It is important to open our minds to the wide world of BPD. Psychiatry and psychology have not always responded well to BPD and this has coloured the discourse over the years. Today we are beginning to understand the disorder much better. Our own personal experience of BPD is only one perspective; there are many different manifestations of the disorder…over 250 different ways for it to be present, and different levels of severity too.

2009 Borderline Personality Disorder The Nice Guideline on Treatment and Management National Clinical Practice Guideline Number 78, Commissioned by the National Institute for Health and Clinical Excellence, published by The British Psychological Society and The Royal College of Psychiatrists. The NICE Guideline on Treatment and Management of BPD is the official UK guidelines. It is designed for those who work in the mental health system, to guide them. It gives us insight into the different ways BPD is considered in the UK. It is interesting to compare it with our own Australian Guidelines.

2009 Biosocial developmental model of borderline personality: elaborating and extending Linehan’s theory by Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. Published in Psychological Bulletin, 135(3), 495-510. doi: 10.1037/a0015616. This review extends on the proposed biosocial model of the development of BPD. It suggests that BPD initially starts with an early vulnerability that is expressed as impulsivity and followed by greater emotional sensitivity. This can be intensified by environmental risk factors that lead to further dysregulation.

2010 Report to Congress on Borderline Personality Disorder published by US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. This illuminating document was prepared by the US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). The main difference between this document and official documents in Australia is the acceptance in USA at the highest levels of the research that identifies a prevalence of BPD as 5.9%. This is an easy to read overview of BPD.

2010 NEA BPD Fact Sheet Borderline Personality Disorder A Most Misunderstood and Maligned Mental Illness, funded by the National Institute of Mental Health. Based on USA data, this fact sheet is simple, straightforward and easy to understand.

2011 Foundations for Change, Borderline Personality Disorder - Consumers' and Carers' Experiences of Care Summary Report, by Janne McMahon and Sharon Lawn. This is a summary report which provides an overview of the experience of the mental health system here in Australia. This is the beginning of a mapping of the Australian experience which will be regularly updated and will then be able to measure change across the country.

There is a 40 – 60 % genetic predisposition to the development of BPD. The environment of the person with BPD is critical to the development of the disorder. When we take into account Marsha Linehan’s statement that a person with BPD is like an emotional burns victim because of their high sensitivity, we can appreciate the importance of family relationships. All this and more requires a sensitive understanding for the person with lived experience of BPD and their families.

2008 Childhood Trauma in the Etiology of Borderline Personality Disorder: Theoretical Considerations and Therapeutic Interventions by Linda Baird. Childhood trauma in the aetiology of BPD can be a controversial discussion. Linda Baird from the USA studies the relationship between childhood trauma and attachment issues in relation to BPD. This paper is dense and an interesting discussion.   

2008  BPD's Interpersonal Hypersensitvity Phenotype: A Gene-Environment-Development Model  by John G Gunderson and Karlen Lyons-Ruth. Published by the National Institute of Health. Gunderson and Lyons-Ruth of the USA explore the role of hypersensitivity in the development of the child and the subsequent interactions within the family. This gene-environment interactional theory helps explain the development of BPD. The work acknowledges that while a basic physiological disposition for BPD is accepted, the clinical theories focus on the aspect of a disturbed relationship underpinning their work. The study explores how hypersensitivity effects attachment.    

2009 Borderline Personality Disorder: Ontogeny of a Diagnosis by John G Gunderson. The purpose of this paper is to describe the development of the diagnosis and in doing this it outlines how BPD has been seen from the pre 1970 position of an untreatable disorder, to 1990 when specific treatments were refined. Of interest is the reference to the study that found that treating patients as victims of abuse, usually made the condition worse highlighting that while childhood trauma (including sexual abuse) is related to BPD, “a history of such trauma is unnecessary…” and BPD “often develops without a history of significant trauma.”

2015 Trauma and Mental Health 10 year mental health plan technical paper. Published by the Victorian Government. This paper was prepared for a 10 year mental health plan by the Victorian Govt and refers to the importance of trauma informed care. It highlights that 1 in 3 Australian women and 1 in 6 men will have experienced sexual abuse before the age of 16. Also, 1 in 5 women and 1 in 20 men have experienced sexual violence since the age of 15. Helpfully the definition of trauma is given and discussed.

