Borderline Personality Disorder in Adolescence: A Mentalizing Approach

Despite the fact that the diagnosis of personality disorder in youth is legitimized in psychiatric nomenclature (DSM 5 and the ICD-11) as well as national treatment guidelines in the United Kingdom and Australia, personality disorder is not routinely assessed for or treated in most child and mental health services. This workshop will review the existing evidence base for BPD in adolescents, followed by a discussion and demonstration of evidence-based approaches to the assessment and treatment of BPD in adolescents, with a specific focus on the development of identity and adolescence and a mentalization-based approach to understanding and treating personality pathology.

To achieve the above general aim, the course will include:

1. Introduction to the classification of personality disorders: Historical context; problems in classification and diagnosis of personality disorders.

2. Personality disorder in youth – what it is and why it matters: Participants will be provided with state-of-the-science information on the conceptualization of personality disorder as well as its correlates, causes and outcomes.

3. Assessment, diagnosis, and treatment of personality problem in youth: Participants will be provided with hand-on training in the assessment of personality problems in youth. The main treatment approaches will be introduced and discussed, with a particular focus on approaches that strengthen relationships and attachments

Mentalization-based approaches to treating and preventing personality pathology in youth: Participants will be introduced to the mentalization-based approach to increase the literacy of interaction in youth with personality pathology.

Required readings are indicated with asterisks *** in front. Other positions are advised to read.

Day 1: Introduction to the classification of personality disorders: Historical context; problems in classification and diagnosis of personality disorders.

*** Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., ... Zimmerman, M. (2017, March 23). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology. Advance online publication. http://dx.doi.org/10.1037/abn0000258

Hopwood, C.J., Kotov, R., Krueger, R.F., Watson, D., Widiger, T.A. et al. (2017). The time has come for dimensional personality disorder diagnosis. Personality and Mental Health, 12, 82-86.

Herpertz, S. C., Huprich, S. K., Bohus, M., Chanen, A., Goodman, M., Mehlum, L, Moran, P., Newton-Howes, G., Scott, L., & Sharp, C. (2017). The challenge of transforming the diagnostic system of personality disorders. Journal of Personality Disorders, 31, 577-590.

Sharp, C. (2016). Current trends in BPD research as indicative of a broader sea-change in psychiatric nosology. Personal Disord, 7(4), 334-343. doi:10.1037/per0000199

Sharp, C., Wright, A. G. C., Fowler, J. C., Frueh, B. C., Allen, J. G., Oldham, J., & Clark, L. (2015). The structure of personality pathology: Both general (‘g’) and specific (‘s’) factors? Journal of Abnormal Psychology, 124(2), 387-398.

Day 2: Personality disorder in youth – what it is and why it matters: Participants will be provided with state-of-the-science information on the conceptualization of personality disorder as well as its correlates, causes and outcomes.

Sharp, C. & Tackett, J. (2013). Handbook of Borderline Personality Disorder in Children and Adolescents. New York: Springer.

Chanen, A., Sharp, C., Hoffman, P., Global Alliance for, P., & Early Intervention for Borderline Personality, D. (2017). Prevention and early intervention for borderline personality disorder: a novel public health priority. World Psychiatry, 16(2), 215-216. doi:10.1002/wps.20429

*** Sharp, C. (2016). Bridging the gap: the assessment and treatment of adolescent personality disorder in routine clinical care. Arch Dis Child. http://dx.doi.org/10.1136/archdischild-2015-310072

Sharp, C., & Wall, K. (2017). Personality pathology grows up: adolescence as a sensitive period. Curr Opin Psychol, 21, 111-116. doi:10.1016/j.copsyc.2017.11.010

Day 3: Assessment, diagnosis, and treatment of personality problem in youth through a mentalizing lens: Participants will be provided with hand-on training in the assessment of personality problems in youth through a mentalizing lens.

Fonagy, P. (1989). On tolerating mental states: theory of mind in borderline personality. Bulletin of the Anna Freud Centre.

Fonagy, P., & Bateman, A. (2008). The development of borderline personality disorder-a mentalizing model. J Personal Disord, 22(1), 4-21.

*** Fonagy, P., & Luyten, P. (2009). A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol, 21(4), 1355-1381.

Sharp, C., & Kalpakci, A. (2015). Mentalization in borderline personality disorder: From bench to bedside. Personal Disord, 6(4), 347-355. doi:10.1037/per0000106

Day 4: Mentalization-based approaches to treating and preventing personality pathology in youth I: Participants will be introduced to the mentalization-based approach to increase the literacy of interaction in youth with personality pathology.

*** Sharp, C., & Rossouw, T. (in press). Treating adolescents with borderline pathology. In A. Bateman & P. Fonagy (Eds.), Handbook of Mentalizing in Mental Health Practice. Washington: APA.

Rossouw, T. I., & Fonagy, P. (2012). Mentalization-Based Treatment for Self-Harm in Adolescents: A Randomized Controlled Trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51(12), 1304-1313. doi:DOI 10.1016/i.jaac.2012.09.018

Sharp, C., & Fonagy, P. (2015). Practitioner Review: Borderline personality disorder in adolescence--recent conceptualization, intervention, and implications for clinical practice. J Child Psychol Psychiatry, 56(12), 1266-1288. doi:10.1111/jcpp.12449

Day 5: Mentalization-based approaches to treating and preventing personality pathology in youth II: Participants will be introduced to the mentalization-based approach to increase the literacy of interaction in youth with personality pathology.

*** Bateman, A., & Fonagy, P. (2016). Mentalization-based treatment for personality disorders: A practical guide. Oxford: Oxford University Press.

1. Gain an understanding of the classification and diagnosis of personality pathology in adults and youth.

2. Understand current debates around problems with the current classification systems.

3. Understand the barriers (myths) regarding early detection and intervention of BPD in adolescents.

4. Appreciate the evidence in support of the borderline diagnosis in youth.

5. Understand why adolescence is a sensitive period for the development of BPD.

6. Gain an understanding of personality disorder in youth, its correlates, causes and its outcomes.

7. Gain a perspective on the need for early identification and prevention and the role teachers and schools can play in prevention.

8. Know the key developmental theories on the development of BPD.

9. Gain basic knowledge for the identification of personality problems in school settings.

10. Gain an understanding of treatment approaches available.

11. Gain basic skills in mentalization-based approaches to intervention in youth with BPD.

70% grade: Final test with multiple choice and open-ended questions.

30% - Working with the written case study (individually) – including case conceptualization , planning treatment

No more than one class can be missed, irrespective of excuse

Students must respect the principles of academic integrity. Cheating and plagiarism (including copying work from other students, internet or other sources) are serious violations that are punishable and instructors are required to report all cases to the administration.