{"id":12061,"date":"2020-11-24T03:03:01","date_gmt":"2020-11-24T01:03:01","guid":{"rendered":"https:\/\/neabpd-dev.niziilan.co.il\/?page_id=12061"},"modified":"2021-04-01T22:36:30","modified_gmt":"2021-04-01T19:36:30","slug":"gap-initiative-early-diagnosis","status":"publish","type":"page","link":"https:\/\/neabpd-dev.niziilan.co.il\/en\/gap-initiative-early-diagnosis\/","title":{"rendered":"GAP Initiative (Early Diagnosis)"},"content":{"rendered":"

Prevention and early intervention for borderline personality<\/strong>
\ndisorder: a novel public health priority<\/strong><\/p>\n

The article was published in World Psychiatry 16:2 – June 2017 (215-216) – click here to download the article in PDF format.<\/a><\/span><\/strong><\/h4>\n

There is now a broad evidence-based consensus that borderline
\npersonality disorder (BPD) is a reliable, valid, common and
\ntreatable mental disorder1. The adverse personal, social and economic
\nconsequences of BPD are severe. They include persistent
\nfunctional disability2, high family and carer burden3, incomplete
\neducation with fewer qualifications and disproportionately high
\nunemployment4, physical ill health5, greater burden of mental
\ndisorders, recurrent self-harm, and a suicide rate of around 8%1.
\nThe high economic costs of BPD (estimated to be e16,852 per
\npatient per annum in the Netherlands) are attributable to high
\ndirect treatment costs and high indirect costs, chiefly workrelated
\ndisability1. BPD is a stronger predictor of being on disability
\nsupport than either depressive or anxiety disorders6.<\/p>\n

Although BPD usually has its onset in the period between
\npuberty and emerging adulthood (young people)7, delay in the
\ndiagnosis and treatment is the norm, and discrimination against
\npeople with BPD is widespread. Specific treatment is
\nusually only offered late in the course of the disorder, to relatively
\nfew individuals, and often in the form of inaccessible,
\nhighly specialized and expensive services4. Accumulating evidence
\nindicates that such \u201clate intervention\u201d often reinforces
\nfunctional impairment, disability and therapeutic nihilism.<\/p>\n

The proliferation of knowledge about BPD in adolescents
\nand emerging adults (\u201cyouth\u201d) over the past two decades8,9
\nhas provided a firm basis for establishing early diagnosis and
\ntreatment (\u201cearly intervention\u201d) for BPD and for subthreshold
\nborderline personality pathology7. Several salient issues arise
\nfrom this literature. First, personality disorder begins in childhood
\nand adolescence, and can be diagnosed in young people.
\nSecond, DSM-5 BPD is as valid and reliable a diagnosis in
\nadolescence as it is in adulthood, based on similarity in prevalence,
\nphenomenology, stability and risk factors, marked separation
\nof course and outcome from other disorders, and efficacy
\nof disorder-specific treatment. Third, BPD is common among
\nyoung people: the estimated prevalence is 1-3% in the community,
\nrising to 11-22% in outpatients, and 33-49% in inpatients
\n7,8. Fourth, when BPD is compared with other mental
\ndisorders, it is among the leading causes of disability-adjusted
\nlife years (DALYs) in young people9. BPD is also a substantial
\nfinancial burden for the families of young people, with estimated
\naverage costs per annum in the US of $14,606 out-ofpocket,
\nplus $45,573 billed to insurance10. Fifth, the \u201cfirst
\nwave\u201d of evidence-based treatments has demonstrated that
\nstructured treatments for BPD in young people are effective4.
\nFinally, the weight of empirical evidence has led the DSM-5
\nand the UK and Australian national treatment guidelines to
\n\u201clegitimize\u201d the diagnosis of BPD prior to age 18.<\/p>\n

The Global Alliance for Prevention and Early Intervention
\nfor BPD had its origins at a meeting convened under the auspices
\nof the National Education Alliance for BPD in New York
\nin May 2014. The Alliance calls for action through a set of scientifically
\nbased clinical, research and social policy strategies
\nand recommendations.<\/p>\n