Gaining a diagnosis is a high priority for people with lived experience and their families. A diagnosis allows for people to learn and understand what has been happening to them.

2007 Why Psychiatrists are reluctant to diagnose Borderline Personality Disorder by Joel Paris. Published in  the January edition of Psychiatry. The paper considers the interface between BPD and Depression, Bipolar and Psychosis. The co-morbidities that commonly exist with BPD are often a reason for clinicians to avoid diagnosis. In this easy to read paper, Dr Paris suggests that giving a diagnosis does more justice than not giving a diagnosis.

2009 Emotion Dysregulation as a core feature of Borderline Personality Disorder by Catherine R Glenn and E David Klonsky. Published in Journal of Personality Disorders. There has been considerable discussion to rename BPD as Emotional Regulation Disorder. In this article, the researchers argue that emotional dysregulation is a unique aspect of BPD separate to issues of negative emotionality including depression, anxiety and negative affect.

2010 Borderline Personality Disorder and the Misdiagnosis of Bipolar Disorder by Camilo J Ruggero, Mark Zimmerman, Iwona Chelminski and Diane Young. Published in National Institute of Health. BPD is often misdiagnosed as Bipolar Disorder. The research this article is based upon concludes that regardless of how a patient meets the criteria of BPD, that is, regardless which of the criteria are present, people with BPD are at an increased risk of being diagnosed with Bipolar Disorder.

2010 Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population by Pagura, J., Stein, M. B., Bolton, J. M., Cox, B. J., Grant, B., & Sareen, J. Pubished in J Psychiatr Res. 44(16), 1190-1198. doi: 10.1016/j.jpsychires.2010.04.016. The overlap between BPD and PTSD shows that 30.2% of people diagnosed with BPD have PTSD and 24.2% of people diagnosed with PTSD have BPD. This comorbidity is associated with poorer quality of life and greater odds of attempting suicide.

2011 A BPD Brief - An Introduction to Borderline Personality Disorder: A Diagnosis, Origins, Course, and Treatment by John G Gunderson

2013 Revising the Borderline Diagnosis for DSM-V: An Alternative Proposal by John G Gunderson. Published in National Institute of Health. The Diagnostic Statistical Manual (DSM 5) is the authority for the definitions of mental illness that is commonly used in Australia. It is an American resource and it is regularly reviewed and updated. If we are to change the name of BPD, for example, it is the DSM that will do it. In 2013 the DSM was last updated. In spite of considerable discussion to update the diagnosis, it remained the same. Prior to this event, John Gunderson proposed a change to the diagnosis, suggesting the 4 sectors: Interpersonal Hypersensitivity, Emotional Dysregulation, Behavioural Dyscontrol and Disturbed Self. This article explains why.

2013 Disturbance of Self in Borderline Personality Personality Disorder: An Integrative Approach by Ross Michael Lafleur. Published by University of Wisconsin Milwaukee Digital Commons. The Disturbance of Self is a challenging concept to understand. This article was written towards the completion of a Masters in Psychology and looks at the literature available at the time and proposes an integrative approach to investigate the self in BPD. The paper provides a summary of the different psychological approaches to this concept in relation to BPD which provides an interesting perspective on the different schools of thought.

2014 Complex PTSD, affect dysregulation, and borderline personality disorder by Julian D Ford and Christine A Courtois. Published in BioMed Central. This paper explores the relationship between complex Post Traumatic Stress Disorder (cPTSD) and BPD and identifies that a core difference is the assumption that cPTSD is the result of exposure to traumatic stress. A detailed and dense discussion of the disorders concludes that there is considerable overlap but maintains there are two distinct disorders that require different treatments.

2014 Psychophysiological research of borderline personality disorder: Review and implications for biosocial theory by Tara Cavazzi and Rodrigo Becerra. Published by Edith Cowan University Research Online. We have included this Perth, WA paper for those who want to dig deep into the scientific discussion of tests to compare Psychophysiological Theory and Biosocial Theory.  The paper concludes that more research is needed to pursue this line of investigation.

