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CBT-I in Adults Suffering from Cluster B Personality Disorder and Insomnia: A Feasibility Study (INSOPERSO Study)

Résumé

Introduction

L’insomnie est hautement prévalente parmi les personnes vivant avec un trouble de la personnalité du groupe B (TPB). La thérapie cognitivo-comportementale de l’insomnie (TCC-I) est le traitement le plus recommandé pour l’insomnie persistante, mais aucune étude ne s’est penchée sur l’administration de cette modalité chez les patients avec un TPB. Cette étude vise à évaluer la faisabilité d’un programme de TCC-I pour cette patientèle.

Méthode

Il s’agit d’une étude pilote à devis mixte sans groupe contrôle. Vingt-deux participants souffrant d’insomnie et de TPB ont été recrutés au sein d’un programme spécialisé pour les troubles de la personnalité et ont suivi ce programme de TCC-I conçu spécifiquement pour cette patientèle. Les mesures quantitatives incluaient le taux de recrutement et de rétention ainsi que des questionnaires autorapportés évaluant l’insomnie et des comorbidités qui y sont associées. Les données qualitatives ont été recueillies par une discussion de groupe focalisée et des entrevues semi-structurées effectuées post-traitement.

Résultats

Vingt-deux participants ont été recrutés sur un objectif initial de vingt-quatre. Quatorze participants ont abandonné en cours de traitement pour un taux de rétention de 45 %. Une diminution significative de l’insomnie, de la dépression et de l’anxiété a été observée entre l’inclusion et trois mois après la fin de la thérapie. Par ailleurs, six grands thèmes ont été relevés, lors des entrevues qualitatives, auprès des quatre participants : le contenu, le fonctionnement, le thérapeute, la formule de groupe, l’effet de la thérapie et les facteurs influençant la motivation.

Conclusion

La présente étude pilote a permis d’établir qu’un protocole de TCC-I en groupe de courte durée pour cette clientèle est faisable, mais partiellement acceptable. Par ailleurs, les résultats préliminaires concernant l’évolution clinique sont prometteurs et concordent avec les données probantes existantes. Des améliorations méthodologiques sont prévues pour les recherches subséquentes, notamment l’intégration d’un groupe contrôle afin de renforcer la validité interne des conclusions.

Abstract

Introduction

Insomnia is highly prevalent among individuals with Group B personality disorders (GBPD). Cognitive-behavioral therapy for insomnia (CBT-I) is the most recommended treatment for chronic insomnia; however, no study has examined this approach in patients with GBPD. This study aimed to assess the feasibility of a CBT-I program for this patient population, focusing on acceptability, gathering preliminary measures of effectiveness, and collecting participant experiences to enhance treatment.

Method

This pilot study employs a mixed methods design without a control group. Twenty-two adult participants diagnosed with GBPD and experiencing insomnia were recruited from a specialized program for personality disorders. The four-session CBT-I program was specifically designed for patients with GBPD to enhance treatment retention and therapeutic response. Quantitative measures included recruitment and retention rates and self-administered questionnaires assessing insomnia and comorbidities, collected before, during and three months after treatment. Per protocol and intention-to-treat analyses were conducted on data from these questionnaires. Qualitative data were gathered through group discussions and semi-structured interviews, and the qualitative data were analyzed using thematic content analysis.

Results

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Comparison of social and clinical characteristics according to sex among individuals with cluster B personality disorder

Résumé

Introduction

Dans le domaine des troubles de la personnalité (TP) du groupe B, les études ont surtout porté sur le TP limite/borderline (TPL), incluant principalement les femmes. De plus, les études incluant divers TP du groupe B ont comparé quelques caractéristiques cliniques entre des hommes et des femmes, en particulier les symptômes, sans tenir compte de composantes sociales.

Objectifs

Cette étude visait à comparer les caractéristiques sociales et cliniques de femmes et d’hommes présentant un TP du groupe B, à partir d’une base de données d’un service dédié aux personnes vivant avec un TP.

