Psychotherapy for Borderline Personality Disorder: Does the Type of Treatment Make a Difference?

Purpose of Review: The first aim of this review is to summarize the major evidence-based psychotherapies for borderline personality disorder (BPD) and the research supporting their use. The second aim is to explore the evidence for the differential effectiveness of these treatments. Recent Findings: Four types of specific psychotherapies are identified that show promising results in at least two randomized controlled trials. In addition, several adjunctive and minimal/pragmatic interventions are available that are supported by research evidence. Recent findings highlight the applicability of these treatments across settings and populations and have begun to show that modified versions of them are also beneficial. Summary: There is solid evidence that various specific therapies are superior to treatment as usual in the community for borderline personality disorder. There is no reliable evidence that any of these specific treatments is more effective than any other, however. In addition, existing treatments have many elements in common that may be responsible in part for their effects. Future research will be needed to uncover the influence of various study design factors, patient characteristics, and treatment parameters on psychotherapy outcome for BPD

An Initial Study of Practicing Psychologists\u27 Views of the Utility of Ecological Momentary Assessment for Difficult Psychotherapy Cases

Ecological momentary assessment (EMA) is a burgeoning area of research, and several clinical applications of the resulting data have been identified by researchers, suggesting potential benefit to psychotherapy practice. However, practitioners often do not use traditional empirically-supported tools for diagnosis and outcome monitoring (e.g., validated interview measures and questionnaires). Thus, it is not clear how readily practitioners will take up newer technology-enhanced assessment methods, despite current enthusiasm among researchers. The current study aimed to explore the perceived usefulness of EMA-based tools for clinical assessment and outcome monitoring of difficult psychotherapy cases, as well as to identify correlates of attitudes about the usefulness of these tools. Clinical psychologists in active therapy practice with adults (n = 375) completed an internet survey including the Attitudes toward Standardized Assessment scale and the Attitudes toward Standardized Assessment Scales-Monitoring and Feedback. Respondents characterized their current diagnostic and outcome monitoring practices and rated how helpful they would find several assessment and outcome monitoring resources for a difficult case, including both traditional instruments and EMA-based methods. EMA-based tools had lower perceived usefulness than existing instruments. Attitudes toward standardized assessment and outcome monitoring predicted the perceived utility of these methods, as did several professional variables. Practicing psychologists may not adopt EMA for clinical assessment more readily than traditional assessment tools. Recommendations for facilitating the uptake of new technologies by psychotherapists are offered

Age Differences in the Desirability of Narcissism

Young adult narcissism has been the focus of much discussion in the personality literature and popular press. Yet no previous studies have addressed whether there are age differences in the relative desirability of narcissistic and non-narcissistic self-descriptions, such as those presented as answer choices on the Narcissistic Personality Inventory (NPI; Raskin & Hall, 1979). In Study 1, younger age was associated with less negative evaluations of narcissistic (vs. non-narcissistic) statements in general, and more positive evaluations of narcissistic statements conveying leadership/authority. In Study 2, age was unrelated to perceiving a fictional target person as narcissistic, but younger age was associated with more positive connotations for targets described with narcissistic statements and less positive connotations for targets described with non-narcissistic statements, in terms of the inferences made about the target’s altruism, conscientiousness, social status, and self-esteem. In both studies, age differences in the relative desirability of narcissism remained statistically significant when adjusting for participants’ own narcissism, and the NPI showed measurement invariance across age. Despite perceiving narcissism similarly, adults of different ages view the desirability of NPI answer choices differently. These results are important when interpreting cross-generational differences in NPI scores, and can potentially facilitate cross-generational understanding

The Availability of Training Opportunities in Personality Disorders in American Psychological Association- and Psychological Clinical Science Accreditation System-Accredited Clinical and Counseling Psychology Doctoral Programs

Personality disorders are relatively common, especially in clinical settings. A number of evidence-based treatments are now available, especially for borderline personality disorder. However, little is known about the relevant training available to doctoral students in clinical and counseling psychology. in the current study, data were extracted from 336 clinical and counseling Ph.D. and Psy.D. programs from the Insider’s Guide to Graduate Programs in Clinical and Counseling Psychology (Norcross & Sayette, 2020), including the number of programs with faculty with specific interests in personality disorders and the number of programs with clinical opportunities related to personality disorders. We found that formal training in personality disorders is not widely available to most trainees in APA-accredited doctoral training programs. Only 16% of programs have faculty with interests in personality disorders, all of them clinical psychology programs. Ph.D. programs were more likely to have PD-interested faculty than Psy.D. programs, and, within clinical Ph.D. programs, PCSAS-accredited programs were more likely to have PD-interested faculty than programs without PCSAS accreditation. Similarly, only 15% of programs (all clinical psychology programs) offer practicum opportunities in psychotherapy for personality disorders. Our findings indicate that doctoral level psychology programs are not sufficiently preparing their students with personality disorder training, which serves as a substantial disservice to both trainees and the public

