General Psychiatric Management for Adolescents With Borderline Personality Disorder and Eating Disorders.

IF 2.3 Q2 PSYCHOLOGY, CLINICAL
Marcos S Croci, Marcelo J A A Brañas, Kristin N Javaras, Esther Dechant, Julia Jurist, Georgia Steigerwald, Lois W Choi-Kain
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Abstract

Borderline personality disorder and eating disorders frequently co-occur among youths. These disorders emerge in adolescence, during the critical developmental period of building an independent sense of self and the capacity to relate to one's community. Because of core differences in the development and psychopathology of borderline personality disorder and eating disorders, adjustments are required when treating these disorders when they co-occur. Few established treatment approaches can address these disorders simultaneously. Evidence-based psychotherapies for borderline personality disorder, such as dialectical behavior therapy and mentalization-based treatment, have been adapted to accommodate the shared vulnerabilities and features of the two disorders. However, these approaches are specialized, intensive, and lengthy and are therefore poorly suited to implementation in general psychiatric or primary health care, where most frontline mental health care is provided. Generalist approaches can fill this public health gap, guiding nonspecialists in structuring informed clinical management for these impairing and sometimes fatal disorders. In this overview, the authors describe the adjustment of good (or general) psychiatric management (GPM) for adolescents with borderline personality disorder to incorporate the prevailing best practices for eating disorder treatment. The adjusted treatment relies on interventions most clinicians already use (diagnostic disclosure, psychoeducation, focusing on life outside treatment, managing patients' self-destructive behaviors, and conservative psychopharmacology with active management of comorbid conditions). Limitations of the adjusted treatment, as well as guidelines for referring patients to specialized and general medical treatments and for returning them to primary generalist psychiatric care, are discussed.

对患有边缘型人格障碍和进食障碍的青少年进行一般精神病学管理》(General Psychiatric Management for Adolescents with Borderline Personality Disorder and Eating Disorders)。
边缘型人格障碍和进食障碍经常同时出现在青少年中。这些障碍出现在青春期,正是建立独立的自我意识和与社会建立联系的关键发展时期。由于边缘型人格障碍和进食障碍在发展和精神病理学方面存在核心差异,因此在治疗这两种障碍同时出现时需要做出调整。很少有成熟的治疗方法可以同时治疗这两种障碍。针对边缘型人格障碍的循证心理疗法,如辩证行为疗法和心智化疗法,已经进行了调整,以适应这两种障碍的共同弱点和特征。然而,这些方法都很专业、密集且耗时较长,因此不适合在普通精神科或初级卫生保健中实施,而大多数一线精神卫生保健都是在普通精神科或初级卫生保健中提供的。全科方法可以填补这一公共卫生空白,指导非专业人员对这些有损健康、有时甚至是致命的失调症进行有依据的临床管理。在这篇综述中,作者介绍了针对边缘型人格障碍青少年的良好(或一般)精神治疗(GPM)的调整,以纳入饮食失调治疗的现行最佳实践。调整后的治疗方法依赖于大多数临床医生已经在使用的干预措施(诊断公开、心理教育、关注治疗之外的生活、管理患者的自毁行为、保守的精神药理学并积极管理合并症)。本文还讨论了调整后治疗方法的局限性,以及将患者转介到专科和普通医疗机构进行治疗,以及将他们送回初级普通精神科治疗的指导原则。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
AMERICAN JOURNAL OF PSYCHOTHERAPY
AMERICAN JOURNAL OF PSYCHOTHERAPY PSYCHOLOGY, CLINICAL-
CiteScore
2.90
自引率
4.00%
发文量
39
期刊介绍: Founded in 1939, the American Journal of Psychotherapy (AJP) has long been a leader in the publication of eclectic articles for all psychotherapists. Transtheoretic in reach (offering information for psychotherapists across all theoretical foundations), the goal of AJP is to present an overview of the psychotherapies, subsuming a host of schools, techniques, and psychological modalities within the larger domain of clinical practice under broad themes including dynamic, behavioral, spiritual, and experiential.
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