2015 Classification, assessment, prevalence, and effect of personality disorder by Peter Tyrer, Geoffrey M Reed, and Mike J Crawford. Published in www.thelancet.com Vol.385, February 21 2015

2015 Borderline Personality Disorder by Joel Paris. Published in CMAI

2016 Personality Disorders in DSM-5: A Commentary on the Perceived Process and Outcome of the Proposal of the Personality and Personality Disorders Work Group by Kenneth R Silk. Published by the Harvard Review of Psychiatry

Post-traumatic stress disorder and attachment: possible links with borderline personality disorder by Felicity de Zuleueta

Complex PTSD, affect dysregulation and borderline personality disorder by Julian D Ford and Christine A Courtois. Published in BioMed Central

2018 Dilemmas in recovery-oriented practice to support people with co-occurring mental health and substance use disorders: a qualitative study of staff experiences in Norway by Brekke, E., Lien, L., Nysveen, K., & Biong, S. Published in Int J Ment Health Syst, 12(30), 1-9. doi: 10.1186/s13033-018-0211-5. This study shows the ethical dilemmas therapists face when treating clients with co-occurring mental health issues and substance use disorders. The first dilemma is between mastery and helplessness, where the therapist must find a balance between supporting the client while teaching them independence. The second focuses on being direct versus having a non-judgmental attitude toward the client. The third dilemma is between total abstinence and the acceptance of substance abuse in supporting clients to recovery. 

The burden of BPD on families is insufficiently understood. For families it is a traumatic experience for their loved one to have BPD. That a core element of BPD is ‘relational dysfunction’ indicates that there is an additional burden for family members. The genetic predisposition indicates that there may be family members also struggling with aspects of BPD themselves. When the mental health system abandons the person with BPD, the family is there to pick up the pieces. Sometimes the family rejects their loved one, sometimes the person with BPD rejects the family.

2006 SA Carers Charter Principals by Government of South Australia. This simple 2 page document spells out 7 Principles. Principle number 4 is: ‘Service providers work in partnership with carers.’ Although over 10 years old, the simplicity of this charter still informs us today.

2006 Family Guidelines, Multiple Family Group Program at McLean Hospital by John G Gunderson and Cynthia Berkowitz. Published by The New England Personality Disorder Association. The Family Guidelines are a good overall beginning for family members to begin to understand how best to support their loved ones with BPD. A worthwhile introduction to the subject.

2009 Carers and Supporting Recovery. A report commissioned by the Scottish Recovery Network. In Scotland research was done into what could help families support the recovery process. A small study, it highlighted the importance of ‘Carer Groups’ in this process. The conclusions of the study were that carers want to be more valued by mental health services, that they have the potential to assist the recovery process and that Carers Group are an important part of this process.  

2012 Supporting people in care relationships in Victoria. Published by the State Government of Victoria. This 2 page document relates to The Victorian Carers Recognition Act of 2012. It is an interesting document that sets out the principles of the Act and who is affected by the act (state govt departments, local councils and organisations funded by government).

2013 Burden and support needs of carers of persons with borderline personality disorder: a systematic review by Bailey, R. C., & Greyner, B. F. Published in Harvard Review of Psychiatry, 21(5), 248-258. doi: 10.1097/HRP.0b013e318a75c2c. This meta-analysis shows that carers of people with BPD experience burden, grief and impaired empowerment, as well as anxiety and depression.

2014 Inquiry into Social Inclusion and Victorians with Disability. Published by Family and Community Development Committee, Parliament of Victoria. The state government’s Family and Community Development Committee produced this report in 2014 in light of the changes that would occur with the introduction of the NDIS. The report identifies a number of recommendations under 8 categories as a way to improve the social inclusion of those with disabilities.

2015 Experiences of family carers of people diagnosed with borderline personality disorder by Lawn, S. & McMahon, J. Published in Journal of Psychiatric and Mental Health Nursing, 22, 234-243. doi: 10.1111/jpm.12193. The experiences of carers, their experiences of seeking help for a person with BPD and their own needs are considered in this research. It reveals that carers experience similar challenges and discrimination as those with BPD when it comes to seeking help from health services and highlights which areas need to be, and how they can be improved.

2016 A Practical Guide for Working with Carers of People with a Mental Illness. Published by Mind Australia and Helping Minds, this booklet sets out the 6 Partnership Standards to work with the families of those affected by mental illness. The first standard is that ‘Carers and the essential role they play are identified at first contact, or as soon as possible thereafter.’

2016 The economic value of informal mental health caring in Australia. Commissioned by Mind Australia. This informative report attempts to put a monetary value to the work of informal care by the ‘hidden’ workforce. The report identifies approximating 240,000 mental health carers in Australia in 2015, we would consider that a conservative figure indeed. The overall total replacement cost for informal care in 2015 was estimated at $14.3 billion.

