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European guidelines for personality disorders: past, present and future
Open accessAbstract
Personality disorders (PD) are common and burdensome mental disorders. The treatment of individuals with PD represents one of the more challenging areas in the field of mental health and health care providers need evidence-based recommendations to best support patients with PDs. Clinical guidelines serve this purpose and are formulated by expert consensus and/or systematic reviews of the current evidence. In this review, European guidelines for the treatment of PDs are summarized and evaluated. To date, eight countries in Europe have developed and published guidelines that differ in quality with regard to recency and completeness, transparency of methods, combination of expert knowledge with empirical data, and patient/service user involvement. Five of the guidelines are about Borderline personality disorder (BPD), one is about antisocial personality disorder and three concern PD in general. After evaluating the methodological quality of the nine European guidelines from eight countries, results in the domains of diagnosis, psychotherapy and pharmacological treatment of PD are discussed. Our comparison of guidelines reveals important contradictions between recommendations in relation to diagnosis, length and setting of treatment, as well as the use of pharmacological treatment. All the guidelines recommend psychotherapy as the treatment of first choice. Future guidelines should rigorously follow internationally accepted methodology and should more systematically include the views of patients and users.
Overview
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Written from the paper’s full text.
TL;DR
This review summarizes and evaluates European clinical guidelines for personality disorders, identifying nine guidelines from eight countries and comparing their recommendations on diagnosis, psychotherapy, and pharmacological treatment. It finds broad agreement that psychotherapy is first-choice treatment but important contradictions in diagnosis, treatment length/setting, and medication use, and calls for more rigorous, patient-inclusive future guidelines.
Key findings
- Nine European guidelines from eight countries were identified: five on borderline personality disorder (BPD), one on antisocial personality disorder (ASPD), and three on personality disorders in general.
- All guidelines recommend psychotherapy as the treatment of first choice; for BPD there is broad consensus that outpatient psychotherapy should be primary, but recommendations on length and setting conflict—e.g., Danish guidelines allow short-term (< 12 months) or long-term (≥ 12 months) psychotherapy, while British guidelines warn against brief interventions of less than 3 months, and Swiss recommendations describe outpatient psychotherapy 1–2 sessions per week over 1–3 years.
- Pharmacological treatment is generally not recommended as the primary intervention for PD; it is mainly for comorbid disorders or brief crisis use, though Swiss, Finnish, and Dutch guidelines suggest medication may target specific BPD dimensions such as anger, impulsivity, or negative mood, while British guidelines say not to use drug treatment specifically for BPD or its individual symptoms and limit crisis sedative use to no longer than 1 week.
- Diagnosis recommendations show some consensus on semi-structured interviews, but Swedish guidelines state such interviews alone are insufficient and recommend the LEAD principle, Danish guidelines do not recommend routine screening in primary care, Swiss guidelines recommend screening for specific symptoms and differential diagnoses, and only the Swiss guideline directly addresses severity.
Methods
- Narrative review/overview of European PD guidelines known to the authors, organized by geographical region and evaluated with attention to AGREE domains, especially rigour of development and applicability.
- Guidelines covered include Sweden (2017), Finland (2015), Denmark (2016), Germany (2009), the Netherlands (2008), the UK (2009 BPD and ASPD), Switzerland (2018), and Catalonia/Spain (2011); no Norwegian national clinical guidelines for PDs currently exist.
- The authors compared recommendations across three main areas—diagnosis, psychological treatment, and pharmacological treatment—using tables and qualitative synthesis; they did not perform formal AGREE scoring.
Limitations
- Stated: the authors acknowledge that using the AGREE system would have been a more systematic approach for guideline quality appraisal, but this was not considered feasible due to language barriers and the unfunded nature of the project; the AGREE manual recommends at least 2 and preferably 4 appraisers for reliable rating.
- Stated: existing guidelines vary in quality, recency, completeness, transparency of methods, combination of expert knowledge with empirical data, and patient/service user involvement; many recommendations are based on clinical/expert consensus or very low levels of evidence, and implementation and severity are generally neglected.