Individual Differences and Stability of Dynamics among Self-Concept Clarity, Impatience, and Negative Affect

Self-concept clarity (SCC) is associated with behavioral and emotion regulation, although the nature of this link is unclear. SCC may serve as a self-regulatory resource or it may be a product of well-regulated behaviors and emotions. In two studies using experience sampling among undergraduates (n = 46 and n = 36), we investigate whether models representing relationships among SCC, impatience, and negative affect (NA) states conform to these theories, are similar across individuals, and are stable across a one-month period. Results reveal substantial variation between persons in these dynamic relationships, suggesting that multiple SCC-relevant regulatory processes exist. These patterns were not stable from one month to the next, but changes in them related to changes in stress, suggesting higher-order regulation of these dynamics

Community and Clinical Epidemiology of Borderline Personality Disorder

Several studies of the prevalence of Borderline Personality Disorder (BPD) in community and clinical settings have been carried out to date. Although results vary according to sampling method and assessment method, median point prevalence of BPD is roughly 1%, with higher or lower rates in certain community subpopulations. In clinical settings, BPD prevalence is around 10-12% in outpatient psychiatric clinics and 20-22% among inpatient clinics. Further research is needed to identify the prevalence and correlates of BPD in other clinical settings (e.g., primary care) and to investigate the impact of demographic variables on BPD prevalence

Does \u27Fear of Dying\u27 Indicate a More Severe Presentation of Panic Disorder?

Research suggests a relationship between the presence of fearful cognitions and panic disorder (PD) severity. With little existing evidence addressing the clinical significance of individual panic-cognitions, the current study examined presentation and impairment differences among 331 outpatients with PD according to whether they experience “fear of dying” (FOD) during panic attacks. Patients reporting FOD (n = 153) were compared to patients denying FOD (n = 178) on variables indicating PD severity (e.g., number of symptoms) and psychiatric impairment (e.g., hospitalizations). PD patients with FOD reported a greater number of panic symptoms, agoraphobia diagnoses, and were more likely to be seeking treatment primarily for PD. We found no clinical impairment or comorbidity differences between groups. Results suggest that panic attacks with FOD are related to a more acute presentation of PD. Such results substantiate past research connecting cognitive distress and PD severity and further suggest that FOD may be particularly relevant to this relationship

The Clinical Significance of Single Features of Borderline Personality Disorder: Anger, Affective Instability, Impulsivity, and Chronic Emptiness in Psychiatric Outpatients

Although dimensional models of borderline personality disorder (BPD) are consistent with findings showing that minimal levels of pathology are associated with substantial increases in psychosocial impairment, it is still unclear whether different individual BPD criteria are each clinically significant on their own. The current study uses semistructured interview data from 1,870 adults presenting for outpatient psychiatric treatment to investigate whether the BPD criteria of impulsivity, affective instability, emptiness, and anger are each related to psychosocial morbidity when met in the absence of the other eight criteria. Analyses showed that each of these criteria was associated with dysfunction in comparison with a control group meeting zero BPD criteria, but only the emptiness criterion was a marker of impairment on all indices of psychosocial morbidity: suicidality, history of suicide attempts and psychiatric hospitalizations, social and work dysfunction, Axis I comorbidity, and global functioning. Implications for the study of borderline pathology are discussed

The Role of Emotion Regulation Difficulties in the Connection Between Childhood Emotional Abuse and Borderline Personality Features

In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined the role of emotion dysregulation as a mediator between childhood abuse and borderline personality disorder (BPD) feature severity among a sample of 964 adults presenting for treatment at an outpatient clinic. A structural equation model suggested that emotional abuse relates to BPD features both directly and through difficulties with emotion regulation, whereas physical abuse showed only a weak indirect relation with BPD features. There was no link between sexual abuse and BPD feature severity in the model. Results add specificity to etiological theories of BPD and suggest that future research in treatment should focus on developing and strengthening emotion regulation strategies in clinical populations with a history of emotional abuse. Clinicians should be sure to assess the presence of childhood emotional abuse in addition to sexual and physical abuse