Abbreviations vii Special terms used in this document viii Summary

About borderline personality disorder (BPD)

Making the diagnosis of BPD

Treatments for BPD

Making our health system work better for people with BPD

Supporting families, partners and carers of people with BPD

General principles of BPD care for all health professionals

Executive Summary

About the recommendations

Key recommendations

 Full list of recommendations

Introduction 

Purpose of this guideline 

Intended users of this guideline

 Target population

Healthcare settings to which this guideline applies

Background

The clinical need for this guideline

Methods used to develop this guideline

Scheduled review of this guideline

Funding

 Background

The diagnostic construct

Theories on the aetiology and pathogenesis of BPD

Trauma and BPD

34 2.4 Treatment goals for people with BPD 35 2.5 Considerations when interpreting the evidence 37 3. Managing risk factors and preventing BPD 39 3.1 Risk factors for BPD 39 3.2 Preventing BPD 42 Table of contents Clinical Practice Guideline for the Management of Borderline Personality Disorder iv National Health and Medical Research Council 4. Identifying and assessing BPD 43 4.1 Overview: diagnostic assessment for BPD 43 4.2 Identifying BPD features in young people 46 4.3 Diagnostic tools and assessments for BPD in young people 48 4.4 Clinical and resource implications for recommendations 1–7: identifying and assessing BPD 49 5. Managing BPD 51 5.1 Psychological therapies for BPD 51 5.2 Pharmacotherapy for BPD 59 5.3 Targeting specific outcomes 66 5.4 Complementary therapies for BPD 79 5.5 Delivery modes for BPD treatments 79 5.6 Multimodal treatments for BPD 80 5.7 BPD treatment for adolescents 82 5.8 Managing co-occurring health conditions in people with BPD 85 5.9 Managing complex and severe BPD 89 5.10 Cost-effectiveness of BPD treatments 90 5.11 Clinical and resource implications for recommendations 8–30: managing BPD 91 6. Organising healthcare services to meet the needs of people with BPD 93 6.1 Effectiveness and safety of BPD treatment delivered by different types of healthcare services 93 6.2 Effectiveness of treatments according to service type 95 6.3 Role of acute inpatient care 95 6.4 Role of long-term inpatient care 97 6.5 Role of specialised BPD services 98 6.6 Roles of various health professionals in BPD care 99 6.7 Coordinating care for people with BPD 102 6.8 Supporting health professionals who care for people with BPD 103 6.9 Clinical and resource implications for recommendations 31–50: organising healthcare services to meet the needs of people with BPD 106 7. Supporting families, partners and carers 107 7.1 Influence of families, partners and carers on BPD 107 7.2 Interventions directed at families, partners and carers to support the care of a person with BPD 109 7.3 Needs of families, partners and carers 112 7.4 Interventions to meet families’, partners’ and carers’ needs 116 7.5 Clinical and resource implications for recommendations 51–63: supporting families, partners and carers 120 8. General principles for treatment and care of people with BPD 121 8.1 Gaining trust and managing emotions 121 8.2 Setting boundaries 123 8.3 Managing transitions and endings 123 8.4 Developing a BPD management plan 124 8.5 Assessing and managing risk of self-harm or suicide 126 Table of contents Clinical Practice Guideline for the Management of Borderline Personality Disorder v National Health and Medical Research Council 9. Areas for future research 133 9.1 Risk Factors and prevention 133 9.2 Identifying and assessing BPD 133 9.3 Managing BPD 133 9.4 Organising services 134 9.5 Supporting families, partners and carers 134 10. Templates and resources 135 10.1 BPD management plan template 137 10.2 BPD crisis management plan template 141 11. Clinical questions 145 11.1 Identifying and assessing BPD 145 11.2 Managing risk factors and preventing BPD 145 11.3 Managing BPD 145 11.4 Organising healthcare services to meet the needs of people with BPD 146 11.5 Supporting families and carers 146 Appendices (see separate document available from: http://www.nhmrc.gov.au/guidelines/publications/mh25) List of tables Table i. Definitions of types of recommendations 5 Table ii. Definition of grades for evidence-based recommendations 6 Table 1.1 The need for improved BPD services in Australia 22 Table 1.2 Committee membership 23 Table 1.3 Declaration of interest 24 Table 1.4 BPD Guideline Committee terms of reference 27 Table 2.1 Some outcomes measured in clinical trials assessing BPD treatments 36 Table 3.1 Risk factors for BPD 39 Table 4.1 DSM-IV-TR diagnostic criteria for BPD 44 Table 4.2 ICD-10 diagnostic criteria for emotionally unstable personality disorder, borderline type 44 Table 4.3 Reasons to disclose the diagnosis of BPD to the person 46 Table 4.4 Instruments for screening BPD in young people 49 Table 5.1 Effect of psychological therapies on BPD: updated literature search 52 Table 5.2 Summary of meta-analysis of psychological treatment trials in BPD 55 Table 5.3 Pharmacological treatments in people with BPD: updated literature search 59 Table 5.4 Summary of meta-analysis of pharmacotherapy trials in BPD 62 Table 5.5 Effect of BPD interventions on mental state: updated literature search 67 Table 5.6 Effect of BPD interventions on quality of life: updated literature search 70 Table 5.7 Effect of BPD interventions on suicide and self-harm: updated literature search 71 Table 5.8 Effect of BPD interventions on use of healthcare services: updated literature search 72 Table 5.9 Effect of BPD interventions on social and interpersonal functioning: updated literature search 73 Table 5.10 Delivery modes for BPD care 80 Table 5.11 Multimodal therapies versus single-mode therapies 81 Table of contents Clinical Practice Guideline for the Management of Borderline Personality Disorder vi National Health and Medical Research Council List of tables (continued) Table 5.12 BPD treatment in adolescents: updated literature search 83 Table 5.13 Treatments for co-occurring health conditions in people with BPD 86 Table 5.14 Risk factors for BPD: updated literature search 90 Table 6.1 Effectiveness and safety of BPD treatment according to type of healthcare service 93 Table 6.2 Role of acute inpatient care for BPD 96 Table 6.3 Effectiveness of long-term inpatient care for BPD 97 Table 6.4 Supporting healthcare professionals for BPD care 104 Table 7.1 Principles for collaborating with families and carers 111 Table 7.2 Priorities for carers of people with mental illness 113 Table 7.3 Checklist for health professionals caring for children of parents with a mental illness 118 Table 8.1 Principles for working with people with BPD 122 Table 8.2 Planning transitions between services and treatments 124 Table 8.3 Components of a management plan for a person with BPD 125 Table 8.4 Indicators of increased suicide risk in people with BPD 127 Table 8.5 Principles of response to a BPD crisis 131 Table 8.6 What to do if a person with BPD is at high acute risk of suicide 132 List of figures Figure 1.1 Process used by the committee to synthesise evidence and formulate guideline recommendations 32 Figure 8.1 Estimating probable level of suicide risk based on self-harm behaviour 128

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