No Simple Way to Judge Borderline Personality Disorder Treatment Success
Borderline personality disorder (BPD) is diagnosed with reference to a range of nine potential symptoms, and people affected by the condition may have only a few of these symptoms in common. In a study review published in January 2015 in the journal Borderline Personality Disorder and Emotional Dysregulation, researchers from two U.S. institutions examined the methods used to treat BPD and assessed the likelihood of developing a simple way to judge treatment success. These researchers concluded that there is no simple metric by which physicians can measure borderline personality disorder treatment outcomes.
Diversity of Borderline Personality Disorder
All people with borderline personality disorder have entrenched personality traits that make it difficult for them to do such things as control their thought processes or emotions, avoid acting impulsively or maintain stable relationships with friends, acquaintances or loved ones. The American Psychiatric Association includes the illness in a larger group of conditions known as cluster B personality disorders, all of which feature problems with unpredictable, excessively dramatic and/or unusually intense emotional responses. The other three cluster B illnesses are narcissistic personality disorder, histrionic personality disorder and antisocial personality disorder.
Even though BPD centers on a core group of personality-related issues, the condition can manifest in starkly different ways in different individuals. This is true, in part, because any affected individual must have only five out of nine possible symptoms before receiving an official diagnosis. Practically speaking, this means that any two people dealing with borderline personality disorder may seem to have little in common. For example one person may have prominent problems with suicidal thought and behavior (one of the most severe BPD-related symptoms), while another person may lack any suicide-related issues and instead have prominent problems with things such as extreme fear of abandonment, highly volatile mood changes and acts of purposeful self-injury not associated with suicidal thinking or suicide attempts.
Doctors typically start borderline personality disorder treatment with some form of psychotherapy, the National Institute of Mental Health reports. Specific options commonly in use include cognitive behavioral therapy and two partially related approaches called dialectical behavior therapy and schema-focused therapy. Additional possible therapies for people with BPD include a family-focused form of dialectical behavior therapy and a technique called Systems Training for Emotional Predictability and Problem Solving (STEPPS). There are no medication options specifically designed to help individuals affected by borderline personality disorder. However, doctors may prescribe medications to address particular aspects of the illness. In some cases, women with BPD may benefit from the doctor-directed use of omega-3 fatty acid supplements.
How Can We Measure Recovery?
In the study review published in Borderline Personality Disorder and Emotional Dysregulation, researchers from the Menninger Clinic and the Baylor College of Medicine looked at the various outcomes that mental health professionals may use to measure recovery from borderline personality disorder. They also explored the potential of developing a relatively quick and convenient method of measuring recovery in any given individual.
After completing an analysis of a large number of well-designed, modern studies, the researchers concluded that diversity is a hallmark of the attempts to measure the outcomes of BPD treatment. For example, when measuring recovery, some doctors rely on objective assessments of their patients’ moods and behaviors. However, other doctors rely on subjective reports submitted by their BPD-affected patients. Diversity of approach also extends to the specific signposts that doctors use to measure their patients’ recovery. For example, some physicians place an emphasis on “primary” indications of recovery such as a reduction in suicidal thought and action, increased mood stability and a reduction of interpersonal conflicts with others. These physicians tend to place less emphasis on “secondary” indications of recovery such as compliance with the terms of treatment and a general reduction in their patients’ distress levels. However, some doctors view both primary and secondary treatment outcomes as important signs of recovery. Crucially, the researchers note, no two studies under consideration used the same overall criteria to measure successful BPD treatment.
The study’s authors concluded that, even if clinicians and researchers were able to devise a single set of criteria for measuring recovery from borderline personality disorder, it would be highly improbable that anyone could develop a quick and convenient method of using such criteria in a doctor’s office. Practically speaking, all of this means that BPD recovery will remain largely a matter of case-by-case assessment.