Méthodes

Les variables cliniques examinées étaient : la gravité de la psychopathologie selon les intervenants et les symptômes perçus des TP. Ces dernières ont été mesurées avec des outils validés et entrées dans la base de données du service. Les variables sociales incluaient par exemple, le statut conjugal et le réseau social. Ces caractéristiques ont été colligées systématiquement à l’entrée des personnes dans le service. De plus, les buts de thérapie, faisant partie de l’évaluation initiale ont été comparés de manière qualitative.

Résultats

Sur le plan social, il n’y avait pas de différence statistiquement significative entre les hommes (n = 103) et les femmes (n = 283) concernant le statut conjugal, la scolarité, la source de revenus et le nombre de loisirs. Les hommes avaient un réseau social plus limité que les femmes (p < 0,001). Selon le Borderline Personality Questionnaire (BPQ), plus de femmes ont obtenu la cote du diagnostic de TPL que les hommes (p < 0,001). L’analyse des dimensions du BPQ a montré que les femmes avaient plus de symptômes dissociatifs (p = 0,04). Aussi, la proportion de femmes ayant consommé des substances dans le dernier mois était significativement plus élevée (p = 0,04). Concernant les thèmes des buts au préalable de la thérapie, ce qui était le plus fréquent chez les femmes était d’améliorer la relation avec soi et les autres. Chez les hommes, les buts touchaient surtout la relation avec les symptômes et les activités de la vie courante (ex., trouver un emploi, reprise d’habitudes de vie saines).

Conclusion

Cette étude poursuit la réflexion sur la prise en compte du sexe et du genre dans l’offre des services pour les personnes vivant avec un TP du groupe B. Même s’il y a plusieurs similitudes entre les hommes et les femmes, certaines différences sur le plan social soutiennent l’ajout d’interventions ciblant entre autres les habitudes de vie pour les hommes.

Abstract

Introduction

In the field of Cluster B personality disorders (PDs), studies have primarily focused on borderline personality disorder (BPD), predominantly including women. Moreover, studies comparing various Cluster B PDs have examined some clinical features between men and women, particularly symptoms, without considering social characteristics.

Objectives

This study aims to compare the social and clinical characteristics of women and men with Cluster B PDs, using a database from a specialized service for persons with a PD.

Methods

Clinical variables examined included the severity of psychopathology as assessed by clinicians and perceived PD symptoms. These were measured using validated tools and entered into the service’s database. Social variables included for example marital status and social network, and were systematically collected upon entry into the service. Additionally, therapy goals, part of the initial assessment, were qualitatively compared.

Results

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Targeting cognitive impairments in borderline personality disorder: A cognitive remediation approach

Résumé

Problématique

Plusieurs études rapportent la présence d’atteintes neuropsychologiques chez les personnes vivant avec un trouble de la personnalité limite (TPL). Ces atteintes seraient associées à la sévérité des symptômes, l’automutilation, le dysfonctionnement psychosocial et l’adhésion au traitement. Actuellement, aucune intervention spécifique pour le TPL ne cible ces déficits. La remédiation cognitive (RC) a démontré son intérêt sur ces aspects dans plusieurs troubles mentaux. Une RC spécialisée pour le TPL permettrait d’améliorer le pronostic fonctionnel des personnes.

Objectif

L’objectif de cet article est de présenter la démarche conceptuelle entreprise ainsi que le programme de RC conçu.

Méthodologie

Le développement du programme a suivi les phases 0 à 2 du Medical Research Council (MRC) du Royaume-Uni pour les interventions complexes. La phase 0 a consisté en une revue de portée sur le profil neurocognitif TPL et les interventions de RC existantes, la phase 1 en la définition des composantes de l’intervention via des consultations avec neuf professionnels de la santé et la phase 2 en un essai clinique exploratoire avec cinq participantes avec un TPL, pour évaluer la faisabilité et l’acceptabilité de l’intervention.