- Evident from the text: this is a narrative overview rather than a systematic review, with no formal quality scoring, and the guideline set is limited to those the authors were aware of, so language and awareness barriers may have excluded relevant European guidelines.
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Claims the paper makes
56 No basis given · 31 Not checked yet · 15 Own result · 6 Own interpretation · 1 Own method
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“They do not include a method section outlining a systematic evaluation of the empirical support underlying different recommendations, but rather rely heavily on guidelines from other countries”
§ European guidelines for personality disorders: past, present and future > Introduction > Northern Europe
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“From an evidence-based guidelines perspective, the main limitation concerns the rigour of development, more specifically that the path from evidence to recommendation is not always transparent and reproducible.”
§ European guidelines for personality disorders: past, present and future > Introduction > Northern Europe
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Treatment guidelines for PD were first developed in 2009 by a committee of experts as delegated by a variety of professional societies and associations [15].”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
What the sources say
- Not checked yetcites [15] DGPPN - Deutsche Gesellschaft für Psychiatrie, P.u.N.H., Behandlungsleitlinie Persönlichkeitsstörungen. Reihe: S2 Praxisleitlinien in Psychiatrie und Psychotherapie, Band 1. 2009.
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“This perspective has now been covered in a standardized procedure of care for patients with BPD published in 2017 [18].”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
What the sources say
- Not checked yetcites [18] Instituut, T, Zorgstandaard persoonlijkheidsstoornissen: Kwaliteitsontwikkeling GGZ [Care standard personality disorders: Quality development mental health care]. 2017.
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The first guideline was at level S2.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Due to the lack of efficacy studies, with the exception of BPD, recommendations in the 2009 guideline for the treatment of PD subtypes are based primarily on clinical expertise or published expert opinions.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“To date, eight countries in Europe have developed and published guidelines that differ in quality with regard to recency and completeness, transparency of methods, combination of expert knowledge with empirical data, and patient/service user involvement.”
§ European guidelines for personality disorders: past, present and future > Abstract
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“In the Netherlands, the first Multidisciplinary Guideline for PD was published in 2008 [17].”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
What the sources say
- Not checked yetcites [17] Committee DPMG. Dutch multidisciplinary guideline for personality disorders. Utrecht: Trimbos-institute; 2008.
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“All the guidelines recommend psychotherapy as the treatment of first choice.”
§ European guidelines for personality disorders: past, present and future > Abstract
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our comparison of guidelines reveals important contradictions between recommendations in relation to diagnosis, length and setting of treatment, as well as the use of pharmacological treatment.”
§ European guidelines for personality disorders: past, present and future > Abstract
plain- Asserted: passes — The authors put it forward as true.
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- Probably not a substantial claim. 57
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- The quote only partly states this claim. 1
In the paper
“The Finnish Current Care Guidelines for BPD were developed by the Finnish Medical Society Duodecim in cooperation with the Finnish Psychiatric Association in 2015 [12].”
§ European guidelines for personality disorders: past, present and future > Introduction > Northern Europe
What the sources say
- Not checked yetcites [12] Association, F.M.S.D.a.t.F.P., Epävakaa persoonallisuus. Käypä hoito -suositus. [Borderline Personality Disorder. Current Care Guidelines]. 2015.
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Five of the guidelines are about Borderline personality disorder (BPD), one is about antisocial personality disorder and three concern PD in general.”
§ European guidelines for personality disorders: past, present and future > Abstract
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Systematic method and evidence reviews were applied in the development process, but the guideline recommendations can only partly be traced back to the supporting evidence.”
§ European guidelines for personality disorders: past, present and future > Introduction > Northern Europe
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“In Denmark, the National Health Authority published guidelines for BPD in 2016 [14].”
§ European guidelines for personality disorders: past, present and future > Introduction > Northern Europe
What the sources say
- Not checked yetcites [14] Vind, AB, et al. National klinisk retningslinje for behandling af emotionel ustabil personlighedsstruktur, borderline type. 2015.
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“A systematic search for evidence was conducted, and the body of evidence is well described.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
boosted- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Ten specific questions with regards to screening in primary care, diagnosis, length of treatment, uni- or multimodality treatment, monitoring outcomes and pharmacological treatment formed the starting point for the development of the guideline.”
