This document summarizes the results of a study on therapeutic interventions for borderline personality disorder (BPD). The study examined the most effective interventions for BPD, skills needed by providers, and best locations for services. Focus groups and surveys found Dialectical Behavior Therapy and Acceptance and Commitment Therapy were most effective. Key provider skills included non-judgment, understanding, and compassion. Respondents felt public mental health and independent practitioners were best equipped to treat BPD, if given more training, resources, and support for individuals and families. The study highlights the need for a trauma-informed, tailored approach to meeting treatment needs of those with BPD.

1. Therapeutic Interventions for
Borderline Personality Disorder
Peter King
PhD Candidate
Student Number: 3280215
Email: s3280215@student.rmit.edu.au

2. © Peter King 15/08/2016 RMIT University - School of Global, Urban and Social Studies 2
Background
• Global prevalence of between 1.4% and 5.9%
(Samuels, et al., 2002; Coid, et al., 2006; Lenzenweger, et al., 2007; Grant et al., 2008; Trull, et al., 2010).
• Australian data identifies a prevalence of 1% (NHMRC, 2012)
• BPD diagnosis in public mental health system
– up to 23% of psychiatric services outpatient
– up to 43% of inpatient populations’ (NHMRC, 2012).
• High mortality rate
– up to 10% of individuals with BPD suicide a rate almost
50 times higher than general population (American Psychiatric
Association, 2001)
• 65-80% incidence of non-suicidal self-injury (NSSI)
(Brickman, et al., 2014)

3. © Peter King 15/08/2016 RMIT University - School of Global, Urban and Social Studies 3
Background
• BPD represents approximately 6% of all primary care
attendees (Dubovsky and Kiefer, 2014)
• BPD in certain populations, estimated 18% in chronic pain
patients and 26% in depression within all primary care
attendees (Dubovsky and Kiefer, 2014)
• 85% of individuals diagnosed with BPD also meet the
criteria for other mental illnesses or other personality
disorders (Koerner & Linehan, 2000)
• Individuals receiving DSP: BPD more common then mood
and anxiety disorders combined (Ostby, 2014)
• Large proportion of individuals with BPD receiving no
treatment and/or the system is difficult to navigate/access

4. RMIT University - School of Global, Urban and Social Studies 4
Background
• No evidence in the literature of which therapeutic treatment to offer for any
particular service type nor service location, nor could a consensus-based
recommendation be made by an Australian expert panel to identify best
practice.
– 7.2.1 Summary of evidence: which BPD treatments to offer according to service type
No studies were identified.
– 7.2.2 Discussion: which BPD treatments to offer according to service type
The Committee determined that there was insufficient evidence to formulate evidence-based recommendations on
the efficacy of specific BPD therapies to be delivered by particular types of healthcare services, and elected not to
make consensus-based recommendations.
(NHMRC, 2012, p.123)
© Peter King 15/08/2016

5. RMIT University - School of Global, Urban and Social Studies 5
Research Questions
• What are the most effective therapeutic interventions for working
with individuals diagnosed with borderline personality disorder
• What skills, knowledge and attributes aide effectively delivery of
therapeutic interventions when working with individuals
diagnosed with borderline personality disorder?
• Where are services for people with borderline
personalitydisorder best located?
© Peter King 15/08/2016

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Results: Most Effective Interventions
Elements of Interventions (from focus groups)
– “Mindfulness”
– “non-judgmental approach”
– “consistent and clear”
– “a mixture of skills development in dealing with relationships,
coping with crisis and emotions, and being able to focus on what is
happening now”
– “life skills, group work, individual therapy and helping in stressful
times”
–“Interventions which are specific to the situation and are
individalised”
© Peter King 15/08/2016

