Treatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs?
Open accessAbstract
OBJECTIVES: This study aimed to assess the supply of and demand for treatment of borderline personality disorder (BPD) to inform current standards of care and training in the context of available resources worldwide. METHODS: The total supply of mental health professionals and mental health professionals certified in specialist evidence-based treatments for BPD was estimated for 22 countries by using data from publicly available sources and training programs. BPD prevalence and treatment-seeking rates were drawn from large-scale national epidemiological studies. Ratios of treatment-seeking patients to available providers were computed to assess whether current systems are able to meet demand. Training and certification requirements were summarized. RESULTS: The ratio of treatment-seeking patients with BPD to mental health professionals (irrespective of professionals' interest or training in treating BPD) ranged from approximately 4:1 in Australia, the Netherlands, and Norway to 192:1 in Singapore. The ratio of treatment-seeking patients to clinicians certified in providing evidence-based care ranged from 49:1 in Norway to 148,215:1 in Mexico. Certification requirements differed by treatment and by country. CONCLUSIONS: Shortages of both providers available to treat BPD and providers certified in specialist treatments of BPD exist in most of the 22 countries studied. In well-resourced countries, training clinicians to provide generalist or abbreviated treatments for BPD, in addition to specialist treatments, could help address the current implementation gap. More resource-efficient alternatives must be considered in countries with insufficient staff to implement even generalist treatments. Consideration of realistic allocation of care may shape future guidelines and standards of BPD treatments, beyond intensive evidence-based psychotherapies.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The extensive training required to deliver specialist therapies is likely to limit broader implementation.
“Nevertheless, the extensive training required to deliver specialist therapies is likely to limit broader implementation. 4”
From Acceptability and feasibility of a short-term group therapy for people with borderline personality disorder symptoms (2024) · cites this paper as [4]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Cognitive-behavioral treatment of chronically parasuicidal borderline patients
Linehan, M. M. (1991) · Archives of General Psychiatry · doi:10.1001/archpsyc.1991.01810360024003 · Cited by 2,203 · see citing works
Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., Korslund, K. E., Tutek, D. A., Reynolds, S. K., & Lindenboim, N. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.7.757 · Cited by 2,025 · see citing works
Mental health literacy: empowering the community to take action for better mental health
Jorm, A. F. (2012) · American Psychologist · doi:10.1037/a0025957 · Cited by 1,783 · see citing works
Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., Smith, S. M., Dawson, D. S., Pulay, A. J., Pickering, R. P., et al. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0404 · Cited by 1,618 · see citing works
Treatment gap in mental health care.
Abramowitz, M. Z., Greenberg, D., & Levav, I. (2008) · PubMed · Cited by 1,482 · see citing works
Bateman, A., & Fonagy, P. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.10.1563 · Cited by 1,416 · see citing works
PRACTICE GUIDELINE FOR THE Treatment of Patients With Major Depressive Disorder
Gelenberg, A. J., Freeman, P. B., Markowitz, J. C., Rosenbaum, J. F., Thase, M. E., Trivedi, M. H., & Rhoads, R. S. (2010) · Cited by 1,372 · see citing works
Barriers to mental health treatment: results from the WHO World Mental Health surveys
Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., de Graaf, R., et al. (2014) · Psychological Medicine · doi:10.1017/s0033291713001943 · Cited by 1,289 · see citing works
Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I., Nadort, M., & Arntz, A. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.6.649 · Cited by 1,248 · see citing works
Evaluating three treatments for borderline personality disorder: a multiwave study
Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007) · American Journal of Psychiatry · doi:10.1176/ajp.2007.164.6.922 · Cited by 997 · see citing works
Bateman, A., & Fonagy, P. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09040539 · Cited by 961 · see citing works
Psychological therapies for people with borderline personality disorder.