New South Wales Civil and Administrative Tribunal - Administrative and Equal Opportunity Division. Chalker v Murrays Australia Pty Ltd [2017] NSWCATAD 112 (10 April 2017) http://www.austlii.edu.au/au/cases/nsw/NSWCATAD/2017/112.html

We have a vision of how a mental health system should be responsive to the needs of the community. There are some grand plans, but still we know that the amount of budget money directed towards mental health is sadly inadequate.

2006 Senate Report - Select Committee on Mental Health: A national approach to mental health - from crisis to community.  Document printed by the Senate Pricing Unit, Parliament House, Canberra. This large (nearly 600 pages) report is a thorough review of the Mental Health System of Australia. Of particular interest to the BPD Community is the recommendations relating to the need for state government to introduce dual diagnosis facilities within Emergency Departments, that there be specialised inpatient facilities for people with dual diagnosis, specialised programs within community health facilities to treat conditions such as personality disorders, and more.

2016 Borderline Personality Disorder in the Emergency Department: Good Psychiatric Management by Victor Hong. Published in Harvard Review of Psychiatry. Although this is a US paper, it is entirely relevant to the Australian context. The difficulties for people with BPD to receive appropriate care and attention in Emergency Departments, is well understood in the BPD Community. This paper considers the use of Good Psychiatric Management as a method to reduce harm and improve care.

2016 "Good Enough" Psychiatric Residency Training in Borderline Personality Disorder: Challenges, Choice Points and a Model Generalist Curriculum by Brandon T Unruh and John G Gunderson. Published in Harvard Review of Psychiatry. The paper identifies that the “prevailing disposition of psychiatrists toward the disorder remains characterized by misinformation, stigma, aversive attitudes, and insufficient familiarity with effective generalist treatments that can be delivered in nonspecialized health care settings.” To address these concerns, the authors suggest a generalist training program.

Sometimes controversial, sometime illuminating, the field of neuroscience is fascinating. There is much we can learn about BPD from this field of study. It was the understanding of the plasticity of the brain that brought us a glimmer of hope that we could understand, recovery is possible. MRIs and scans of the brains of people with BPD highlight the areas of the brain affected – the neural pathways from the amydala to the prefrontal cortex are limited which affects emotional regulation. We know that we can rebuild and strengthen neural pathways. And we know how hard that can be.

2015 The Heart, the Brain, and the Regulation of Emotion by Sarah N Garfinkel, Jessica A Eccles and Hugo D Critchley. Published in JAMA Psychiatry, Vol 72, No.11, November 2015. This is an interesting review of a study using ECGs which shows that people with BPD have a higher heartbeat which is a predictor of symptoms of emotional instability. While those in remission, have a more normal heartbeat. The importance of being able to detect one’s own heartbeat is also called into question. The findings have an impact on the use of treatments to enhance emotional regulation and self awareness.

Recovery is more than treatment. We can tie ourselves in knots talking about cures, symptoms, if BPD is a mental illness or not, and more. Those with BPD and their families want recovery. A simple definition of a person in recovery is if they can live independently (can care for themselves without relying on others for day to day living), have a productive occupation (this includes work that does not bring an income, eg volunteer work etc) and a minimum of two close personal relationships (family of origin, spouse, partner and close long term friendships). 

2015 Dialectical behaviour therapy and domains of functioning over two years by Wilks, C. R., Korslund, K. E., Harned, M., & Linehan, M. M. Published in Behav Res Ther 77, 162-169. doi: 10.1016/j.brat.2015.12.013, The course and prediction of recovery over a two-year period of DBT was investigated in this study. Significant improvements have been recorded, with emotion dysregulation being the greatest predictor of symptom improvement. Specifically, that higher levels of emotion dysregulation were related to a slower rate of improvement.

BPD Community’s mission is to replace stigma and discrimination with hope and optimism. It is stigma and discrimination that prevents recovery, the source of our hope and optimism.

1988 Personality disorder: The patients psychiatrists dislike by Glyn Lewis and Louis Appleby. Published in British Journal of Psychiatry. This landmark paper based upon research concluded that to have a Personality Disorder is an enduring pejorative judgement rather than a clinical diagnosis. It is hoped we have come some way since this report, but old attitudes and habits are hard to break.

