Conceptual Development and Case Data for a Modular, Personality-Based Treatment for Borderline Personality Disorder

Abstract

Borderline personality disorder (BPD) is a heterogenous condition and variations in its presentation may be accounted for by individual differences in personality dimensions. Extant treatments for BPD are long-term and intensive; it is possible that prioritizing the personality-based difficulties that underlie an individual’s symptoms may improve the efficiency of care. This manuscript describes the conceptual background for the development of a novel, personality-based intervention for BPD (BPD Compass) informed by recent research on personality mechanisms maintaining this condition to address gaps left by existing treatments and be maximally efficient and disseminable. BPD Compass is a comprehensive, short-term package with a fully modular design that allows for personalization (e.g., all skills can be presented in isolation or in any order based on pre-treatment assessment). We discuss the theoretical background for its development, an overview of the skills included in the treatment, as well as preliminary efficacy data.

Conceptual development and case data for a modular, personality-based treatment for borderline personality disorder.

“…Another important consideration for maximizing widespread dissemination of an intervention is the burden placed on clinicians to deliver it. BPD Compass is a manualized cognitive–behavioral treatment (CBT) with a patient workbook (Sauer-Zavala et al, 2020) and therapist guide (Sauer-Zavala et al, 2021). By providing clear guidance on the application of this treatment for clinicians in a familiar format (i.e., workbook chapters corresponding to session-by-session material), any mental health provider that is inclined to work through BPD Compass with their patients will be able to more quickly learn and apply it.…”

Future Challenges in Psychotherapy Research for Personality Disorders

“…The inclusion criterion would then not be a specific PD diagnosis but instead on a specific severity spectrum (e.g., severe PD according to ICD-11). An alternative possibility is to select patients based on the nature of their problematic traits [12][13][14]. Especially for mild or moderate PD's according to ICD-11, it seems realistic to find patients who only fulfil the criteria for a certain trait domain but not for other trait domains.…”

“…More research is needed to learn whether the dimensional constructs defining PDs may parallel specific functional domains ( [21], e.g., reward responsiveness and valuation, and their relationship with the disinhibition trait domain [22]). Such re-conceptualization of PDs may have an impact on treatment content [14], length [23], and format of delivery [24].…”

Incremental integration of nosological innovations is improving psychiatric diagnosis and treatment

“…Innovations in PD classification are also beginning to impact thinking about effective approaches to intervention, through incremental integration. Sauer‐Zavala et al 9 provide a compelling example of framing such approaches as transitional, via modules aimed at unpacking heterogeneity in the classical category of borderline PD. Rather than reifying this category, they embrace the heterogeneity of presentations within it, by parsing it in terms of modern dimensional approaches.…”