Résultats

Les résultats ont démontré la faisabilité et l’acceptabilité de l’intervention pour un groupe de 3 à 5 participantes, avec des ajustements nécessaires (ajouts d’exemples, d’explications, de questions de discussions). Le taux d’abandon s’élevait à 40 %. Le programme RC révisé s’étend sur 8 semaines, avec des séances hebdomadaires de deux heures où les participants identifient des objectifs, entraînent leurs fonctions cognitives, reçoivent de l’éducation psychologique, et apprennent des stratégies d’adaptation. Chaque séance aborde des thèmes spécifiques comme les habitudes de vie, l’impulsivité, l’attention, la mémoire, les fonctions exécutives, la motivation, et la procrastination.

Discussion

Ce programme se distingue par sa durée et son intensité réduites par rapport aux études antérieures. Il cible les déficits cognitifs spécifiques au TPL et intègre des stratégies métacognitives. Bien que les résultats soient prometteurs, d’autres études seront nécessaires afin d’évaluer son efficacité.

Abstract

Background

Over the past decade, there has been growing recognition and investigation of neuropsychological impairments in BPD. These impairments have been linked to symptom severity, suicidal behavior, self-harm and treatment adherence. While current therapies for BPD have been linked with symptom reduction, research has shown that psychosocial functioning tends to remain impaired in BPD patients. Although it has not been extensively explored in BPD, research has demonstrated that impairments in psychosocial functioning can be linked to neuropsychological deficits. To our knowledge, there is no specialized intervention addressing these impairments for the BPD population. Therefore, cognitive remediation therapy (CRT) could present itself as a compelling alternative. Given this observation, researchers and clinicians from the Institut Universitaire de Santé Mentale de Montréal (IUSMM) worked on developing a CR intervention that would be specialised for BPD.

Objective

The aim of this article is to describe the conceptual method and to outline the program designed.

Methodology

The development of the program followed phases 0 to 2 of the Medical Research Council (MRC) of the United Kingdom for complex interventions. Phase 0 consisted of a scoping review of the BPD neurocognitive profile and existing CR interventions, Phase 1 involved defining the components of the intervention through consultations with nine mental health professionals (psychiatrists, neuropsychologists and occupational therapists), and Phase 2 involved an exploratory clinical trial with five participants with BPD to assess the feasibility and acceptability of the intervention.

Results

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Impact of a French-speaking, international, and online training on personality disorder

Résumé

Contexte

Alors que la prévalence du Trouble de la Personnalité Limite (TPL) est élevée et qu’il est caractérisé par une importante sévérité, les personnes atteintes rencontrent souvent des obstacles à l’accès à des soins efficaces en raison de la stigmatisation dans les services de santé. Les formations sur le sujet jouent un rôle crucial pour améliorer la compétence des intervenants et changer leur regard sur les personnes vivant avec le TPL. Dans ce contexte, une équipe de professeurs a développé une formation en ligne autonome intégrant des témoignages de patients partenaires.

Objectifs

Évaluer la satisfaction des participants à cette formation, ainsi que l’impact sur différents domaines (perception et compréhension du TPL, impact sur leur pratique).

Matériels et méthodes

Étude transversale utilisant deux sondages auprès de l’ensemble des étudiants inscrits à un cours en ligne de janvier à septembre 2023. Outre une description des résultats des deux échantillons, nous avons réalisé une approche qualitative des réponses des participants aux questions ouvertes.

Résultats

En plus d’une importante satisfaction, nous avons retrouvé une augmentation du confort des apprenants avec les patients vivant avec un TPL après avoir suivi le cours en ligne. Les réponses qualitatives ont mis en évidence l’intégration de nouvelles approches thérapeutiques, une meilleure compréhension du TPL, une confiance accrue dans la prise en charge des patients, des changements concrets dans la pratique clinique, ainsi qu’une amélioration de la gestion des émotions.

Discussion et conclusion

Les participants au cours ont intégré plusieurs compétences, et la formation aurait amélioré la perception des personnes vivant avec un TPL chez les cliniciens, renforçant la compréhension, réduisant les préjugés, et favorisant une meilleure gestion émotionnelle. L’étude s’inscrit dans la littérature sur la pédagogie médicale en ligne. Bien qu’efficaces, elles doivent être considérées comme des stratégies complémentaires aux approches en présence.

