Background: There is a wealth of evidence to suggest that the Borderline Personality Disorder (BPD, or similar Emotionally Unstable Personality Disorder, EUPD) construct is harmful. We provide a commentary on the ideas expressed in the May Debate issue, highlighting both concerns and alternatives. Method: We bring together lived experience, clinical and research expertise. This commentary was written collaboratively drawing on all these sources of evidence. Results: We outline evidence that the BPD construct is invalid, harmful, not necessary for effective treatment and a potential block to the development and evaluation of alternatives. Conclusions: We ask readers to consider these concerns, perspectives and ideas. Key Practitioner Message• There is a wealth of evidence from a range of sources to suggest that BPD can be a harmful, invalid construct that is unnecessary for and might be detrimental to treatment. • We propose that these risks are even greater in adolescence.• We highlight alternative forms of practice that warrant further consideration, development and evaluation.
Introduction: After initial psychological treatment patients with Obsessive Compulsive Disorder are treated with selective serotonin re-uptake inhibitors (SSRIs). Treatment may later be augmented with clomipramine and/or an antipsychotic. This study focuses on the biological treatment received after, or in parallel to, the psychological. Aim: To collate and evaluate the levels of biological treatment currently received by OCD outpatients in the Bedford east catchment of Bedfordshire and Luton mental health and social care partnership NHS trust. Objectives: In particular we wished to establish how many of the patients were receiving an atypical antipsychotic as well as maximal SSRIs. Method: An anonymised database of 45 outpatients with symptoms of OCD was prepared. Treatment groups were identified and the percentage of the cohort occupied by these groups was calculated. The possibilities for increased medication were noted. Results: Only 7% of patients had one SSRI, at maximum dose, plus clomipramine, plus an antipsychotic, even here the dosing was not maximal. Another 7% had a second SSRI instead of the tricyclic and may benefit from a trial of clomipramine. In the remaining 86% there was further scope for increasing biological therapy. Discussion: Relatively few of our patients were having maximal SSRI treatment and an antipsychotic, despite guideline recommendations. Conclusion: There is plenty of leeway for the escalation of patients' biological therapy. Given the number of patients currently receiving secondary care, an escalation of their treatment should result in better patient health and a subsequent increase in discharges.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.