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Results: Most Effective Interventions
Specific Therapeutic Interventions (from online survey)
• Dialectical Behaviour Therapy (DBT) (rank = 2.03)
• Acceptance & Commitment Therapy (ACT) (rank = 4.64)
• Mindfulness (rank = 5.45)
• Mindfulness Based Cognitive Therapy (MBCT) (rank = 5.55)
• Mentalization-Based Treatment (MBT) (rank = 6.06)
• Psychotherapy (rank = 6.06)
• Psychoeducation (rank = 6.06)
• Cognitive Behavioural Therapy (CBT) (rank = 6.18)
• Cognitive Analytic Therapy (CAT) (rank = 7.73)
• Life-Skills Programs (rank = 7.76)
• Psychopharmacology (rank = 8.48)
© Peter King 15/08/2016

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Results: Skills, Knowledge & Attributes
• Focus Group Discussion
– “Compassion”
– “Flexibility”
– “Understanding”
– “Non-judgment”
– “Patience”
– “Professional knowledge”
– “Thick Skin”
– “Appropriate training and supervision”
– “not taking things personally”
– “experience”
– “open to feedback and need for further supervision”
© Peter King 15/08/2016

9. Results: Skills, Knowledge & Attributes
Level of Importance Clarified via Online Survey
• Specific skills, knowledge and attributes of a trauma informed and recovery
approach were identified by respondents as important
–100% (n = 35) non-judgmental stance
– 97% (n = 34) understanding
– 94 % (n = 33) compassion
– 91% (n = 32) supervision
– 89% (n = 31) evidence informed approaches
– 89% (n = 31) specific education
RMIT University - School of Global, Urban and Social Studies 9© Peter King 15/08/2016

10. Results: Skills, Knowledge & Attributes
Are current supervision and education arrangements meeting need to
develop mental health professionals?
– 88% (n = 31) would like to improve their ability to respond to individuals
with BPD and BPD traits
• Specific attributes were identified by respondents as important for effective
therapeutic interventions
–100% (n = 35) open to feedback
– 97% (n = 34) professional knowledge
– 91% (n = 32) supervision
– 88% (n = 31) specific education
RMIT University - School of Global, Urban and Social Studies 10© Peter King 15/08/2016

11. Results: Skills, Knowledge & Attributes
• Mental health professional’s confidence in performing role
– 89% (n = 31) respondents felt confident in performing their role to
individuals with BPD
– with further professional development, 85% (n = 30) respondents would
feel more confident in performing their role to individuals with BPD
– 74% (n = 26) respondents believe their personal beliefs and experiences
aid the ability to perform their role
RMIT University - School of Global, Urban and Social Studies 11© Peter King 15/08/2016

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Results: Service Locations
• Focus Group Discussion
– “When in crisis the public mental health services”
– “Not-for-profit with the support of a skilled mental health
professional with specific knowledge of Borderline Personality
Disorder”
– “Primary practice with the support of groups and counselling”
– “Treatment is least desirable in the public mental health service
unless the presentation is crisis driven and requires intensive
response”
– “A warm non-clinical environment with specialist staff”
– “Somewhere where the person can feel most comfortable going to
receive therapy, interact with others in a group and in their own
environment where most of the distress occurs”
© Peter King 15/08/2016

13. Results: Service Locations
Most effective service location ranked by respondents (most effective = 1 to
least effective = 5)
Current Service Funding With Resources & Funding
1. Public Mental Health
2. Private Mental Health Services
3. Independent Practitioners
4. Primary Mental Health
5. Mental Health Community
Support Services (MHCSS)
RMIT University - School of Global, Urban and Social Studies 13
1. Public Mental Health
2. Independent Practitioners
3. Primary Mental Health
4. Private Mental Health Services
5. Mental Health Community
Support Services (MHCSS)
© Peter King 15/08/2016

14. Results: Service Locations
• Additional resources identified by respondents:
– Staffing
– Training Funds & Adequate Training
– BDP Specific Programs and Program Staffing
– Allocation of Appropriate Time to Perform Role
– Clear Practice Guidelines
– More input to include Consumer Perspectives
– More options for individuals with BPD
– Family Support
– Supervision
– Collegial & Service Collaboration
RMIT University - School of Global, Urban and Social Studies 14© Peter King 15/08/2016