Abstract

Context

While the prevalence of Borderline Personality Disorder (BPD) is high and it is characterized by significant severity, individuals affected often encounter obstacles to accessing effective care due to stigma in healthcare services. Training on the subject plays a crucial role in improving the competence of caregivers and changing their perception of individuals living with BPD. In this context, a team of professors developed an autonomous online training integrating testimonials from patient partners.

Objectives

To evaluate the satisfaction of participants in this training, as well as its impact on various domains (perception and understanding of BPD, impact on their practice).

Materials and methods

A cross-sectional study was conducted using two surveys among all students enrolled in an online course from January to September 2023. The first survey, conducted after the course, was gradually administered before the allocation of training credits, while the second, anonymous survey was distributed via the student forum, accessible to all enrolled students in September 2023, regardless of their stage of course completion. Sample 1, consisting of 32 respondents predominantly female (F/H ratio = 3.3), mainly comprised physicians (42.8%) working in a hospital setting (39.0%) and frequently exposed to individuals living with BPD. Sample 2, with 44 respondents, mainly included participants who had partially completed the course (61.4%) and had not participated in synchronous sessions (70.4%), with no data on socio-demographic characteristics.

Results

Sample 1, mainly composed of physicians working in hospital settings and frequently exposed to patients with BPD, reported an increase in their comfort with these patients after completing the online course, with high satisfaction both for the online format and the course length. Qualitative responses highlighted the integration of new therapeutic approaches, a better understanding of BPD, increased confidence in patient care, concrete changes in clinical practice, as well as improved emotional management and counter transference. Improvement suggestions included more in-depth content on comorbidities and therapies, aspects related to professional practice and external management, as well as particular attention to prevention and pharmacology. As for Sample 2, respondents’ satisfaction was high, emphasizing the expertise of the trainers, the variety of educational materials, the relevance and updating of the content, as well as the flexibility and accessibility of the course. Areas for improvement included lack of diversity of viewpoints, length and density of content, lack of associated resources and the ability to download course materials, as well as issues with audiovisual quality and use of sophisticated terms.

Discussion and conclusion

Participants have integrated several skills, and the training appears to have improved clinicians’ perception of individuals living with BPD, enhancing understanding, reducing biases and resistance, and promoting better emotional management. While the strengths of the training have been identified, improvements are needed, including greater diversity of perspectives and more effective management of content length and density. The study aligns with the literature on online medical education. Although online training can be effective, it should not completely replace traditional training and should be viewed as supplementary strategies. The study results are limited by a low response rate, but suggest that online training on BPD is feasible and effective, with implications for enhancing future courses and the need for further research to assess its impact on participants’ knowledge.
 
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Abstract

 

Methods: This open-label study recruited adults with BPD who were not undergoing psychotherapy. Participants completed informational psychoeducation sessions, followed by 10 daily sessions of 20-minute tDCS over 2 weeks. Stimulation involved a continuous 2-mA current with the anode over the left DLPFC and the cathode over the right DLPFC. During each session, participants simultaneously engaged in online cognitive training using the Lumosity app (aspredicted.org no. 206 001).

Results: We included 29 participants. We noted significant improvements in cognitive functions, including the Towers of London task (Cohen d = −0.38 to −0.78), the Corsi Block-Tapping direct and total scores (d = −0.41 and −0.42, respectively), and the Stroop Interference and Alternance tests (d = 0.80 and 0.94, respectively). Emotional dysregulation showed a substantial reduction (d = 0.44), while impulsivity did not change significantly. Symptoms of BPD decreased (d = 0.69), while general functioning (d = 0.33) and the internal component of BPD functioning improved (d = −0.51).

Limitations: Although these preliminary findings are encouraging, further controlled studies are necessary to validate the efficacy and long-term effect of the intervention.

Conclusion: This combined approach appears to be well tolerated and produced promising short-term improvements in cognitive performance, BPD symptoms, and overall functioning. The results underscore the relevance of the left DLPFC in developing neuropsychologically integrative interventions for BPD.

