The guideline on Borderline Personality Disorder, commissioned by NICE and developed by the National Collaborating Centre for Mental Health, sets out clear, evidence- and consensus-based recommendations for healthcare staff on how to treat and manage borderline personality disorder.

Personality disorder now accounts for a substantial portion of the workload of most community mental health teams in the UK and borderline personality disorder is associated with significant functional impairments for the individual. The NICE guideline takes the first comprehensive view of the disorder and is an important resource for healthcare professionals to improve people’s long-term outcomes.

Recent years have seen an exponential rise in available treatments for personality disorder and the guideline on borderline personality disorder covers the available evidence on all of those interventions. It also includes management of crises, configuration and organisation of services and experience of care. The primary focus is on adults, but the guideline looks at emerging characteristics of borderline personality disorder in younger people. The guideline also considers the needs of those with learning disabilities and contains a useful overview of borderline personality disorder.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERS
• ACKNOWLEDGEMENTS
• 1. PREFACE
  • 1.1. NATIONAL GUIDELINE
  • 1.2. THE NATIONAL BORDERLINE PERSONALITY DISORDER GUIDELINE
• 2. BORDERLINE PERSONALITY DISORDER
  • 2.1. THE DISORDER
  • 2.2. DIAGNOSIS
  • 2.3. EPIDEMIOLOGY
  • 2.4. AETIOLOGY
  • 2.5. TREATMENT AND MANAGEMENT
  • 2.6. MULTI-AGENCY PERSPECTIVE
  • 2.7. YOUNG PEOPLE
  • 2.8. THE EXPERIENCE OF SERVICE USERS, AND THEIR FAMILIES AND CARERS
  • 2.9. ECONOMIC IMPACT
• 3. METHODS USED TO DEVELOP THIS GUIDELINE
  • 3.1. OVERVIEW
  • 3.2. THE SCOPE
  • 3.3. THE GUIDELINE DEVELOPMENT GROUP
  • 3.4. CLINICAL QUESTIONS
  • 3.5. SYSTEMATIC CLINICAL LITERATURE REVIEW
  • 3.6. HEALTH ECONOMICS REVIEW STRATEGIES
  • 3.7. STAKEHOLDER CONTRIBUTIONS
  • 3.8. VALIDATION OF THIS GUIDELINE
• 4. EXPERIENCE OF CARE
  • 4.1. INTRODUCTION
  • 4.2. PERSONAL ACCOUNTS
  • 4.3. REVIEW OF THE QUALITATIVE LITERATURE
  • 4.4. FAMILY AND CARER EXPERIENCE
  • 4.5. SUMMARY OF THEMES
  • 4.6. CLINICAL PRACTICE RECOMMENDATIONS
• 5. PSYCHOLOGICAL AND PSYCHOSOCIAL TREATMENTS IN THE MANAGEMENT OF BORDERLINE PERSONALITY DISORDER
  • 5.1. INTRODUCTION
  • 5.2. ARTS THERAPIES
  • 5.3. BRIEF PSYCHOLOGICAL INTERVENTIONS
  • 5.4. COMPLEMENTARY THERAPIES
  • 5.5. INDIVIDUAL PSYCHOLOGICAL THERAPIES
  • 5.6. COMBINATION THERAPY
  • 5.7. PSYCHOLOGICAL THERAPY PROGRAMMES
  • 5.8. THERAPEUTIC COMMUNITIES
  • 5.9. DATA BY OUTCOME
  • 5.10. OVERALL CLINICAL SUMMARY
  • 5.11. OVERALL SUMMARY OF ECONOMIC EVIDENCE
  • 5.12. CLINICAL PRACTICE RECOMMENDATIONS
  • 5.13. RESEARCH RECOMMENDATIONS
• 6. PHARMACOLOGICAL AND OTHER PHYSICAL TREATMENTS IN THE MANAGEMENT OF BORDERLINE PERSONALITY DISORDER
  • 6.1. INTRODUCTION
  • 6.2. ANTICONVULSANTS AND LITHIUM
  • 6.3. ANTIPSYCHOTICS
  • 6.4. ANTIDEPRESSANTS