2006 Borderline Personality Disorder: Stigma, and Treatment Implications by Ron Aviram, Beth Brodsky, Barbara Stanley. Published in Harvard Review of Psychiatry. The authors of this paper make the point that the very behaviours that make it difficult to work with people with BPD contribute to the stigma of BPD. The result of this is a self fulfilling prophecy and a cycle of stigmatisation. This excellent paper considers this point and more.

2007 Why Psychiatrists are Reluctant to Diagnose Borderline Personality Disorder by Joel Paris. Published in Psychiatry (January). Dr Paris from Canada explores the issue of the relationships between BPD and Depression, Bipolar and Psychoses. He identifies that many psychiatrists may withhold a diagnosis in the belief that it is stigmatising. He proposes that the patients with the same symptoms under a different name will still be stigmatised against. He also considers that thinking the disorder is untreatable lends to discrimination. He also suggests that the challenges in diagnosing require clinical judgement and this contributes to withholding of diagnosis.

2011 Foundations for Change Borderline Personality Disorder - Consumers' and Carers' Experience of Care Summary Report by Australian Medical Association on behalf of the Private Mental Health Consumer Carer Network (Australia). This Australian report in discussing the experience of those with lived experience of BPD and their families identifies the effect of stigma upon them. The report concludes that there are many problems in our mental health services in relation to BPD.

2012 Mental Illness in the news and the information media - A Critical Review by Jane Pirkis and Catherine Francis (April). This Australian study, searched for articles relating to mental illnesses but did not include Personality Disorders or BPD (or bipolar) in its search. Nonetheless it concluded that news and entertainment media often present a distorted and inaccurate picture of mental health and illness.

2013 Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review by Leonieke van Boekel, Evelien Brouwers, Jaap van Weeghel and Henk Garretsen. Published in the Elsevier Ireland. This Dutch study concluded that negative attitudes towards patients with substance abuse are common and this contributes to less the patients receiving less than optimal care.

2014 Reducing mental illness stigma in health care students and professionals: a review of the literature by Alison Stubbs. Published by Australasian Psychiatry (December).  An Australian Medical student conducted this study. It indicated that direct and some other forms of intervention were an effective short term strategy to reduce stigma, however to reduce stigma over the long term, it is recommended that further studies be undertaken before any wide scale interventions are implemented.

2015 Interventions Targeting Mental Health Self-Stigma: A Review and Comparison by Philip T. Yanos, Alicia Lucksted, Amy L. Drapalski, David Roe, and Paul Lysaker. Published in Psychiatric Rehabilitation Journal This review considers the effect of self stigma on people diagnosed with a mental illness. Self stigma is where the person concerned accepts and internalises the stigma they experience, believing it to be accurate.

2016 Borderline Personality Disorder, Stigma and Young People. Published by Orygen, The National Centre of Excellence in Youth Mental Health. Orygen (an Australian Mental Health provider for young people) published this paper. It particularly addresses the issues of gaining a diagnosis. The paper suggests that a tendency not to diagnose BPD in young people reinforces the stereotype of BPD as an enduring illness from which people have little chance of recovery. 

2016 The Stigma of Personality Disorders by Lindsay Sheehan, Katherine Nieweglowski and Patrick Corrigan. Sheehan defines stigma to arrive at four forms of stigma: public stigma, provider stigma, self stigma and structural stigma in relation to Personality Disorders. He concludes that the erroneous belief that Personality Disorders are not treatable underlies provider stigma and that structural stigma especially in relation to funding for these disorders, needs to be addressed.

2017 Stigma and Discrimination by BPD Community. 

2020 Consumer Perspective from people with a diagnosis of BPD. How are the NHMRC BPD Guidelines faring in practice? is by Proctor, Lawn and McMahon and published in Wiley. This study considers research done in 2011 and 2017 to assess changes in the perspective from people with BPD over time, especially since the publication of the national guidelines. The news is that stigma and discrimination still exists but there is improved understanding of BPD and widespread adaptation of the guidelines is not apparent.