Introduction

Borderline personality disorder (BPD) is a mental disorder that exhibits instability in several domains, such as relationships, emotions, and self-perception.1 This disorder is also characterized by substantial impulsivity.1 Its prevalence is estimated at 1%–2% within the general population and around 15%–28% among patients with psychiatric conditions.2–4 Clinical research has advanced considerably in the symptomatic treatment of BPD, primarily through psychotherapy.5 However, although these treatments show moderate effect sizes in reducing symptoms, their overall influence on psychosocial functioning is generally regarded as limited.5,6

One possible explanation for this limited improvement is that these treatments primarily focus on emotions, relational patterns, and dysfunctional cognitive schemas without particularly targeting neuropsychological impairments.7 Although these factors are connected to psychosocial functioning, they may not fully account for it.7 Compared with the general population, people with BPD exhibit substantial neuropsychological impairments across multiple domains, particularly in cognitive flexibility, inhibition, and executive control.8 A meta-analysis by D’Iorio and colleagues8 found moderate-to-strong effect sizes in areas like executive functioning, working memory, decision-making, and sustained attention. Processing speed and visuospatial abilities showed smaller deficits, while memory — primarily verbal and spatial — exhibited significant levels of impairment.9–11 A meta-analysis by Ruocco and colleagues11 and a systematic review by McClure and colleagues12 both found that patients with BPD also experience notable difficulties in planning.13 These neuropsychological impairments are associated with daily functional challenges.8,14

Numerous studies have highlighted specific brain regions or networks that support these neuropsychological functions. 15 In BPD, neurobiological anomalies are linked to symptoms and cognitive dysfunctions, particularly corticolimbic alterations.16,17 Therefore, a central aspect of the neurobiological explanation for BPD involves functional and structural alterations of the dorsolateral prefrontal cortex (DLPFC), which plays a critical role in impulse control, cognitive functions, and emotional regulation.18,19 Findings about the lateralization of the DLPFC are yet to be specific to 1 side.18,19 The left DLPFC has been directly implicated in several studies specific to BPD, although the results are somewhat contradictory.18,20,21 Hypoactivation of the left DLPFC in BPD has been observed during reward-based tasks, reflecting a potential dysfunction in processing motivational salience or future-oriented behaviour, which contributes to impulsivity and difficulty in decision-making.18 This reduced activation impairs the DLPFC’s ability to modulate limbic and subcortical activity, which is essential for controlling impulsive behaviour.17,20–22 Interestingly, the left DLPFC may show heightened activation during tasks involving negative emotional stimuli and behavioural inhibition (e.g., aggression regulation), suggesting an overengaged cognitive control system in emotionally charged contexts, further complicating emotional regulation.18,20,21 Another study reported that people with BPD exhibit reduced bilateral DLPFC activation during negative emotion processing, suggesting a reduced capacity for cognitive control and the use of emotion regulation strategies, which are key features of the disorder’s cognitive dysfunction.18,23 In contrast, healthy individuals show more functionally distinct lateralization in the DLPFC, with the left DLPFC consistently engaged in working memory, stimulus interference control, planning, and proactive control, often without right DLPFC involvement, while the right DLPFC is associated with behavioural inhibition and impulse control during reactive tasks such as go/no-go or stop-signal paradigms.18,23,24

These findings have paved the way for new therapeutic approaches like neuromodulation. In the past decade, these methods have emerged to treat various mental health conditions.25 Notably, many neuromodulation studies in BPD have targeted the left DLPFC, particularly in protocols aiming to enhance regulatory capacities and cognitive functions.25 This focus highlights the potential functional relevance of the left DLPFC in treatment-oriented approaches. Among all these techniques, transcranial direct current stimulation (tDCS) is the most cost-efficient and logistically simple to administer, with the added advantage of potential for supervised home use.26 It applies a low electrical current to the scalp to modulate neuronal excitability and enhance cognitive functions.26,27 It has shown effectiveness for several mental illnesses, including major depressive disorder, anxiety disorders, obsessive–compulsive disorder, and bipolar disorder.26

