Interpersonal Psychotherapy Adapted for Borderline Personality Disorder (IPT-BPD): A Review of Available Data and a Proposal of Revision

Interpersonal psychotherapy (IPT) was developed by Klerman in 1984 for patients with major depression. IPT is aimed to the resolution of interpersonal difficulties, improving both social functioning and psychiatric symptoms. The promising results that this model of psychotherapy has obtained in unipolar depression have led investigators to enlarge the application of IPT beyond this clinical population. Specific adaptations of IPT have been required to address the different psychopathological and clinical characteristics of each disorder. IPT has been proposed to treat borderline personality disorder because of the frequent comorbidity with mood disorders and the serious relational problems. Markowitz and colleagues in 2006 proposed an adaptation for this severe personality disorder, IPT-BPD, including a specific conceptualization of BPD, a prolonged length of treatment to 34 sessions, and a more flexible setting. Clinical efficacy of this adaptation of IPT was investigated in a few clinical trials during the last decade. Our research group conducted three randomized controlled trials. Our findings suggested that combined treatment with IPT-BPD and antidepressants (fluoxetine) can be considered a useful treatment option in treating BPD patients. The efficacy of this combined therapy was superior to single pharmacotherapy in improving core BPD symptom clusters, including disturbed interpersonal relationships, inadequate control of impulsive behaviors, and affective instability. The main effects of IPT-BPD registered after 32 weeks of treatment were maintained during a follow-up of two years. In particular, the superior effects of the addition of IPT-BPD on impulsive behavioral dyscontrol and interpersonal relationships instability were maintained. More severe BPD symptoms and higher degree of fear of abandonment, affective instability, and impaired identity were identified as predictors of response to combined therapy. On the basis of our experience, we present a proposal of revision of IPT-BPD (IPT-BPD-R) with the aim to deal with problems emerged from patients’ treatment.