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Evidence-Based Treatments for Borderline Personality Disorder: Implementation, Integration, and Stepped Care

Choi-Kain, Lois W. MD; Albert, Elizabeth B. BA; Gunderson, John G. MD

doi: 10.1097/HRP.0000000000000113

Learning Objective After participating in this activity, learners should be better able to:

• Evaluate evidence-based therapies for borderline personality disorder

Several manualized psychotherapies for treating borderline personality disorder (BPD) have been validated in randomized, controlled trials. Most of these approaches are highly specialized, offering different formulation of BPD and different mechanisms by which recovery is made possible. Mental health clinicians are challenged by the degree of specialization and clinical resources that these approaches require in their empirically validated adherent forms. While these effective treatments have renewed optimism for the treatment of BPD, clinicians may feel limited in their ability to offer any of them or may integrate an eclectic assortment of features from the different treatments. This article will evaluate four major evidence-based treatments for BPD—dialectical behavioral therapy, mentalization-based treatment, transference-focused psychotherapy, and General Psychiatric Management—and possible modes of implementation in adherent and integrative forms. Models of implementing these diverse treatment approaches will be evaluated, and the potential advantages of combining evidence-based treatments will be discussed, along with some cautionary notes. A proposal for providing stepwise care through assessment of clinical severity will be presented as a means of achieving system-wide changes and greater access to care.

From Harvard Medical School (Drs. Choi-Kain and Gunderson) and McLean Hospital, Belmont, MA (Drs. Choi-Kain and Gunderson, and Ms. Albert).

Original manuscript received 16 October 2015, accepted for publication subject to revision 4 December 2015; revised manuscript received 8 January 2016.

Correspondence: Lois W. Choi-Kain, MD, McLean Hospital, 115 Mill St., Belmont, MA 02478. Email:

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© 2016 President and Fellows of Harvard College
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