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Abstract

Background/Objectives: Borderline Personality Disorder (BPD) involves emotional dysregulation, interpersonal instability and impulsivity. Although treatments have advanced, evaluating the latest innovations remains essential. This rapid review aimed to (1) identify and classify recent therapeutic innovations for BPD, (2) assess their effects on clinical and functional outcomes, and (3) highlight research gaps to inform future priorities. Methods: Employing a rapid review design, we searched PubMed/MEDLINE, PsycINFO, and Embase for publications from 1 January 2019 to 28 March 2025. Eligible studies addressed adult or adolescent BPD populations and novel interventions—psychotherapies, pharmacological agents, digital tools, and neuromodulation. Two independent reviewers conducted screening, full-text review, and data extraction using a standardised form. Results: Sixty-nine studies—predominantly from Europe and North America—were included. Psychotherapeutic programmes dominated, ranging from entirely novel models to adaptations of established treatments (for example, extended or modified Dialectical Behavior Therapy). Pharmacological research offered fresh insights, particularly into ketamine, while holistic approaches such as adventure therapy and digital interventions also emerged. Most investigations centred on symptom reduction; far fewer examined psychosocial functioning, mortality, or social inclusion. Conclusions: Recent innovations show promise in BPD treatment but underserve the needs of mortality and societal-level outcomes. Future research should adopt inclusive, equity-focused agendas that align with patient-centred and recovery-oriented goals, supported by a coordinated, integrated research strategy.

