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PSICOTERAPIA EN EL TRASTORNO LÍMITE DE LA PERSONALIDAD: NUEVOS AVANCES
Authors: Gutiérrez López, M.I
Number of views: 9
Borderline personality disorders are considered a major problem within mental health given their severity and their high epidemiology. The high dysfunctionality in their behavior derived from their severe difficulty of emotional regulation is a central feature of the disorder and is evidenced on numerous occasions in the form of self-destructive behaviors, being its maximum exponent suicide attempts.
Borderline personality disorders involve high costs for health systems as well as for patients and their families themselves, especially if we consider that it is a disorder in which prolonged treatments and hospital admissions are usually performed when crises require it. It has also been reported that these patients are often hyperfrequenters of health services.
Due to their characteristics, borderline personality disorders pose a significant therapeutic challenge. The complexity of its clinical expression, the high frequency of comorbid disorders and the presence of other elements that prevent the proper development of therapy, such as premature abandonment of treatment, make them often considered difficult patients and the therapy is seen by clinicians and therapists as complex and frustrating.
Currently, psychotherapy is positioned as the first-line treatment for borderline personality disorders supplemented with pharmacotherapy aimed at reducing symptoms (1,2). Several psychotherapeutic models have adapted their intervention to limit personality disorders. Dialectical behavioral therapy is undoubtedly the treatment that has had the greatest expansion, being in the current literature frequent references to it. Other forms of treatment such as mentalization-based therapy or transfer-focused psychotherapy have received significant attention from the various authors.
Regarding the effectiveness of psychotherapy in borderline personality disorders we find an encouraging situation that shows the benefits that the different therapies exert on improving the reduction of symptoms, reducing self-injurious behaviour or increasing functionality and interpersonal adjustment.
Current evidence suggests that dialectical-behavioral therapy is the treatment of choice for borderline personality disorders, showing its effectiveness in both improving the symptomatology of boundary disorders(3) as in the reduction of self-injury and suicide attempts(4).
Other therapeutic models such as transfer-focused psychotherapy, mentalization-based therapy or interpersonal psychotherapy, despite having an important place in the treatment of borderline personality disorders have been noticeably less studied compared to dialectical-behavioral therapy.
Although the different authors find promising results in psychotherapy, it has been noted that the potency of the studies available to date is weak (3,5,6), so further analysis and study is recommended.
The aim of this paper is to analyse new developments in the efficacy of psychotherapy in borderline personality disorders through a systematic review of the studies published in the last 5 years. It also seeks to know the predictors of therapeutic success as well as those that hinder therapy.
A systematic review of the studies published in the last 5 years was carried out by searching for clinical trials present in PubMed, PsycINFO and The Crochrane Central Registrer of Controlled Trials databases.
Following this review, there is a greater prevalence of studies focused on the analysis of the efficacy of dialectical-behavioral therapy, with the other therapeutic models being the object of less research production. In general, a benefit of psychotherapy is found in the treatment of borderline personality disorders. Some predictors of therapeutic change and abandonment of treatment were also discovered.