  • 6.5. OMEGA-3 FATTY ACIDS
  • 6.6. NALOXONE
  • 6.7. EFFECT OF TREATMENT ON SYMPTOMS
  • 6.8. EFFECT OF TREATMENT ON GENERAL FUNCTIONING AND OTHER OUTCOMES
  • 6.9. EFFECT OF TREATMENT ON ACCEPTABILITY/TOLERABILITY OUTCOMES
  • 6.10. SUMMARY OF CLINICAL EVIDENCE REVIEW
  • 6.11. HEALTH ECONOMIC EVIDENCE
  • 6.12. CLINICAL PRACTICE RECOMMENDATIONS
  • 6.13. RESEARCH RECOMMENDATION
• 7. MANAGEMENT OF CRISES
  • 7.1. INTRODUCTION
  • 7.2. CURRENT PRACTICE
  • 7.3. REVIEWING THE EVIDENCE BASE
  • 7.4. GENERAL MANAGEMENT OF CRISES
  • 7.5. PHARMACOLOGICAL MANAGEMENT OF CRISES
  • 7.6. MANAGEMENT OF INSOMNIA
• 8. THE CONFIGURATION AND ORGANISATION OF SERVICES
  • 8.1. INTRODUCTION
  • 8.2. THE ROLE OF SPECIALIST SERVICES
  • 8.3. RISK FACTORS FOR SUICIDE IN PEOPLE WITH BORDERLINE PERSONALITY DISORDER
  • 8.4. THE ROLE OF INPATIENT SERVICES
  • 8.5. CARE PATHWAY
  • 8.6. RESEARCH RECOMMENDATION
  • 8.7. SPECIAL CONSIDERATIONS FOR PEOPLE WITH LEARNING DISABILITIES
  • 8.8. SPECIAL CONSIDERATIONS FOR PEOPLE FROM BLACK AND MINORITY ETHNIC GROUPS
• 9. YOUNG PEOPLE WITH BORDERLINE PERSONALITY DISORDER
  • 9.1. INTRODUCTION
  • 9.2. DIAGNOSIS
  • 9.3. STABILITY OF THE DIAGNOSIS OF BORDERLINE PERSONALITY DISORDER IN YOUNG PEOPLE
  • 9.4. SUICIDE RISK IN YOUNG PEOPLE WITH BORDERLINE PERSONALITY DISORDER
  • 9.5. ASSESSMENT
  • 9.6. TREATMENT
  • 9.7. SERVICE CONFIGURATION
  • 9.8. SUGGESTED CARE PATHWAY FOR YOUNG PEOPLE WITH BORDERLINE PERSONALITY DISORDER
  • 9.9. OVERALL CLINICAL SUMMARY
  • 9.10. CLINICAL PRACTICE RECOMMENDATIONS
• 10. SUMMARY OF RECOMMENDATIONS
  • GUIDANCE
  • RESEARCH RECOMMENDATIONS
• 11. APPENDICES
  • APPENDIX 1. SCOPE FOR THE DEVELOPMENT OF THE CLINICAL GUIDELINE
  • APPENDIX 2. DECLARATIONS OF INTERESTS BY GDG MEMBERS
  • APPENDIX 3. SPECIAL ADVISORS TO THE GUIDELINE DEVELOPMENT GROUP
  • APPENDIX 4. STAKEHOLDERS AND EXPERTS WHO SUBMITTED COMMENTS IN RESPONSE TO THE CONSULTATION DRAFT OF THE GUIDELINE
  • APPENDIX 5. RESEARCHERS CONTACTED TO REQUEST INFORMATION ABOUT UNPUBLISHED OR SOON-TO-BE PUBLISHED STUDIES
  • APPENDIX 6. CLINICAL QUESTIONS
  • APPENDIX 7. SEARCH STRATEGIES FOR THE IDENTIFICATION OF CLINICAL STUDIES
  • APPENDIX 8. CLINICAL STUDY DATA EXTRACTION FORM
  • APPENDIX 9. QUALITY CHECKLISTS FOR CLINICAL STUDIES AND REVIEWS
  • APPENDIX 10. OUTCOMES
  • APPENDIX 11. PHARMACOLOGY PEER REVIEWER CONSULTATION TABLE
  • APPENDIX 12. SEARCH STRATEGIES FOR THE IDENTIFICATION OF HEALTH ECONOMICS EVIDENCE
  • APPENDIX 13. QUALITY CHECKLIST FOR ECONOMIC STUDIES
  • APPENDIX 14. DATA EXTRACTION FORM FOR ECONOMIC STUDIES
  • APPENDIX 15. EVIDENCE TABLES FOR ECONOMIC STUDIES PSYCHOLOGICAL AND PSYCHOSOCIAL TREATMENTS IN THE MANAGEMENT OF BORDERLINE PERSONALITY DISORDER BRIEF PSYCHOLOGICAL INTERVENTIONS
  • APPENDIX 16. STUDY CHARACTERISTICS TABLES
  • APPENDIX 17. CLINICAL EVIDENCE FOREST PLOTS
  • APPENDIX 18. GRADE EVIDENCE PROFILE TABLES
• 12. REFERENCES
• 13. ABBREVIATIONS

The views presented in this book do not necessarily reflect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity (no. 229642).