico exhaustivo. Se realizó una búsqueda bibliográfica en PubMed (desde 2007) con las palabras clave (en inglés) «trastorno límite de la personalidad», «suicidio» y «conductas autolíticas». A partir de los resultados, se elaboraron las siguientes conclusiones: 1) las conductas autolesivas no autolíticas se diferencian de los intentos letales de suicidio en pronóstico y en rasgos de personalidad; 2) hay resultados contradictorios, probablemente porque el trastorno límite de la personalidad es una categoría heterogénea; y 3) el riesgo global de suicidio consumado en estos pacientes es elevado y los actuales criterios diagnósticos (DSM-IV-TR) son insuficientes para capturar los indicadores de riesgo asociados (afección comórbida, entorno y rasgos de personalidad). Finalmente se propone una exploración topográfica de la personalidad, que incluye aspectos relevantes no capturados por el DSM-IV(AU)

This review explores suicide risk factors in patients diagnosed with borderline personality disorder and proposes a comprehensive diagnostic assessment. A literature search in PubMed (since 2007) was performed, with the following key word search: "borderline personality disorder", "suicide", and "self-harming behaviour". With the selected articles, the following conclusions were drawn up: 1) self harming behaviors are different to lethal suicide attempts in terms of prognosis and personality traits; 2) there are controversial results, probably explained by the fact that borderline personality disorder is an heterogeneous category; and 3) the global risk of completed suicide in these patients is high and the current diagnostic criteria (DSM-IV-TR) do not take into account the associated risk factors (comorbidities, environment, personality traits). Lastly, a topographic assessment of personality, including those aspects not present in the DSM, is proposed(AU)

Preventive psychiatric admission for patients with borderline personality disorder: a pilot study.

PURPOSE: The purpose of this study was to establish the preliminary effects of preventive psychiatric admission of patients with severe borderline personality disorder (BPD) on the rate of agreement over treatment, patient service use, and patient views on the intervention. DESIGN AND METHODS: A retrospective pre-post test design with quantitative measures and qualitative interviews was used. FINDINGS: Agreement over treatment increased substantially and significantly, and services use decreased substantially, yet not significantly. Patients were highly content with the intervention. PRACTICE IMPLICATIONS: Preliminary results indicate that preventive admissions may be easy to use and cost effective with severe BPD patients in mainstream psychiatric services, but more research into the intervention is needed.