Integrating early intervention for borderline personality disorder and mood disorders

Chanen, Andrew M., Berk, Michael and Thompson, Katherine 2016, Integrating early intervention for borderline personality disorder and mood disorders, Harvard review of psychiatry, vol. 24, no. 5, pp. 330-341, doi: 10.1097/HRP.0000000000000105.

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Title Integrating early intervention for borderline personality disorder and mood disorders
Author(s) Chanen, Andrew M.
Berk, MichaelORCID iD for Berk, Michael
Thompson, Katherine
Journal name Harvard review of psychiatry
Volume number 24
Issue number 5
Start page 330
End page 341
Total pages 13
Publisher Wolters Kluwer
Place of publication Philadelphia, Pa.
Publication date 2016-09
ISSN 1465-7309
Keyword(s) adolescence
bipolar disorder
borderline personality disorder
clinical staging
early intervention
risk factor
Summary Borderline personality disorder (BPD) has been demonstrated to be a reliable and valid construct in young people (adolescents and young adults). Both borderline- and mood-related psychopathology become clinically apparent from puberty through to young adulthood, frequently co-occur, can reinforce one another, and can be difficult to differentiate clinically. This Gordian knot of overlapping clinical features, common risk factors, and precursors to both BPD and mood disorders complicates clinical assessment, prevention, and treatment. Regardless of whether an individual crosses an arbitrary diagnostic threshold, a considerable proportion of young people with borderline- and mood-related psychopathology will develop significant and persistent functional, vocational, and interpersonal impairment and disability during this critical risk and developmental period. There is a clear need for early intervention, but spurious diagnostic certainty risks stigma, misapplication of diagnostic labels, inappropriate treatment, and unfavorable outcomes. This article aims to integrate early intervention for BPD and mood disorders in the clinical context of developmental and phenomenological change and evolution. "Clinical staging," similar to disease staging in general medicine, is presented as a pragmatic, heuristic, and trans-diagnostic framework to guide prevention and intervention. It acknowledges that the early stages of these disorders cannot be disentangled sufficiently to allow for disorder-specific preventive measures and early interventions. Clinical staging defines an individual's location along the continuum of the evolving temporal course of a disorder. Such staging aids differentiation of early or milder clinical phenomena from those that accompany illness progression and chronicity, and suggests the application of appropriate and proportionate intervention strategies.
Language eng
DOI 10.1097/HRP.0000000000000105
Field of Research 110319 Psychiatry (incl Psychotherapy)
1103 Clinical Sciences
1702 Cognitive Science
Socio Economic Objective 920410 Mental Health
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2016, President and Fellows of Harvard College
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