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Abstract

Progress in understanding borderline personality disorder has unfolded in the last decade, landing in a new COVID-19–influenced world. Borderline personality disorder is now firmly established as a valid diagnosis, distinct from its co-occurring mood, anxiety, trauma-related, and behavioral disorders. Further, it is also understood as a reflection of general personality dysfunction, capturing essential features shared among all personality disorders. Neuroimaging research, representing the vast neurobiological advances made in the last decade, illustrates that the disorder shares frontolimbic dysfunction with many psychiatric diagnoses but has a distinct signature of interpersonal and emotional hypersensitivity. This signature is the conceptual basis of the psychotherapies and clinical management approaches proven effective for the disorder. Medications remain adjunctive and are contraindicated by some guidelines internationally. Less invasive brain-based therapeutics show promise. The most significant change in the treatment landscape is a focus on briefer, less intensive formats of generalist management. Shorter variants of therapies, such as dialectical behavior therapy and mentalization-based treatment, are in the process of being shown to be adequately effective. Earlier intervention and greater emphasis on functional improvement are needed to more effectively curb the disabilities and risks of borderline personality disorder for patients and their families. Remote interventions show promise in broadening access to care.

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Published in print: Fall 2022
Published online: 25 October 2022

Keywords

  1. Borderline personality disorder
  2. neuroimaging
  3. dimensional classification
  4. treatment planning
  5. psychotherapy
  6. psychopharmacology
  7. Treatment assessment & planning

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Lois W. Choi-Kain, M.D., M.Ed. [email protected]
Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston.
Zeynep Sahin, Ph.D.
Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston.
Jenna M. Traynor, Ph.D.
Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston.

Notes

Send correspondence to Dr. Choi-Kain ([email protected]).

Competing Interests

Dr. Choi-Kain receives book royalties from Springer Publishing and the American Psychiatric Association. Dr. Traynor is a coinvestigator on a Multidisciplinary Association for Psychedelic Studies (MAPS)-funded clinical trial of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy; she has also received compensation as an independent contractor for the role of study therapist on a MAPS-funded clinical trial of MDMA-assisted psychotherapy. Dr. Sahin reports no financial relationships with commercial interests.

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