Clinical priorities<\/strong> include: a) early intervention (i.e., diagnosis
\nand treatment of BPD when an individual first meets DSM-5 criteria
\nfor the disorder, regardless of his\/her age) should be a routine
\npart of child and youth mental health practice; b) training of
\nmental health professionals in evidence-based early interventions
\nshould be prioritized; c) indicated prevention (preventing
\nthe onset of new \u201ccases\u201d by targeting individuals showing subthreshold
\nfeatures of BPD) currently represents the best starting
\npoint toward developing a comprehensive prevention strategy
\nfor BPD; d) early identification should be encouraged through
\nworkforce development strategies (knowledge about BPD as a
\nsevere mental disorder affecting young people should be disseminated
\namong trainees and clinicians in the child and youth
\nmental health professions; programs should address clinician=centred
\ndiscomfort with the label, mistaken beliefs, and prejudicial
\nand discriminatory attitudes and behaviour); e) the diagnosis
\nof BPD should not be delayed (non-diagnosis of BPD is discriminatory
\nbecause it denies individuals the opportunity to make
\ninformed and evidence-based treatment decisions, and excludes
\nBPD from health care planning, policy and service implementation,
\nultimately harming the young people\u2019s prospects); f) misleading
\nterms, or the intentional use of substitute diagnoses,
\nshould be discouraged (when sub-threshold BPD is present,
\nterms such as \u201cBPD features\u201d or \u201cborderline pathology\u201d are preferred);
\ng) family and friends should be actively involved as collaborators
\nin prevention and early intervention (typically, family
\nand friends are the \u201cfront line\u201d for young people with BPD, and
\ntheir central role should be recognized and supported).<\/p>\n

Research priorities<\/strong> are as follows: a) prevention and early
\nintervention for BPD must be integrated with similar efforts
\nfor other severe mental disorders, such as mood and psychotic
\ndisorders, acknowledging the \u201cequifinal\u201d and \u201cmultifinal\u201d pathways
\nfor the development of psychopathology; b) building a
\nknowledge base for a health care system response to prevention
\nand early intervention for BPD can take two approaches (for
\nindicated prevention and early intervention, a critical task is to
\nidentify risk factors for the persistence or worsening of problems,
\nrather than the \u201conset\u201d or incidence of disorder per se; or treatment
\ndevelopment can be based upon causal mechanisms that
\nunderlie risk, such as environmental adversities); c) novel, lowcost
\npreventive interventions that can be widely disseminated
\nshould be developed and evaluated (such interventions will need
\nto be developmentally appropriate, and stage\/phase specific,
\nincorporating stepped care service models); d) education and
\nskill development programs for families with a young person
\nwith BPD are a key priority for treatment research; e) research
\nneeds to fully quantify the educational, vocational and social
\noutcomes for young people with BPD; f) further development
\nand validation of brief and \u201cuser-friendly\u201d assessment tools is
\nneeded to promote the systematic use of standardized evaluation
\nin research and clinical settings; g) detailed health economic
\ndata are needed to support prevention and early intervention
\nprograms for BPD and should be included in all clinical trials; h)
\nresearch identifying methods to improve access to evidencebased
\ntreatments and reduce treatment dropout is a priority (this
\nshould include novel locations and formats for delivery of treatments,
\nsuch as in schools, out-of-home care, or youth forensic
\nsettings).<\/p>\n

Social and policy priorities<\/strong> include the following: a) BPD
\nneeds to be recognized as a severe mental disorder at all levels
\nof the health system; b) evidence-based policy is needed to
\naddress BPD from primary through to specialist care, with the
\naim of building a health care system response to prevention
\nand early intervention with young people and those who care
\nfor them as its focus, and including young people and families
\nas partners in the design of such systems; c) discriminatory
\npractices in health care systems must be eliminated, especially
\nregarding BPD as a \u201cdiagnosis of exclusion\u201d from services and
\nrefusing health insurance coverage for people with BPD.<\/p>\n

Andrew M. Chanen\u00b9, Carla Sharp\u00b2, Perry Hoffman\u00b3 and the Global<\/strong>
\nAlliance for Prevention and Early Intervention for Borderline<\/strong>
\nPersonality Disorder.<\/strong><\/p>\n