§ European guidelines for personality disorders: past, present and future > Introduction > Northern Europe
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, the connection between evidence and strength of recommendations is not fully transparent and many recommendations were based on very low levels of evidence.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The guideline was developed by an expert workgroup and is based on the results of scientific research critically and systematically appraised according to the level of evidence and completed with professional expertise.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The GRADE system was used in developing the recommendations.”
§ European guidelines for personality disorders: past, present and future > Introduction > Northern Europe
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Currently, there are no Norwegian national clinical guidelines for PDs.”
§ European guidelines for personality disorders: past, present and future > Introduction > Northern Europe
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The first systematically developed European guidelines on the management of PDs were published in 2008 and 2009 and came from Finland, Germany, the Netherlands and the UK.”
§ European guidelines for personality disorders: past, present and future > Introduction
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The guideline was developed to improve the treatment of individuals with PDs.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“The earliest European guidelines that we were able to identify derived from The Swedish Psychiatric Society. The Society developed Clinical guidelines for personality disorders in 2006, which were recently updated (2017) [9].”
§ European guidelines for personality disorders: past, present and future > Introduction > Northern Europe
What the sources say
- Not checked yetcites [9] Ekselius L, et al. Personlighetssyndrom, kiniska riktlinjer för utredning och behandling. 2017: Gothia Förlag AB.
hedged- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The working process, methods and analyses behind the recommendations are publicly available on the National Health Authority website”
§ European guidelines for personality disorders: past, present and future > Introduction > Northern Europe
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“To date, eight countries in Europe have developed and published guidelines that differ in quality with regard to recency and completeness, transparency of methods, combination of expert knowledge with empirical data, and patient/service user involvement.”
§ European guidelines for personality disorders: past, present and future > Abstract
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one. The quote only partly states this claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Currently, an S3 guideline on BPD is in progress”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The major limitation of the guideline concerned implementation, especially in regard to systematically considering barriers and monitoring progress.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The guidelines cover many clinically important questions, but recommendations are often based on clinical/expert consensus rather than evidence.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Instead, they suggest adopting the LEAD principle (Longitudinal Expert All Data) as the gold standard.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“Screening tools are addressed in three guidelines.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“while the Danish guidelines go even further in not recommending the use of screening in primary care due to the high rate of false positives and negatives.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“The question of severity of the disorder is only directly addressed in the new Swiss guidelines, which state that it should be taken into consideration.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“we found a considerable overlap between the different national guidelines, there were also significant differences”
§ European guidelines for personality disorders: past, present and future > Discussion
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“the German guideline, which specifically state that DBT has better empirical evidence than other types of specialized psychotherapy for BPD”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Methodologically, the guideline was developed using the system SIGN (Scottish Intercollegiate Guidelines Network) [22].”
§ European guidelines for personality disorders: past, present and future > Introduction > Southern Europe
What the sources say
- Not checked yetcites [22] Network, S.I.G., R.T. Harbour, and L. Forsyth, SIGN 50: a guideline developer's handbook. 2008: Scottish Intercollegiate Guidelines Network.
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“the Danish guidelines include a practice-based recommendation of both short (< 12 months) and long-term treatments”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“In 2009, the Guidelines on BPD [10] and Antisocial Personality disorder [19] were published.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
What the sources say
- Not checked yetcites [10] Excellence, N.I.f.H.a.C., Borderline personality disorder: treatment and management (CG78). 2009.
- Not checked yetcites [19] Excellence, N.I.f.H.a.C., Antisocial personality disorder:prevention and management (Clinica guideline CG77). 2009.
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“In Switzerland, the Swiss Association for Psychiatry and Psychotherapy set up a task force consisting of personality experts with the aim of coming up with practical and relevant clinical treatment recommendations for BPD rather than a new guideline. The task force published recommendations in 2018”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
What the sources say
- Not checked yetcites [21] Euler S, et al. Borderline-Störung: Behandlungsempfehlungen der SGPP. Psychiatr Psychother. 2018;169(5):135–43.
