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Hi my name is Dr Elizabeth Buchanan and today I'm going to be

giving an overview of the general

psychiatric management of borderline personality disorder.

This presentation was given by Dr john

Gunderson through the Harvard Medical School.

Unfortunately, shortly after the chorus concluded, Dr Gunderson passed away,

Harvard posted a lovely memoriam to him on

their website that I thought was worth sharing

during this course.

He was very passionate and you could tell how dedicated

he was to borderline personality disorder treatment throughout his lifetime.

The last sentence really sums up

his work and that this was his final opportunity to teach about GPM,

which is a model he created and is now considered the gold standard

for BPD treatment.

Next I just listed the D. S. M. Five diagnostic criteria.

We all know that there's eight of them.

And if the client meets five or more that that indicates a BPD diagnosis,

clients with BPD often get worse from uninformed treatment.

Treatment of BPD is not done consistently.

This is supported by the prevalence statistic which states that 20% of psychiatric

admissions

are from BPD clients.

This is greater than bipolar and schizophrenia admissions. Combined,

Borderline personality disorder clients also account for 9% of all er visits.

And when we consider how often the Ed is used

and how often it is misused. This is a really significant and staggering statistic.

Most clinicians don't like treating BPD patients which in the next

side we'll talk about some myths and how to approach them.

There's also a shortage of adequately trained BpD treaters

which is something that Dr Gunderson highlighted a lot.

The general psychiatric management model

highly stresses that there is no need for special

training or specialist to adequately treat these clients.

These plants also deserve

and should be able to assume that their clinician is informed on how to treat them.

Thank you.

These clients also have a unique disorder that they are incorrectly treated.

It will actually worsen

their diagnosis,

meaning that they will become more symptomatic more frequently.

Next that there are five myths that many of us

know about and I think they're worth acknowledging and debunking.

So the first one is that BPD patients resist treatment.

Mhm.

And while it is well documented that clients often

get worse when starting to work with the clinician,

that this is often a sign

or a symptom of their diagnosis

and not non compliance

nor refusal to treatment.

So it's really important that we challenge us as clinicians to try to understand if

they are really declining treatment or if

they are just having that they're symptomatic,

and that what they're expressing is a symptom of BPD.

The second myth is that BPD patients angrily attacked their treaters.

Again, this can often be

seen as an angry attacked, but it's actually a symptom of their disorder

in an event, that there is an angry attack or an

escalated interaction with the client.

The general psychiatric management model encourages

the clinician to use this as an

opportunity to discuss that this is a symptom of their disorder and provide

input and advise them on less maladaptive ways to deal with their symptoms.

The third myth is that BPD patients rarely get better

as you can see the statistics listed below,

But many BPD clients actually improve on their own with no treatment.

The 4th Myth

is that

Riak current risk of suicide burdens treaters with

excessive responsibility and the ongoing risk of litigation.

If the clinician ever feels burdened by the clients, ask or what they required,

it is of course

important to prioritize the clinicians well being.

Um but moving the client to a higher level of clear will also benefit the client.

The general psychiatric management approach

highly encourages clinicians to provide

higher level care when needed.

The last myth is that BPD patients get better

only if given extended intensive treatment by experts.

The whole basis and purpose of

creating the general psychiatric management approach

is too

inform clinicians that clients will get

equally as better and have just as much improvement

without specialist training.

And a quote

untrained clinician

yields clinically significant improvements in these patients.

So why does B. P. D. Have such a bad reputation?

Well, for 20 years, they were profoundly mistreated

in the sense that they were not given the treatment that would benefit them.

In fact, it had a counter

a counter active approach.

So for 20 years psychoanalysis was considered

the gold standard for treating clients with BPD

when the utilization of psychoanalysis was retested.

It was revealed that this approach was actually triggering to the clients

and triggered their worst fears which are being watched,

abandoned whether real or perceived

and or being uncared for.

Listed below is the article written by Dr Henderson

which expands in great detail on his model.

Its benefits,

focuses and communicates how non specialists are

equally as successful in treating these clients.

I'll briefly go over six of the distinct features of Gpm.

Um but we will go into each one in separate modules within this training.

So first diagnostic disclosure is an essential first step and

there's a whole portion of the training that's dedicated to that

interpersonal hypersensitivity.

This is the core of the psychopathology of borderline personality disorder

which is very high yield.

And we will go into the explanation of that, what that looks like,

how that was formed and the emotional and behavioral shifts that come with

interpersonal hypersensitivity.

Next case management focuses on like outside of treatment, not within

DR Gunderson had a great quote that

um we want these clients not to be good at therapy but to be good at life

the course

and the social handicaps that come along with this diagnosis.

A lot of these statistics information and new literature are

very helpful and indicative of where BPD treatment is headed

Next. We're going to

discuss progress which determines the duration and intensity of treatment

and how to navigate that.

Lastly,

psychodynamic

and behavioral

attributes are discussed and reflected on

this image is particularly important because it

gives a quick snapshot into what the literature

yielded.

So as you can see on the left,

it's the evidence based treatment that we are more familiar with

T. F. P.

Being transference focused psychotherapy which is

related and highlights on interpersonal relationships

and they it was equally as effective as supportive therapy.

Under the generalist model.

As you can see cognitive analytical therapy and MBT which

is mental ization based therapy which is long term psychotherapy

also had the same results as structured clinical management.

Lastly is the most important and kind of groundbreaking finding which is that DBT

dialectical behavioral therapy which is the go to for BPD treatment and symptom

management was equally as effective as

the good psychiatric management generalist model.

These findings again were

were tested at great length for validity

and

this finding indicates

um that using the generalist model would be more cost effective.

Moving forward because no special training

would be required for clinicians to treat

borderline personality disorder with the same amount of effectiveness.

This next image um

kind of expands on the last one.

The first row says

decreasing hospitalization self harm and depression

when using G. P. M. It is equally as effective as DVT

and with increasing co morbidity.

Using GPM was actually had

greater results than DVT.

The

representation of RCT findings.

RCT standing for randomized control trial which is the highest level and most valid

research study that can be conducted validates that DVT and GPM are seen equally.

However, GPM again is more cost effective because of the

um

no additional training is needed.

This is the article that expands on that

and talks about

the R. C. T.

That um challenged DVT against GPM and what those detailed findings were.

Before we conclude this portion of the modules I wanted to

discuss briefly the psychotherapy indications that Dr Gunderson expanded on.

So the client should only be seen once a week individually

after about eight weeks of that. If that's

bound to be unsuccessful, it is appropriate to move them to higher level of care.

If GPM fails,

that's fine psychotherapy approaches would be more

beneficial to the client at that point,

meaning they would need DBT

um

M M B T N T F. P.

They would also need medication management,

family involvement and group therapy.

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