Update on Psychiatry Residency Training in Personality Disorders: Becoming a Good Psychiatrist Through Becoming "Good Enough" at Treating Borderline and Narcissistic Personality Disorders.

Abstract

Purpose of review: We review recent clinical developments in borderline personality disorder and personality disorders more broadly, as well as changes in national psychiatry residency training guidelines in an effort to establish a roadmap for psychiatry residency training directors to create curricula to prepare residents to manage these disorders.

Recent findings: Though no randomized controlled trials exist, small studies demonstrating positive effects of teaching specialized treatment models to residents in programs with resources in these areas. The ACGME's Milestones 2.0 and their relevance for personality disorder curriculum are discussed. Narcissistic Personality Disorder (NPD), its increasing importance in public and clinical consciousness, and recent developments in diagnosis, theory, and manualized treatments are noted, including a recent model of group psychoeducation. The current state of dimensional models for personality including the DSM 5 Section III (the Alternative Model for Personality Disorders) and ICD-11's version introduced in 2022 are reviewed. Given BPD's widespread prevalence, especially in the clinical setting, and the combination of the disorder's complexity, comorbidity, and treatment challenges, we argue that devoting curricular resources to teaching about BPD makes good educational sense. We present a model curriculum based on the generalist approach of Good Psychiatric Management (GPM). This, we argue, can allow programs without specialist faculty to provide "good enough" preparation of residents for treating BPD, while also allowing more resource rich programs to add specialized Evidence Based Treatment (EBT) training for interested residents. We also offer GPM's adapted approach to NPD as the basis for residency curricula for this important disorder. Finally, we propose ways to teach the use of the Alternative Model for Personality Disorders in the classroom setting, and in working with NPD patients.