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Recommendations were based on a consensus view giving weight to scientific evidence, good clinical practice and national applicability.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plaindirect- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“It is clear that there are both similarities and discrepancies across guidelines.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The emergence of new evidence has been monitored since 2009, but none of the emergent evidence has been deemed sufficiently strong to warrant changing the guideline recommendations.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“existing guidelines still have many limitations that need to be effectively tackled in future iterations”
§ European guidelines for personality disorders: past, present and future > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, these specific recommendations are not consistent and are somewhat at odds with the more general recommendation of being cautious with the use of medications.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In the United Kingdom, National Institute of Health Care and Excellence (NICE) is an independent public body that provides national guidance and advice to improve health and social care in the United Kingdom”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“recommendations on pharmacological treatment are in overall agreement that, based on sparse trial evidence, medication should not be considered the primary intervention for PD, but should be used mainly for treating comorbid disorders and in some cases used briefly during times of crisis”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The recommendations are currently available in French and German.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The Swiss, Finnish and Dutch guidelines suggest that medication may be used to reduce specific dimensions of BPD such as anger, impulsivity or negative mood.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“This Standard of Care was developed and formulated from the patient’s perspective and the main goal of care was psychosocial recovery.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“However, both guidelines date back to 2009, with new relevant evidence having emerged since then [23, 24].”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
What the sources say
- Not checked yetcites [23] Bamelis LL, et al. Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. Am J Psychiatr. 2014;171(3):305–22. source
- Not checked yetcites [24] Weinbrecht A, et al. Avoidant personality disorder: a current review. Curr Psychiatry Rep. 2016;18(3):29. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“On a general level, the consensus regarding the diagnosis of PD is focused on which instruments to use and with what purpose and caveats.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“The guideline was developed by a team including a methodology consultant, psychiatrists, psychologists, a nurse and social workers, and was based on a systematic search and rating (AGREE and OSTEBA) of evidence.”
§ European guidelines for personality disorders: past, present and future > Introduction > Southern Europe
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“there are similarities in the broader field of recommended PD treatment, but also important differences, for example with respect to treatment of suicidal and self-harming behaviours”
§ European guidelines for personality disorders: past, present and future > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The guideline is oriented towards specialists in mental health who are responsible for the treatment and care of individuals with BPD”
§ European guidelines for personality disorders: past, present and future > Introduction > Southern Europe
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In Spain, a clinical practice guideline for BPD was developed in 2011 by the Catalan Agency for Health Information, Assessment and Quality.”
§ European guidelines for personality disorders: past, present and future > Introduction > Southern Europe
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The recommendations in terms of both length of treatment and use of multiple modalities are not clear and are sometimes contradictory even within a guideline as well as between guidelines.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“although the Swedish guidelines specifically state that such interviews alone are not sufficient.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In addition, the German guidelines state that CBT has the strongest empirical support in the treatment of Avoidant PD (AvPD).”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“although this has not always been made explicit by the authors”
§ European guidelines for personality disorders: past, present and future > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“and according to Google Scholar, the two guidelines have thus far been cited more than 250 times in the scientific literature.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The only recommendations we found for Antisocial Personality Disorder were cognitive-behavioural therapy (CBT), which was recommended by both the British and the German guidelines.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“For BPD, there is broad consensus that outpatient psychotherapy should be the primary treatment.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Finally, the Swiss guidelines recommend the use of screening instruments to ascertain specific symptoms and differential diagnoses.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The guideline has several strengths in addressing important clinical questions and in considering national particularities but may be criticised in terms of a lack of transparency in using multiple levels of evidence without defining how this is reflected in the strength of recommendations.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“the British guidelines specifically warn against the use of psychotherapy treatments lasting less than 3 months”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Over the past decade, throughout Europe, a range of clinical guidelines for the management of PDs have emerged.”