Stoffers-Winterling, J. M., Völlm, B. A., Rücker, G., Timmer, A., Huband, N., & Lieb, K. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005652.pub2 · Cited by 895 · see citing works
McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., & Streiner, D. L. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2009.09010039 · Cited by 729 · see citing works
Cristea, I. A., Gentili, C., Cotet, C. D., Palomba, D., Barbui, C., & Cuijpers, P. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2016.4287 · Cited by 655 · see citing works
Trull, T. J., Jahng, S., Tomko, R. L., Wood, P. K., & Sher, K. J. (2010) · Journal of Personality Disorders · doi:10.1521/pedi.2010.24.4.412 · Cited by 651 · see citing works
Psychological treatment of generalized anxiety disorder: A meta-analysis
Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.01.002 · Cited by 527 · see citing works
Kennedy, S. H., Lam, R. W. M., Parikh, S. V., Patten, S. B., & Ravindran, A. V. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.06.043 · Cited by 526 · see citing works
A 27-year follow-up of patients with borderline personality disorder
Paris, J., & Zweig-Frank, H. (2001) · Comprehensive Psychiatry · doi:10.1053/comp.2001.26271 · Cited by 507 · see citing works
Doering, S., Hörz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C., Buchheim, A., Martius, P., & Buchheim, P. (2010) · British Journal of Psychiatry · doi:10.1192/bjp.bp.109.070177 · Cited by 440 · see citing works
Oldham, J. M. (2005) · Focus · doi:10.1176/foc.3.3.396 · Cited by 429 · see citing works
Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2009.01.002 · Cited by 428 · see citing works
The Economic Burden of Personality Disorders in Mental Health Care
Soeteman, D. I., Hakkaart-van Roijen, L., Verheul, R., & Busschbach, J. J. V. (2008) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v69n0212 · Cited by 417 · see citing works
Blum, N., St. John, D., Pfohl, B., Stuart, S., McCormick, B., Allen, J., Arndt, S., & Black, D. W. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.07071079 · Cited by 407 · see citing works
Borderline Personality Disorder, Stigma, and Treatment Implications
Aviram, R. B., Brodsky, B. S., & Stanley, B. (2006) · Harvard Review of Psychiatry · doi:10.1080/10673220600975121 · Cited by 402 · see citing works
Empirical Evidence and Psychotherapy: A Growing Scientific Base
Gabbard, G. O. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.1.1 · Cited by 357 · see citing works
Bonabi, H., Müller, M., Ajdacic-Gross, V., Eisele, J., Rodgers, S., Seifritz, E., Rössler, W., & Rüsch, N. (2016) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0000000000000488 · Cited by 308 · see citing works
Pharmacological interventions for borderline personality disorder
Stoffers, J., Völlm, B. A., Rücker, G., Timmer, A., Huband, N., & Lieb, K. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005653.pub2 · Cited by 302 · see citing works
A systematic review of comparative efficacy of treatments and controls for depression
Khan, A., Faucett, J., Lichtenberg, P., Kirsch, I., & Brown, W. A. (2012) · PLoS ONE · doi:10.1371/journal.pone.0041778 · Cited by 288 · see citing works
Mack, S., Jacobi, F., Gerschler, A., Strehle, J., Höfler, M., Busch, M. A., Maske, U. E., Hapke, U., Seiffert, I., Gaebel, W., et al. (2014) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1438 · Cited by 284 · see citing works
The cost of borderline personality disorder: societal cost of illness in BPD-patients
van Asselt, A. D. I., Dirksen, C. D., Arntz, A. R., & Severens, J. L. (2007) · European Psychiatry · doi:10.1016/j.eurpsy.2007.04.001 · Cited by 271 · see citing works
The Burden of Disease in Personality Disorders: Diagnosis-Specific Quality of Life
Soeteman, D. I., Verheul, R., & Busschbach, J. J. V. (2008) · Journal of Personality Disorders · doi:10.1521/pedi.2008.22.3.259 · Cited by 218 · see citing works
Franklin, J. C., Fox, K. R., Franklin, C. R., Kleiman, E. M., Ribeiro, J. D., Jaroszewski, A. C., Hooley, J. M., & Nock, M. K. (2016) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000093 · Cited by 217 · see citing works
Torous, J., Larsen, M. E., Depp, C., Cosco, T. D., Barnett, I., Nock, M. K., & Firth, J. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0914-y · Cited by 207 · see citing works
Handbook of Good Psychiatric Management for Borderline Personality Disorder
(2014) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378432 · Cited by 199 · see citing works
The Frequency of Personality Disorders in Psychiatric Patients
Zimmerman, M. A., Chelminski, I., & Young, D. (2008) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2008.03.015 · Cited by 186 · see citing works
