Managing borderline personality disorder from a life course perspective: Clinical staging and health management.

Abstract

Personality disorders change phenomenologically throughout the life course, in interaction with biological, psychological, and social events. In this article, we present a life course perspective on borderline personality disorder (BPD), based on clinical staging (conditional stimulus [CS]) and health management (HM). CS is presented as an alternative to the traditional categorical classification, providing improved opportunities to assess the severity of borderline impairment throughout the life course. It is primarily proposed as a heuristic strategy to guide design and selection of appropriate treatment according to the stage of disease progression. In addition, we introduce the concept of HM in the field of BPD, to organize continuous and coordinated health care management for patients with (emerging) BPD. HM redirects the exclusive focus on curative treatment of late-stage disorders to the broad spectrum of preventive, curative, and care interventions necessary to respond to the various needs in the different stages of BPD throughout the life course. Combining clinical staging and HM could provide a more effective and efficient framework for organizing mental health care for BPD.

Positive schemas in schema therapy with older adults: clinical implications and research suggestions

“…So, EMS can be more or less active throughout the lifespan, because of strategies that allow schemas to stay hidden. This is in line with the lifespan course of personality disorder symptoms, that tend to wax and wane from adolescence up to old age, and their presentation depends on contextual factors (Hutsebaut et al, 2019;Videler et al, 2019). Two Delphi studies even point to the existence of 'late-onset' personality disorders, having their first manifestation late in life due to a combination of pre-existing maladaptive personality features and contextual and developmental changes (Van Alphen et al, 2012a;Rosowsky et al, 2018).…”

“…In line with the waxing and waning course of personality disorder symptoms, as discussed earlier, the majority of older personality disorder patients have gathered more 'wisdom of their years' and have functioned better in middle adulthood (Hutsebaut et al, 2019;Videler et al, 2015Videler et al, , 2019. This could be explained by two different processes, in which EMS are less active or EAS are more active in middle adulthood.…”

Personality Disorders in Older Adults: a Review of Epidemiology, Assessment, and Treatment

“…Furthermore, experts believe that interventions for PDs in older adults can be considered allocated on a continuum, ranging from supportive-structuring treatment approaches (e.g., psychoeducation, behavioral counseling) to adaptationfocused (e.g., social skills training) to personality-changing interventions (e.g., schema therapy, dialectical behavior therapy) for each of which in-and exclusion criteria were formulated [44,45]. Moreover, initial results show that applying clinical staging of PDs in treatment indication might improve its outcomes and may facilitate early detection [46,47]. While empirical research addressing interventions for older adults with PDs are needed, the above-described recommendations can aid in defining achievable treatment goals and choosing the most appropriate treatment level.…”

Heterogeneity of Borderline Personality Disorder Symptoms in Help-seeking Adolescents

“…In community samples, the sex ratio is 1:1, while clinical samples usually show three times more females than males with the disorder (1). Forth and probably most importantly, because BPD presents differently across the lifespan (14), the majority of studies have examined adults with mean ages ranging between 20 and 42 years (18-22, 27, 28), while our sample consisted of adolescents with a mean age of 15 years. We are aware of three studies investigating subtypes of BPD in adolescence.…”

“…However, only the borderline type will remain in the 11th revision of the ICD (13). Concerning withinindividual variability, evidence indicates that "acute" symptoms such as impulsivity, self-harm and anger dominate during adolescence, while more "chronic" symptoms such as interpersonal di culties and feelings of emptiness come to the fore during adulthood (14). The phenomenological heterogeneity of the disorder represents a major challenge, both for clinical practice and research.…”