§ European guidelines for personality disorders: past, present and future > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, inpatient treatment specifically adapted to BPD and day hospital treatment are also recommended.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The Swedish guidelines warn against using screening for diagnostic purposes”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“some guidelines recommend the prescription of antipsychotic or antidepressant medication to target specific symptoms, other guidelines insist on a general caution when it comes to psychopharmacological treatment”
§ European guidelines for personality disorders: past, present and future > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“guidelines for other PDs are either outdated or missing completely”
§ European guidelines for personality disorders: past, present and future > Conclusions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“the issue of severity is generally neglected in existing guidelines”
§ European guidelines for personality disorders: past, present and future > Conclusions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
In the paper
“Guideline quality can be assessed and quantified using the AGREE system (Appraisal of Guidelines, Research and Evaluation), where a guideline is assessed across six domains [6].”
§ European guidelines for personality disorders: past, present and future > Introduction
What the sources say
- Not checked yetcites [6] Brouwers MC, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. Can Med Assoc J. 2010;182(18):E839–42. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Compared to those without a PD, they lead shorter lives, and their quality of life is often significantly reduced [1, 2].”
§ European guidelines for personality disorders: past, present and future > Introduction
What the sources say
- Not checked yetcites [1] Fok ML-Y, et al. Life expectancy at birth and all-cause mortality among people with personality disorder. J Psychosom Res. 2012;73(2):104–7. source
- Not checked yetcites [2] Cramer V, Torgersen S, Kringlen E. Personality disorders and quality of life. A population study. Compr Psychiatry. 2006;47(3):178–84. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The Grade working group (www.gradeworkinggroup.org) provides guidance on how to link the body of evidence with the degree of strength of the recommendation (strong vs. weak/conditional).”
§ European guidelines for personality disorders: past, present and future > Introduction
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“GRADE emphasizes the importance of phrasing recommendations using active language and of avoiding ambiguous or unclear wording, such as ‘if clinically appropriate’ or ‘if necessary’ [7].”
§ European guidelines for personality disorders: past, present and future > Introduction
What the sources say
- Not checked yetcites [7] McDonald CJ, Overhage JM. Guidelines you can follow and can trust: an ideal and an example. Jama. 1994;271(11):872–3. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“in a recent meta-analysis it was concluded that both DBT and psychodynamic approaches (the last category defined very broadly and including both MBT and brief therapy based on psychoanalytic principles) are effective for BPD symptoms [25].”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
What the sources say
- Not checked yetcites [25] Cristea IA, et al. Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry. 2017;74(4):319–28. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Because of the proficiency in English by most academics across Europe, these guidelines have been used and referenced in all later European guidelines”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, a lack of diverse representation in the guideline development group may have limited the utility of these recommendations.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the differences we have identified are probably due to, to a large extent, the lack of methodological rigour with which guidelines have been developed along with the paucity of evidence for many of the clinical questions addressed by the guidelines”
§ European guidelines for personality disorders: past, present and future > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: unclear — It is unclear whether it could be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These may in part reflect the different ages of the guidelines.”
§ European guidelines for personality disorders: past, present and future > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This is a major limitation as guidelines based on consensus are likely to have limited impact.”
§ European guidelines for personality disorders: past, present and future > Introduction > Western Europe
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For PDs in general a five years criterion might be too strict due to the slower accumulation of evidence.”
§ European guidelines for personality disorders: past, present and future > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
In the paper
“the AGREE manual [6] recommends at least 2 appraisers and preferably 4 in order to achieve a reliable rating”
§ European guidelines for personality disorders: past, present and future > Discussion
What the sources say
- Not checked yetcites [6] Brouwers MC, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. Can Med Assoc J. 2010;182(18):E839–42. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“due to language barriers and the unfunded nature of the project this was not considered feasible”
§ European guidelines for personality disorders: past, present and future > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
Recommendations in diagnosis and general treatment are independent of national health systems and thus generalizable to the whole of Europe.
“These areas were chosen because recommendations in diagnosis and general treatment should be independent of national health systems and thus be generalizable to the whole of Europe.”
The paper relies on this without support.
Widespread comorbidity is often seen in people with PDs, including several comorbid PDs and comorbidity with other clinical syndromes such as anxiety, depression, PTSD and substance use disorders.
“the widespread comorbidity often seen in people with PDs, not only in terms of several comorbid PDs, but also in terms of comorbidity with other clinical syndromes, such as anxiety, depression, post-traumatic stress disorder and substance use disorders”
The paper relies on this without support.
