Clinical guidelines for psychotherapy for patients with borderline personality disorder.

In planning a course of psychotherapy for borderline patients, clinicians must take into account the heterogeneity of the clinical presentation in the borderline domain. Borderline personality disorder is usually accompanied, for example, by one or several "symptom disorders," such as an eating disorder, depression, posttraumatic stress disorder, premenstrual tension, dissociative disorder, or anxiety disorder--not to mention one or more other personality disorders. The nature of the "comorbidity" in each patient will determine which medications, if any, are applicable. The accompanying personality disorders will have an impact on amenability to psychotherapy. The main forms of therapy currently in use are supportive, cognitive-behavioral (including dialectical behavioral therapy) and psychodynamic (including transference-focused psychotherapy). Group therapy is often used adjunctively with any of these approaches. The main question is no longer, Which of these approaches is best, overall? but rather, Which approach is best for which type of borderline patient? Contemporary research is addressed to this latter question.