    \n
  1. Orygen, National Centre of Excellence in Youth Mental Health & Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia;<\/li>\n
  2. University of Houston, Houston, TX, USA;<\/li>\n
  3. National Education Alliance for Borderline Personality Disorder, USA<\/li>\n<\/ol>\n

    A. Chanen and C. Sharp are joint first authors of this letter. The Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder includes: B. Aguirre, G. Andersen, R. Barkauskiene, A. Bateman, E. Bleiberg, M. Bohus, R. Brunner, A. Chanen, L. Courey, S. Crowell, F. de Fruyt, M.-P. De Valdivia, M. Debban!e, B. De Clercq, K. Ensink, D. Flynn, P. Fonagy, A. Fossati, A. Fruzetti, L. Gervinskaite-Paulaitiene, M. Goodman, K. Goth, K. Gratz, J. Gunderson, K. Hall, S.B. Hansen, S. Herpertz, H. Herrman, C. Hessels, P. Hoffman, J. Hutsebaut, M. Jacobsen, M. Kaess, C. Kaplan, C. Kempinsky, R. Kissell, M. Kongerslev, B. Krueger, P. Luyten, K. Lyons-Ruth, J. Mazza, L. McCutcheon, P. McGorry, L. Mehlum, A. Miller, C. Mirapeix, A. New, J. Oldham, J. Paris, J. Rathus, M.E. Ridolfi, T. Rossouw, S. Schl\u20acuter-M\u20aculler, C. Schmahl, K. Schmeck, C. Sharp, R. Shiner, E. Simonsen, M. Speranza, B. Stanley, S. Stepp, J. Tackett, \u00d8. Urnes, R. Verheul, M. Wells, C. Winsper, S. Yen, M. Zanarini; the International Society for the Study of Personality Disorders, the European Society for the Study of Personality Disorders, the North American Society for the Study of Personality Disorders, the National Education Alliance for Borderline Personality Disorder USA, the National Education Alliance for Borderline Personality Disorder Australia, the National Education Alliance for Borderline Personality Disorder Israel, the National Education Alliance for Borderline Personality Disorder Italy, and the Sashbear Foundation.<\/p>\n

    1. Leichsenring F, Leibing E, Kruse J et al. Lancet 2011;377:74-84.
    \n2. Gunderson JG, Stout RL, McGlashan TH et al. Arch Gen Psychiatry 2011;
    \n68:827-37.
    \n3. Bailey RC, Grenyer BF. Harv Rev Psychiatry 2013;21:248-58.
    \n4. Chanen AM. J Clin Psychol 2015;71:778-91.
    \n5. El-Gabalawy R, Katz LY, Sareen J. Psychosom Med 2010;72:641-7.
    \n6. Ostby KA, Czajkowski N, Knudsen GP et al. Soc Psychiatry Psychiatr Epidemiol
    \n2014;49:2003-11.
    \n7. Chanen AM, McCutcheon LK. Br J Psychiatry 2013;202:s24-9.
    \n8. Sharp C, Fonagy P. J Child Psychol Psychiatry 2015;56:1266-88.
    \n9. The Public Health Group. The Victorian burden of disease study. Melbourne: Victorian Government Department of Human Services, 2005.
    \n10. Goodman M, Patil U, Triebwasser J et al. J Person Disord 2011;25:59-74.
    \nDOI:10.1002\/wps.20429<\/p>\n","protected":false},"excerpt":{"rendered":"

    Prevention and early intervention for borderline personality disorder: a novel public health priority The article was published in World Psychiatry 16:2 – June 2017 (215-216) – click here to download the article in PDF format. There is now a broad evidence-based consensus that borderline personality disorder (BPD) is a reliable, valid, common and treatable mental disorder1. The adverse personal, social<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"yoast_head":"\nGAP Initiative (Early Diagnosis) - NEABPD ISRAEL<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/neabpd-dev.niziilan.co.il\/en\/gap-initiative-early-diagnosis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"GAP Initiative (Early Diagnosis) - NEABPD ISRAEL\" \/>\n<meta property=\"og:description\" content=\"Prevention and early intervention for borderline personality disorder: a novel public health priority The article was published in World Psychiatry 16:2 – June 2017 (215-216) – click here to download the article in PDF format. 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