Korzekwa, M., Dell, P. F., Links, P. S., Thabane, L., & Webb, S. P. (2008) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2008.01.007 · Cited by 181 · see citing works
Choi-Kain, L. W., Albert, E. B., & Gunderson, J. G. (2016) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000113 · Cited by 171 · see citing works
Self-citationvan Asselt, A. D. I., Dirksen, C. D., Arntz, A. R., Giesen-Bloo, J. H., van Dyck, R., Spinhoven, P., van Tilburg, W., Kreimers, I. P., Nadort, M., & Severens, J. L. (2008) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.106.033597 · Cited by 165 · see citing works
Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury
Stanley, B., Brodsky, B., Nelson, J. D., & Dulit, R. (2007) · Archives of Suicide Research · doi:10.1080/13811110701542069 · Cited by 157 · see citing works
Borderline Personality Disorder (DRAFT)
BATEMAN, A. W., & Krawitz, R. (2013) · Oxford University Press eBooks · doi:10.1093/med:psych/9780199644209.001.0001 · Cited by 144 · see citing works
Brazier, J. E., Tumur, I., Holmes, M. C., Ferriter, M., Parry, G. D., Dent-Brown, K., & Paisley, S. (2006) · Health Technology Assessment · doi:10.3310/hta10350 · Cited by 131 · see citing works
Bush, N. E., Smolenski, D. J., Denneson, L. M., Williams, H. B., Thomas, E. K., & Dobscha, S. K. (2017) · Psychiatric Services · doi:10.1176/appi.ps.201600283 · Cited by 124 · see citing works
A preliminary, randomized trial of psychoeducation for women with borderline personality disorder
Zanarini, M. C., & Frankenburg, F. R. (2008) · Journal of Personality Disorders · doi:10.1521/pedi.2008.22.3.284 · Cited by 122 · see citing works
Carmel, A., Rose, M. L., & Fruzzetti, A. E. (2014) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-013-0504-6 · Cited by 112 · see citing works
Implementing dialectical behaviour therapy: programme survival in routine healthcare settings
Swales, M. A., Taylor, B., & Hibbs, R. A. B. (2012) · Journal of Mental Health · doi:10.3109/09638237.2012.689435 · Cited by 112 · see citing works
Integrating Early Intervention for Borderline Personality Disorder and Mood Disorders
Chanen, A. M., Berk, M., & Thompson, K. (2016) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000105 · Cited by 107 · see citing works
Stewart, R. E., Chambless, D. L., & Baron, J. A. (2011) · Journal of Clinical Psychology · doi:10.1002/jclp.20832 · Cited by 104 · see citing works
Kramer, U., Kolly, S., Berthoud, L., Keller, S., Preisig, M., Caspar, F., Berger, T., de Roten, Y., Marquet, P. P., & Despland, J. (2014) · Psychotherapy and Psychosomatics · doi:10.1159/000358528 · Cited by 101 · see citing works
Sulzer, S. H. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.08.008 · Cited by 100 · see citing works
Perseius, K., Kåver, A., Ekdahl, S., Åsberg, M., & Samuelsson, M. (2007) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2007.01146.x · Cited by 95 · see citing works
Lam, R. W. M., Kennedy, S. H., Parikh, S. V., MacQUEEN, G. M., Milev, R. V., Ravindran, A. V., & the CANMAT Depression Work Group (2016) · The Canadian Journal of Psychiatry · doi:10.1177/0706743716659061 · Cited by 94 · see citing works
Bales, D. L., Timman, R., Luyten, P., Busschbach, J. J. V., Verheul, R., & Hutsebaut, J. (2017) · Personality and Mental Health · doi:10.1002/pmh.1381 · Cited by 93 · see citing works
Pharmacological treatment of generalized anxiety disorder
Reinhold, J. A., Mandos, L. A., Rickels, K., & Lohoff, F. W. (2011) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2011.618496 · Cited by 90 · see citing works
Bales, D. L., Verheul, R., & Hutsebaut, J. (2017) · Personality and Mental Health · doi:10.1002/pmh.1368 · Cited by 85 · see citing works
Coid, J. W., Yang, M., Bebbington, P., Moran, P., Brugha, T. S., Jenkins, R., Farrell, M., Singleton, N., & Ullrich, S. (2009) · Psychological Medicine · doi:10.1017/s0033291708004911 · Cited by 83 · see citing works
McMain, S. F., Chapman, A. L., Kuo, J. R., Guimond, T., Streiner, D. L., Dixon-Gordon, K. L., Isaranuwatchai, W., & Hoch, J. S. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1802-z · Cited by 82 · see citing works
Implementing dialectical behavior therapy
Swenson, C. R., Torrey, W. C., & Koerner, K. (2002) · Psychiatric Services · doi:10.1176/appi.ps.53.2.171 · Cited by 79 · see citing works
Paris, J. (2013) · Psychiatric Services · doi:10.1176/appi.ps.201200451 · Cited by 76 · see citing works
Zanarini, M. C., Conkey, L. C., Temes, C. M., & Fitzmaurice, G. M. (2018) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.16m11153 · Cited by 71 · see citing works
