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Borderline Personality Disorder:
From Research to Treatment: Advancing the Agenda
Saturday, October 6, 2007
Fort Worth Botanic Garden
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Moderator for the Day:
Peter Kowalski, MD
Diplomate, American Board of Psychiatry and Neurology
General, Child and Adolescent Psychiatry
Fort Worth, Texas |
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| Welcome |
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Perry D. Hoffman, PhD
President, National Education Alliance for Borderline
Personality Disorder
Rye, New York |
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Borderline Personality Disorder:
Charting the Future |
1 hr 12 min 4 sec |
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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 |
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Focus
• A dimensional approach to defining BPD
• Latest information about evidence-based treatment of BPD
• The longitudinal course of this disorder
Abstract
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. |
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An Overview of Treatment Strategies
for Borderline Personality Disorder |
1 hr 4 min 33 sec |
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Glen Gabbard, MD
Brown Foundation Professor of Psychoanalysis
Director, Baylor Psychiatry Clinic, Houston, Texas
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Objectives:
• 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.
Abstract
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. |
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Recent Developments:
Mentalization Based Therapy (MBT)
for Borderline Personality Disorder |
1 hr 28 min 2 sec |
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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 |
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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 |
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Interactive Panel: Isn’t It time for a New Name?
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Anthony Bateman, MD
Glen Gabbard, MD
John Oldham, MS, MD |
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1 hr, 9 min, 52
sec |
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