Management of borderline personality disorder using the STEPPS Program

Donald W Black

Management of borderline personality disorder using the STEPPS Program

Donald W Black

University of Lowa, USA

: Int J Ment Health Psychiatry

Abstract

Borderline personality disorder (BPD) is a disorder of dysregulated emotions that is prevalent, disabling, and challenging to treat. The author presents data on the definition of BPD, its epidemiology and risk factors, etiology, course and outcome, and clinical management strategies. While medication had limited success in treating the symptoms of BPD, group therapy programs have been developed in the past two decades, and many are now evidence-based. Clinical management strategies are reviewed including the use of psychotropic medication, the role of group treatment programs and lifestyle changes. The author has extensively researched and written about the systems training for emotional predictability and problem solving (STEPPS) program that was developed at the University of Iowa in 1995 and has now been disseminated widely, including within the UK. STEPPS is a 5 month program that utilizes a mix of cognitive-behavioral elements, psycho-education and skills training. Randomized clinical trials conducted in the US and the Netherlands and uncontrolled studies, showed the program to reduce the symptoms of BPD, lift mood, reduce negative affectivity, reduce self-harm, and reduce health care utilization. The program has also been shown to be effective in BPD patients in correctional settings. The program is well accepted by patients and therapists. More work is needed to learn which patients are most likely to benefit from the program.