Psychoanalytically oriented partial hospitalization is superior to standard psychiatric care for patients with borderline personality disorder. Replication is needed with larger groups, but these results suggest that partial hospitalization may offer an alternative to inpatient treatment.

Borderline personality disorder (BPD) is a complex and serious mental disorder characterized by a pervasive pattern of difficulties with emotion regulation and impulse control, and instability both in relationships and in self-image (1). It represents a serious public health problem, because it is associated with suicide attempts and self harm, both of which are consistent targets of mental health services. Recurrent suicidal behaviour is reported in 69-80% of patients with BPD, and suicide rates are estimated to be up to 10% (2).BPD is a common condition that is thought to occur globally with a prevalence of 0.2-1.8% in the general population (3). Higher prevalence rates are found in clinical populations. Moran et al (4) found a prevalence rate of 4-6% among primary care attenders, suggesting that people with BPD are more likely to visit their general practitioner. Chanen et al (5) reported a prevalence rate of 11% in adolescent outpatients and 49% in adolescent inpatients. The highest prevalence has been found in people requiring the most intensive level of care, with a rate of 60-80% among patients in forensic services (6,7).The high prevalence and increased suicide rate in patients with BPD make an unassailable argument that effective treatment needs to be developed and that treatment has to be widely available. Whilst a number of treatments for BPD have been shown to be moderately effective in randomized controlled trials, it remains of considerable concern that most of them require extensive training, making them unavailable to most patients. Mentalization based treatment (MBT) was developed with this in mind. It requires relatively little additional training on top of general mental health training, and has been implemented in research studies by community mental health professionals, primarily nurses, with limited training given modest levels of supervision.Mentalizing is the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes. It is a profoundly social construct in the sense that we are attentive to the mental states of those we are with, physically or psychologically. Given the generality of this definition, most mental disorders will inevitably involve some difficulties with mentalization, but it is the application of the concept to the treatment of borderline personality disorder (BPD), a common psychiatric condition with important implications for public health, that has received the most attention. Patients with BPD show reduced capacities to mentalize, which leads to problems with emotional regulation and difficulties in managing impulsivity, especially in the context of interpersonal interactions. Mentalization based treatment (MBT) is a time-limited treatment which structures interventions that promote the further development of mentalizing. It has been tested in research trials and found to be an effective treatment for BPD when delivered by mental health professionals given limited additional training and with...

Structured treatments improve outcomes for individuals with borderline personality disorder. A focus on specific psychological processes brings additional benefits to structured clinical support. Mentalization-based treatment is relatively undemanding in terms of training so it may be useful for implementation into general mental health services. Further evaluations by independent research groups are now required.

Borderline personality disorder (BPD) is a complex and serious mental disorder characterized by a pervasive pattern of difficulties with emotion regulation and impulse control, and instability both in relationships and in self-image (1). It represents a serious public health problem, because it is associated with suicide attempts and self harm, both of which are consistent targets of mental health services. Recurrent suicidal behaviour is reported in 69-80% of patients with BPD, and suicide rates are estimated to be up to 10% (2).BPD is a common condition that is thought to occur globally with a prevalence of 0.2-1.8% in the general population (3). Higher prevalence rates are found in clinical populations. Moran et al (4) found a prevalence rate of 4-6% among primary care attenders, suggesting that people with BPD are more likely to visit their general practitioner. Chanen et al (5) reported a prevalence rate of 11% in adolescent outpatients and 49% in adolescent inpatients. The highest prevalence has been found in people requiring the most intensive level of care, with a rate of 60-80% among patients in forensic services (6,7).The high prevalence and increased suicide rate in patients with BPD make an unassailable argument that effective treatment needs to be developed and that treatment has to be widely available. Whilst a number of treatments for BPD have been shown to be moderately effective in randomized controlled trials, it remains of considerable concern that most of them require extensive training, making them unavailable to most patients. Mentalization based treatment (MBT) was developed with this in mind. It requires relatively little additional training on top of general mental health training, and has been implemented in research studies by community mental health professionals, primarily nurses, with limited training given modest levels of supervision. Mentalization based treatment for borderline personality disorder

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This article describes a series of studies involving 2,730 participants on the development and validity testing of the Severity Indices of Personality Problems (SIPP), a self-report questionnaire covering important core components of (mal)adaptive personality functioning. Results show that the 16 facets constituted homogeneous item clusters (i.e., unidimensional and internally consistent parcels) that fit well into 5 clinically interpretable, higher order domains: self-control, identity integration, relational capacities, social concordance, and responsibility. These domains appeared to have good concurrent validity across various populations, good convergent validity in terms of associations with interview ratings of the severity of personality pathology, and good discriminant validity in terms of associations with trait-based personality disorder dimensions. Furthermore, results suggest that the domain scores are stable over a time interval of 14-21 days in a student sample but are sensitive to change over a 2-year follow-up interval in a treated patient population. Taken together, the final instrument, the SIPP-118, provides a set of 5 reliable, valid, and efficient indices of the core components of (mal)adaptive personality functioning.

Psychoanalytically oriented partial hospital treatment for BPD has been shown to be more effective than treatment as usual in a randomized controlled trial and over 18 months of follow-up. Focus of treatment, in the context of group and individual psychotherapy, was on increasing the patient's capacity for mentalization, the capacity to think about mental states of oneself and others as separate from, yet potentially causing actions. We summarize the research and outline the essential theoretical and practical components of mentalization-based treatment. Core aspects of treatment include enhancing mentalization, bearing in mind patient deficits, using transference, retaining mental closeness, and working with current mental states. Finally, it is proposed that mentalization is a common theme in psychotherapy of BPD and may explain why different treatments "work."

Patients with 18 months of mentalization-based treatment by partial hospitalization followed by 18 months of maintenance mentalizing group therapy remain better than those receiving treatment as usual, but their general social function remains impaired.