People with multiple disorders often receive too many or conflicting therapies.
“People with multiple disorders often receive too many or conflicting therapies”
The paper relies on this without support.
Guidelines should base their recommendations on an evidence-based paradigm.
“guidelines should base their recommendations on an evidence-based paradigm”
The paper relies on this without support.
Patients' needs and values are important sources of knowledge for clinical guidelines.
“Patients’ needs, and values are important sources of such knowledge”
The paper relies on this without support.
The strongest recommendations of guidelines stem from randomized controlled trials.
“their strongest recommendations stem from randomized controlled trials”
The paper relies on this without support.
DSM-5 and ICD-11 focus a great deal on severity in the diagnosis of PDs.
“The recently published DSM-5, with its Alternative Model for PDs as well as the upcoming ICD-11, focuses a great deal on severity in the diagnosis of PDs.”
Claims other papers make about this one
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“Today, a range of effective psychotherapeutic interventions are available for people with personality disorders in most of the countries that have so far legalized EAS.”
From Euthanasia and assisted suicide in patients with personality disorders: a review of current practice and challenges (2020) · cites this paper as [30]
Experimental — accuracy not yet measuredIn the citing paper
“National guidelines (e.g. in Germany or the UK) recommend one of the evidence-based psychotherapies mentioned above as first-line treatment [30].”
From Euthanasia and assisted suicide in patients with personality disorders: a review of current practice and challenges (2020) · cites this paper as [30]
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§ European guidelines for personality disorders: past, present and future > Introduction > Northern Europe
“In Denmark, the National Health Authority published guidelines for BPD in 2016 [14].”
§ European guidelines for personality disorders: past, present and future > References
“14. Vind AB National klinisk retningslinje for behandling af emotionel ustabil personlighedsstruktur, borderline type 2015”
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§ European guidelines for personality disorders: past, present and future > Discussion
“With the notable exception of the recent Swiss guideline, none of the guidelines address the issue of severity.”
§ European guidelines for personality disorders: past, present and future > Introduction > Main recommendations across guidelines
“In forensic services, use measures such as PCL-R or PCL-SV to assess the severity of antisocial personality disorder as part of the routine assessment process.”
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Metadata
- Authors
- Simonsen, S., Bateman, A., Bohus, M., Dalewijk, H. J., Doering, S., Kaera, A., Moran, P., Renneberg, B., Ribaudi, J. S., Taubner, S., Wilberg, T., & Mehlum, L.
- Affiliations
- University of Copenhagen (DK)
- Heidelberg University (DE)
- Medical University of Vienna (AT)
- Kanta-Hämeen Keskussairaala (FI)
- University of Bristol (GB)
- Freie Universität Berlin (DE)
- Oslo University Hospital (NO)
- University of Oslo (NO)
- Corresponding author
- Simonsen, Sebastian
- ORCID
- Venue
- Borderline Personality Disorder and Emotion Dysregulation
- Published
- 2019-05-21
- Volume
- 6
- Issue
- 1
- Pages
- 9-9
- ISSN
- 2051-6673 (ISSN-L)
- PMC
- PMC6530178
- OpenAlex
- W2947641077
- Semantic Scholar
- 22c2b16c9d4a9752b9fd180695dba6300ad0d886
- Cited by
- 147
- References
- 26
- Citations by year
- 2026: 11 · 2025: 31 · 2024: 27 · 2023: 22 · 2022: 27 · 2021: 18 · 2020: 10 · 2019: 1
- FWCI
- 2.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Borderline Personality Disorder and Emotion Dysregulation (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- heiDOK (Heidelberg University) (acceptedVersion, other-oa)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Explore Bristol Research (submittedVersion, cc-by)
- Bristol Research (University of Bristol) (submittedVersion, cc-by)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Keywords
- personality disorders, borderline personality disorder, antisocial personality disorder, psychotherapy, pharmacotherapy, diagnosis, guideline methodological quality, European guidelines
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.
A language model drew the claims from the paper on 2026-10-08, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-08 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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 ›
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