Grenyer, B. F. S., Lewis, K. L., Fanaian, M., & Kotzé, B. (2018) · PLoS ONE · doi:10.1371/journal.pone.0206472 · Cited by 71 · see citing works
Clinical outcomes of a stepped care program for borderline personality disorder
Laporte, L., Paris, J., Bergevin, T. A., Fraser, R., & Cardin, J. (2018) · Personality and Mental Health · doi:10.1002/pmh.1421 · Cited by 68 · see citing works
Borderline Personality Disorder: An evidence-based guide for generalist mental health professionals
BATEMAN, A. W., & Krawitz, R. (2013) · Cited by 66 · see citing works
Hermens, M. L., van Splunteren, P. T., van den Bosch, A., & Verheul, R. (2011) · Psychiatric Services · doi:10.1176/ps.62.11.pss6211_1381 · Cited by 65 · see citing works
Cultural Factors in the Emergence of Borderline Pathology
Paris, J. (1996) · Psychiatry · doi:10.1080/00332747.1996.11024760 · Cited by 63 · see citing works
Ditty, M. S., Landes, S. J., Doyle, A., & Beidas, R. S. (2015) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-014-0602-0 · Cited by 61 · see citing works
Personality Disorders in Sociocultural Perspective
Paris, J. (1998) · Journal of Personality Disorders · doi:10.1521/pedi.1998.12.4.289 · Cited by 50 · see citing works
Prada, P., Zamberg, I., Bouillault, G., Jimenez, N., Zimmermann, J., Hasler, R., Aubry, J.-M., Nicastro, R., & Perroud, N. (2017) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12178 · Cited by 47 · see citing works
King, J., Hibbs, R., Saville, C. W. N., & Swales, M. A. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1876-7 · Cited by 47 · see citing works
Personality disorders: Prevalence and demography at a psychiatric outpatient in North India
Gupta, S., & Mattoo, S. K. (2010) · International Journal of Social Psychiatry · doi:10.1177/0020764010387548 · Cited by 43 · see citing works
Landes, S. J., Rodriguez, A. L., Smith, B. N., Matthieu, M. M., Trent, L. R., Kemp, J. E., & Thompson, C. (2017) · Translational Behavioral Medicine · doi:10.1007/s13142-017-0465-5 · Cited by 41 · see citing works
Pharmacological Treatment of Generalized Anxiety Disorder
Baldwin, D. S., Ajel, K. I., & Garner, M. J. (2009) · Current topics in behavioral neurosciences · doi:10.1007/7854_2009_2 · Cited by 39 · see citing works
Dereboy, Ç., Güzel, H. Ş., Dereboy, F., Okyay, P., & Eskin, M. (2013) · International Journal of Social Psychiatry · doi:10.1177/0020764012471596 · Cited by 25 · see citing works
Borderline Personality Disorder
Tusiani-Eng, P., & Yeomans, F. E. (2018) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2018.07.006 · Cited by 25 · see citing works
Borderline Personality Disorder Symptoms and Treatment Seeking Over the Past 12 Months
Selby, E. A., & McHugh, R. K. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.12l08232 · Cited by 8 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- Knight RP: Borderline states. Bull Menninger Clin 1953; 17:1-12
- van den Bosch LM, Sinnaeve R: Dialectical behaviour theory in the Netherlands: implementation and consolidation [in Dutch]. Tijdschr Psychiatr 2015; 57:719-727
- Paris J: Stepped Care for Borderline Personality Disorder: Making Treatment Brief, Effective, and Accessible. New York, Academic Press, 2017
Cited by
Sorted by citations
Juul, S., Jakobsen, J. C., Hestbaek, E., Jørgensen, C. K., Olsen, M. H., Rishede, M., Frandsen, F. W., Bo, S., Lunn, S., Poulsen, S., et al. (2023) · Psychotherapy and Psychosomatics · doi:10.1159/000534289 · Cited by 30 · see citing works
Bartsch, D. R., Cooke-O’Connor, L., Connerty, T. J., van Roekel, H., & Cammell, P. (2024) · Australasian Psychiatry · doi:10.1177/10398562241246485 · Cited by 5 · see citing works
“4 It has been proposed that less resource-intensive treatments be developed through integration of the common factors of effective BPD therapies.”
Background
- Authors
- Iliakis, E. A., Sonley, A. K. I., Ilagan, G. S., & Choi-Kain, L. W.
- Affiliations
- Harvard University (US)
- Venue
- Psychiatric Services
- Published
- 2019-09-01
- Volume
- 70
- Issue
- 9
- Pages
- 772-781
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W2947112920
- Cited by
- 161
- References
- 74
- Citations by year
- 2026: 26 · 2025: 28 · 2024: 35 · 2023: 24 · 2022: 21 · 2021: 12 · 2020: 13 · 2019: 2
- FWCI
- 14.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- borderline personality disorder, mental health professionals, treatment demand, evidence-based psychotherapy, clinician training, cross-national comparison
- MeSH terms
- Borderline Personality Disorder, Certification, Health Workforce, Health Services Needs and Demand, Humans, Mental Health Services, Patient Acceptance of Health Care, Public Health, Specialization, Global Health
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