2014 Functions of non-suicidal self-injury in adolescents and young adults with Borderline Personality Disorder symptoms by Naomi Sadeh, Esme A. Londahl-Shaller, Auran Piatigorsky, Samantha Fordwood, Barbara K. Stuart, Dale E. McNiel, E. David Klonsky, Elizabeth M. Ozer, Alison M. Yaeger. Published in Psychiatry Research.  This study considers non-suicidal self-harm in adolescents in general and in those with BPD and is able to identify that people with BPD self- harm for different reasons than the general self-harming adolescent. A person with BPD will tend to self-harm as a way to help regulate their emotions and to ‘punish’ themselves, the non BPD self-harm is related to bond with peers and the assert autonomy) Understanding this difference can inform treatment choices.

2015 Suicide Prevention 10-year Mental Health Plan Technical Paper. Published by the Department of Health and Human Services, State Government of Victoria. As part of its consultation on Mental Health, the Victorian Govt produced this paper to inform comment on the provision of services for suicide prevention.

2017 The role of DSM-5 borderline personality symptomatology and traits in the link between childhood trauma and suicidal risk in psychiatric patients by Bach, B., & Fjeldsted, R. Published in Borderline Personality Disorder and Emotion Dysregulation, 4(12), 1-10. doi: 10.1186/s40479-017-0063-7. This research shows that individuals who experienced childhood trauma and display BPD symptoms and traits are at greater risk of suicide. Especially the BPD traits of pessimism, guilt and shame and perceptual dysregulation such as dissociation accounted for the relationship between childhood trauma and suicidal risk in adulthood.

2017 A personal-recovery-oriented caring approach to suicidality: Unpublished doctoral dissertation by Sellin, L. of Mälarden University, Sweden.

There are 8 successful treatment types supported by meta data research and 4 supported by research. Of these Dialectical Behaviour Therapy (DBT) is the oldest therapy and possibly the most researched. Marsha Linehan developed this treatment and offers training and accreditation for qualified therapists. Mentalisation is a therapy often practised here in Australia. Schema therapy is also available, as is ‘General Psychiatric Management’. Two more recent therapies are ACT (Acceptance and Commitment Therapy) and Cognitive Analytical Therapy (CAT). The Australian National Guidelines for the Clinical Management of BPD has a good section explaining the different therapeutic approaches.

It is worth noting that there is no known medication that helps with BPD, although there is medication for anxiety and depression and other mental illnesses that might affect a person with BPD.

2003 Dialectical Behaviour Therapy (DBT) for Borderline Personality Disorder by M. Linehan. Retrieved from https://www.dbtselfhelp.com/html/linehan_dbt.html This article provides an overview of the DBT treatment model and its effectiveness, targeting biological and environmental factors. DBT aims to enhance the individual’s capability, motivation, generalisation of new learned skills, the capabilities and motivation of therapists and structure of the environment to support clinical progress, providing more effective results than treatment as usual.

2005 Attachment and Borderline Personality Disorder by Peter Fonagy. Published in Journal of the American Psychoanalytic Association. Peter Fonagy is an authority in Mentalisation treatment. In this article he explores the effect of early trauma based on fear of the caregiver which may inhibit the development of healthy attachment relationships.

2006 The Mechanisms of Change in the Treatment of Borderline Personality Disorder With Transference Focused Psychotherapy by Kenneth N Levy, John F Clarkin, Frank E Yeomans, Lori N Scott, Rachel H Wasserman, Otto F Kernberg . Published in Journal of Clinical Psychology, Vol 62(4). This exploration explains how this treatment works to bring about change for the person with BPD. Transference Focussed Psychotherapy is one of the treatment methods that has been shown to be effective in recovery.

2009 Mindfulness without meditation by Russ Harris. Published in HCPJ (October). This article by Australian Russ Harris explores ACT (Acceptance and Commitment Therapy). He explains that the aim of ACT is to accept what is outside your personal control and commit to taking action that enriches your life. ACT is about mindfulness within the context of values and committed action.

2011 Borderline Personality Disorder and Dialectical Behaviour Therapy in an Australian Private Hospital Setting: Treatment Response and BPD Subtypes by Patricia Altieri. This is the thesis of Dr Altieri. She explores the ‘domains’ of BPD identified by Dr Marsha Linehan in her study. These 5 domains are: emotional dysregulation; interpersonal dysregulation; behavioural dysregulation; cognitive dysregulation; and self dysfunction. The paper is worth a read if only to better understand these domains and what they mean.

