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Tijdschrift voor Psychiatrie 59 (2017) 3, 166 - 174

Essay

Clinical staging and early intervention for borderline personality disorder

J. Hutsebaut, C.J. Hessels

background Within the accumulating evidence for a life span perspective on borderline personality disorder (bpd), the key factor is a developmental perspective.
aim To demonstrate that the lessons learnt from early intervention in somatic medicine and psychosis should be used to improve the diagnosis and treatment of bpd.
method We describe the rationale for early detection and intervention and present a staging model which can serve as a guideline for the development and selection of interventions for bpd.
results There is increasing evidence that bpd first manifests itself in adolescence and that bpd symptoms can already be distinguished from normative adolescent development. bpd tends to develop gradually and to have a progressive, social and professional impact. Inadequate treatment can lead to iatrogenic damage, whereas adequate treatment shows promising results in adolescents with emerging bpd. These findings may underpin an early intervention paradigm for bpd.
conclusion Early intervention and clinical staging can improve the assessment and treatment of severe forms of psychopathology, such as bpd. This has implications for research, mental health care policy and society.

keywords adolescence, borderline personality disorder, clinical staging, early intervention