Borderline Personality Disorder
Think Tank- From the National Institute of Mental Health (NIMH)
Jim Breiling, Ph.D.
National Institute of Mental Health
6101 Executive Blvd., Room 6-179
Bethesda, MD 20892-9651
(Express or Courier Service: Rockville, MD 20852)
E-mail: jbreilin@mail.nih.gov
Voice: 301-443-3527
Fax: 301-443-4611
Borderline Personality Disorder International Think Tank
June 21, 2004
The primary goals for the NIMH International Think Tank for the More
Effective Treatment of Borderline Personality Disorder are to contribute
substantially as a means to the ends of a monotonic acceleration in the rate
of
1. use of research findings and correlated clinical creativity for the development and validation of new treatment models and
methods that are more effective (more potent, more efficient, less expensive, and with fewer iatrogenic effects) for borderline personality
disorder, its underlying dimensions, features and symptoms, and for
enhancing positive functioning.
Some treatment evaluations have provided evidence of treatment effectiveness and so have provided encouragement for
viewing borderline personality disorder as a treatable disorder. We should
celebrate those results of yesterday, but then move on. Even the best
results leave abundant opportunity for substantial improvement in
alleviating the burden of suffering that borderline personality disorder
inflicts. This is to be expected. Our scientific understanding of borderline pd and treatment models and methods for this disorder are in a
very early stage of development. As our scientific understanding progresses, new models and more effective interventions can be expected to
emerge and in good part or entirely retire our current models and methods to
the historical record. So today, tomorrow and in the days to come, our
obligations is to work to accelerate and use advancements in science that
will enable new treatment models and methods that will be more effective in
alleviating the burden of suffering that borderline pd inflicts, and audacious as it may be to mention, also strive to achieve a cure.
2. translation of theories, methods, and findings from basic science, modern statistics and measurement science, and clinical
research for use in borderline personality disorder treatment development
and treatment evaluation research so that this research becomes THE leader
in the speed of developing and validating the most effective treatments and
for identifying with whom and how changes occur and specific treatment
methods work -- psychologically, behaviorally and biologically.
3. development of capacity for the collaborative and multidisciplinary treatment development and treatment evaluation research
and for obtaining the funding required to achieve the above ends.
June 28, 2004
A Quick Overview of Areas of Focus for NIMH's Think Tank for the
More Effective Treatment of BPD
Below are the major areas of focus and illustrative topics for each. Additional topics are welcome as are proposals for brief presentations of
perspectives informed by data and reports of research studies. The contributions of all scientists attending the think tank are welcome.
All investigators who are concerned to develop a strong CV are encouraged to
contact me about possible brief presentations. If accepted for inclusion on
the agenda, these can be legitimately be listed on CVs as invited presentations for NIMH's international think for the more effective
treatment of borderline personality disorder. At the very least, this
should be helpful with department chairpersons.
* The borderline pd diagnosis
Is the borderline pd DSM diagnosis too heterogeneous?
If one is to focus on components, what would be most desirable:
endophenotypes (major features) or other discrete focuses (subtypes)?
What about particular problems that are associated (but not unique) to
borderline pd? Should they be treated as discrete focuses or as part of a
type?
What about co-occurring disorders and the underlying constructs that
may account in good part for these co-occurrences?
How should underlying personality features be taken in to account in
assessment, in treatment, and in reporting study results?
* Treatment
Scientific status of and issues concerning psychosocial and
pharmacological interventions
More effective than no-treatment?
More effective than an attention (therapist-patient alliance
or placebo or efficacious natural agent, e.g., omega-3) control?
Do multiple treatment methods have an additive effect that reflects
the individual effects of the methods?
What is known about adverse side effects - e.g., "toxic"
psychotherapy, weight gain from medication(s)? Are steps taken to prevent
or minimize? Are alternatives sought when and possible?
What treatment is needed after two or three or more years, and how
effective is it?
Toward more effective treatment
Research indicated focuses for treatment
What provisions are there in current psychosocial treatment models and
pharmacological approaches and treatment research for increasing
effectiveness?
What is the status of and priority next steps for research on
mechanisms of change (for identifying the effective elements of treatment
and for illuminating the process by which change, whether treatment induced
or "natural, results)?
Imagining and psychophysiology: what understanding the brain might
contribute
Other new targets and avenues - some preliminary reports.
Interim reports on psychosocial and pharmacological treatment research
.
Engaging pharmaceutical company companies. .
Do the needed psychometrically strong measures exist for treatment
mediators and outcomes? (Without such measures, the likelihood of research
success is dim.) What measures are needed? Who will develop them using
state of the art psychometrics?
Clinical issues discussion
Illustrative topics:
Incorporating research in to clinical work
Maintaining the therapeutic relationship with the borderline
pd patient.
Treating PTSD in the BPD patient
NIMH treatment development and treatment evaluation grants
Consultation: Getting ready for a treatment research grant
Mentoring and model applications
A program for extensive and extended mentoring and training
Addressing design issues that impair the funding success of grant
applications: developing a consensus in the field on how to handle
medications, the appropriate control group(s), and regarding exclusion,
inclusion criteria.
High Priority, High Impact applications vs. pedestrian applications
* Next Steps
This Think Tank is not an end in itself, but a means to the overall end of reducing the burden of suffering that borderline pd inflicts, and
this will require actions to come out of this meeting that will advance the
research enterprise. What such actions would have the most significance, offer the most
traction, have the most impact?
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