2012 Attainment and Stability of Sustained Symptomatic Remession and Recovery Among Patients with Borderline Personality Disorder and Axis II Comparison Subjects: A 16 Year Prospective Follow-up Study by Mary C Zanarini, Frances R Frankenburg, D Bradford Reich, Garrett Fitzmaurice. Published in Am J Psychiatry. This study suggests that remission of symptoms is more common than sustained recovery and that both remission and recovery is more of a challenge for people with BPD than another personality disorder. Remission was defined as not meeting the criteria for BPD for 2 years or longer. Recovery was measured by a Global Assessment of Functioning score of 61 or more.

2013 A BPD Teaching Supplement for the Clinical Community by Frank Yeomans. This undated but extensive booklet Assoc Prof Frank Yeomans of Cornell University, USA was written after 2013 and is therefore reasonably up to date. It is an analysis of a book called Remnants of a Life on Paper, using it to teach clinicians about how to effectively treat BPD. It is easy to read too

2013 Mindfulness Practice, Rumination and Clinical Outcome in Mindfulness-Based Treatments by Lance L. Hawley, Danielle Schwartz, Peter J. Bieling, Julie Irving, Kathleen Corcoran, Norman A. S. Farb, Adam K. Anderson, Zindel V. Segal. Published in Springer Science+Business Media New York. The authors of this Canadian study identified that formal Mindfulness practice decreased ruination which in turn alleviated symptoms, however informal Mindfulness practice did not show the same results.

2013 How Personality became treatable: The mutual constitution of clinical knowledge and mental health law by Martyn Pickersgill. Published in Social Studies of Science. In UK, there was significant effort to introduce what became the 2007 Mental Health Act. Concurrently the perception of Personality Disorders was shifting from being untreatable to treatable. This paper studies how the interaction between the law and mental health professionals shaped the change in perceptions of Personality Disorders.

2016 Evidence Based Treatments for Borderline Personality Disorder: Implementation, Integration and Stepped Care by Lois W. Choi-Kain, Elizabeth B. Albert, and John G. Gunderson. Published in Harvard Review of Psychiatry. This paper considers 4 effective treatments: DBT, Mentalization, TRansferrance focussed psychotherapy and General Psychiatric Management. The authors propose stepwise care through assessment of clinical severity as a method to achieve system wide changes and greater access to care.

2017 Borderline Personality Disorder Psychological Treatment: An Integrative Review by Beverly Reeves-Dudley. Published in Elsevier. In this dense research, Gunderson categorises the therapy types as either psychodynamic or dialectical treatments. He also offers two models of treatment for consideration. He suggests the philosophical foundation for care that is the Tidal model of mental health recovery which has 10 essential values. He concludes that this study is limited to psychological aspects to treatments and suggests that more ‘inductive research’ is important.

2017 Efficacy of Psychotherapies for Borderline Personality Disorder A Systematic Review and Meta-analysis by Ioana A. Cristea, Claudio Gentili, Carmen D. Cotet, Daniela Palomba, Corrado Barbui, Pim Cuijpers. Published in JAMA Psychiatry. This international study considered the research already done on different psychotherapies. It found that Dialectical Behaviour Therapy and psychodynamic approaches are effective. The researchers however cautioned that the effects were inflated by risk of bias and publication bias.

2017 The value of psychological treatment for borderline personality disorder: Systematic review and cost offset analysis of economic evaluations by Denise Meuldijk, Alexandra McCarthy, Marianne E. Bourke, Brin F. S. Grenyer. Published in PLOS One. This Australian study identified that people with BPD consistently seek help and support from the mental health system and such use causes high costs. Nonetheless, the authors suggest that the economic reasons for providing treatments are high and should be prioritised for the person concerned and their family. The existence of a range of evidence based treatments, the authors consider, will lead to a reduction in healthcare costs.

2017 What works in the treatment of Borderline Personality Disorder by Choi-Kain, L. W., Finch, E. F., Masland, S. R., Jenkins, J. A., & Unruh, B. T. Published in Curr Behav Neurosci Rep, 4, 21-30. doi: 10.1007/s40473-017-0103-z. This paper reviews the effectiveness of specialist treatments such as dialectical behavioural therapy (DBT), mentalization-based therapy (MBT), schema-focused therapy (SFT), transference-focused psychotherapy (TFP) and systems training for emotional predictability and problem solving (STEPPS). A comparison is also made to two generalist approaches, namely general psychiatric management (GPM) and structured clinical management (SCM), which can be provided by general clinicians making therapy more accessible but equally effective.