15. Significance for treatment needs of individuals
diagnosed with BPD
• Recovery and trauma informed approach
• Treatment tailored to individual needs
• Two treatment periods: Acute Crisis Care and Therapeutic
Interventions
• Stigma! roadblock to effective treatment
• A non-judgmental approach is highly desired
• Education and Development opportunities = effective treatment
• Mental Health professionals are motivated to support individuals with
BPD although feel ill-equipped
• A range of skills, qualities and attributes make an effective clinician!
• Consumers and Carers want support and a consistent approach
RMIT University - School of Global, Urban and Social Studies 15© Peter King 15/08/2016

16. Next Steps
• Dissemination of results to participants
• Presentation of findings to Spectrum
• Completion of Thesis and Thesis Submission
• Submit methodology, literature review, findings and future research
for publication
• Research to inform publication ‘Somatic Trauma Therapy Workbook’
• Future Research Opportunities:
– Two treatment periods: Acute Crisis Care and Therapeutic
Interventions
– Resource and Funding Allocations for Effective Treatment
– Specific Training Requirements
– Phased treatment approaches
RMIT University - School of Global, Urban and Social Studies 16© Peter King 15/08/2016

17. References
American Psychiatric Association (2001) Work Group on Borderline Personality Disorder Practice
guideline for the treatment of patients with borderline personality disorder. American Journal of
Psychiatry.158(Suppl):1–52.
Brickman, L. J., Ammerman, B. A., Look, A. E., Berman, M. E., & McCloskey, M. S. (2014). The
relationship between non-suicidal self-injury and borderline personality disorder symptoms in a college
sample. Borderline Personality Disorder and Emotion Dysregulation, 1(1), 14. doi:10.1186/2051-6673-
1-14
Coid, J. (2006). Prevalence and correlates of personality disorder in great Britain. The British Journal
of Psychiatry, 188(5), 423–431. doi:10.1192/bjp.188.5.423
Crane, Philip & O'Regan, Maureen (2010) On PAR : Using Participatory Action Research to Improve
Early Intervention. Department of Families, Housing, Community Services and Indigenous Affairs,
Australian Government, Canberra.
Dubovsky, A. N., & Kiefer, M. M. (2014). Borderline personality disorder in the primary care setting.
Medical Clinics of North America, 98(5), 1049–1064. doi:10.1016/j.mcna.2014.06.005Grant et al.,
2008
Koerner, K., & Linehan, M. M. (2000). Research on dialectical behavior therapy for patients with
borderline personality disorder. Psychiatric Clinics of North America, 23(1), 151–167.
doi:10.1016/s0193-953x(05)70149-0
Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality
disorders in the national Comorbidity survey replication. Biological Psychiatry, 62(6), 553–564.
doi:10.1016/j.biopsych.2006.09.019
RMIT University - School of Global, Urban and Social Studies 17© Peter King 15/08/2016

18. References
National Health and Medical Research Council. (2012). Clinical Practice Guideline for the
Management of Borderline Personality Disorder. Retrieved from
https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/mh25_borderline_personality_guideli
ne.pdf
Østby, K. A., Czajkowski, N., Knudsen, G. P., Ystrom, E., Gjerde, L. C., Kendler, K. S., … Reichborn-
Kjennerud, T. (2014). Personality disorders are important risk factors for disability pensioning. Social
Psychiatry and Psychiatric Epidemiology, 49(12), 2003–2011. doi:10.1007/s00127-014-0878-0
Sameuls, J. (2002). Prevalence and correlates of personality disorders in a community sample. The
British Journal of Psychiatry, 180(6), 536–542. doi:10.1192/bjp.180.6.536
Trull, T. J., Jahng, S., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010). Revised NESARC personality
disorder diagnoses: Gender, prevalence, and Comorbidity with substance dependence disorders.
Journal of Personality Disorders, 24(4), 412–426. doi:10.1521/pedi.2010.24.4.412
Wadsworth, Y. (1998) What is Participatory Action Research? Action Research International, Paper 2.
Retrieved from: http://www.aral.com.au/ari/p-ywadsworth98.html
RMIT University - School of Global, Urban and Social Studies 18© Peter King 15/08/2016