1. Introduction

Borderline Personality Disorder (BPD) is a severe and complex psychiatric condition characterised by pervasive instability in emotional regulation, interpersonal relationships, self-image, and impulse control. Individuals with BPD frequently experience intense affective lability, chronic feelings of emptiness, identity disturbance, and recurrent suicidal behaviour or self-injury [1]. Since the seminal study of Linehan [2], substantial progress has been made in the therapeutic management of BPD. A large body of evidence has supported the efficacy of structured psychotherapies [3], and new modalities—both psychological and biological—are continuously emerging. Our understanding of the underlying mechanisms of BPD, its clinical heterogeneity, and the impact on everyday functioning has significantly deepened [4,5]. This growing body of knowledge is now shedding lig on specific therapeutic targets [4,6,7]—mortality, symptoms, psychosocial functioning, and social inclusion—which will be explored in the following section, alongside emerging personalised interventions.
Among all treatment priorities, life expectancy stands out as the most fundamental. While death is an inherent part of life, the stark inequalities in life expectancy between individuals with BPD and the general population are both striking and unacceptable [8,9,10]. Reducing this gap is imperative because, without life, no other therapeutic goal retains its meaning. Historically, efforts to extend life expectancy have focused primarily on lowering suicide, which remains the most prominent cause of excess mortality in individuals with BPD compared to the general population [9,11]. Consequently, suicide prevention has become a central focus of numerous therapeutic interventions. While several treatments have demonstrated effects on suicidal ideation, self-injurious behaviour, and suicide attempts [3,12], it is important to recognise that no intervention to date has shown a definitive impact on reducing suicide mortality itself. Moreover, a critical but often overlooked reality is that most individuals with BPD ultimately die from physical health conditions—many of which are both preventable and more prevalent in this population than in the general population (e.g., cardiovascular disease, substance-related disorders, metabolic syndrome) [8,9].
Beyond its potential to mitigate mortality risks associated with both BPD and comorbid conditions, symptom reduction also addresses the core reasons individuals seek psychiatric care, making it a critical therapeutic priority. Treating BPD involves alleviating the emotional distress and functional impairments associated with core BPD symptoms, along with those stemming from common comorbidities. Over the past decades, most clinical studies have focused on reducing BPD symptomatology as the primary treatment target [3,13]. However, there is a growing recognition that comorbid conditions—such as depression, anxiety, PTSD, substance use disorders, ADHD and eating disorders—are not only highly prevalent in individuals with BPD [14], but also significantly influence clinical outcomes, including relapse [15], quality of life [16], and suicide risk [17,18]. Acknowledging the central role of comorbidities underscores the importance of considering their reduction and management as essential therapeutic outcomes.
The third level of treatment targets broader, person-centred outcomes such as quality of life, sense of purpose, functional recovery, and social integration. For many individuals with BPD, the pursuit of a fulfilling life—encompassing gratifying relationships, stable employment, meaningful activities and projects, and a coherent life narrative—remains a significant challenge [19] and a goal [20]. While symptomatic remission is often achievable, complete recovery, defined by both clinical and functional remission, is far less common [21]. Despite their importance, these outcomes have traditionally been treated as secondary endpoints in clinical research, often overshadowed by symptom reduction and safety measures. This raises important questions about treatment development and evaluation priorities: Are we aiming for mere symptom control or for the possibility of functioning optimally in everyday activities and thriving in a meaningful life? Addressing this gap calls for a shift toward long-term, holistic goals that reflect patients lived experiences and aspirations.
A fourth level of treatment targets operates at the interpersonal and societal level, reflecting the bidirectional relationship between individuals with BPD and their social environment. It is well established that early relational trauma—particularly during childhood and adolescence—plays a central role in the development of BPD [22]. Later in life, social stigma, especially within healthcare systems, can further exacerbate suffering and reinforce exclusion [23]. Conversely, BPD significantly affects others. As a disorder fundamentally rooted in interpersonal dysfunction, BPD can place considerable strain on families [24], partners, children [25], friends, and professional networks. At a broader level, the disorder poses challenges to healthcare systems and society, contributing to high rates of service use, emotional burden on caregivers, and workplace difficulties [26]. Acknowledging and addressing this social dimension is essential. Therapeutic innovations must not only aim to support the individual but also repair and strengthen social bonds, reduce stigma, and consider systemic impacts, ultimately fostering healthier relational ecosystems around the person with BPD.
While research continues to provide growing evidence on how best to treat individuals with BPD, efforts often remain fragmented. Each study pursues its own path, focusing on specific aspects of the disorder without contributing to a unified understanding. Despite the clinical and societal burden of BPD, research funding remains limited [27], and there is currently no coordinated strategy or collective roadmap to address the four central domains of treatment outcomes: premature mortality, symptom reduction, psychosocial functioning, and societal impact. This fragmentation also impacts clinical care [28]. People with BPD and their families consistently express a desire for high-quality, professional healthcare that is rooted in respect, compassion, and meaningful therapeutic relationships [29]. This rapid review examines whether current therapeutic innovations truly reflect and respond to the full complexity of BPD.
The objectives of this rapid review were threefold. First, to systematically identify and classify recent therapeutic innovations for BPD, including novel psychotherapies, pharmacological treatments, digital tools, and neuromodulation techniques, published between 2019 and 2025. Second, to evaluate how these interventions address key clinical and functional outcome domains, such as mortality (e.g., suicide prevention and reduction in physical health-related mortality), symptomatology (targeting core BPD symptoms and common comorbidities), psychosocial functioning (including recovery, quality of life, and global remission), and societal impact (such as stigma reduction, interpersonal relationships, and occupational functioning). Third, this review aimed to identify persisting research gaps and misalignments between current innovation trends and pressing therapeutic needs, to inform future research priorities and promote a more socially responsive and outcome-relevant research agenda.

2. Materials and Methods

2.1. Rapid Review Methodology

This study employed a rapid review approach, defined as a form of knowledge synthesis that accelerates the systematic review process by streamlining or omitting specific steps to deliver evidence in a resource- and time-efficient manner. As outlined by the Cochrane Rapid Reviews Methods Group [30], rapid reviews are beneficial when timely evidence is needed for urgent or high-priority decision-making. In this specific case, our goal was to provide our research community with timely insights so they could identify any potential gaps in the protocol and address them as needed. Methodological adaptations may include narrowing eligibility criteria, limiting the number of databases searched, simplifying screening and data extraction processes, and using single-reviewer approaches with verification.

2.2. Eligibility Criteria

  • Inclusion Criteria
    ○
    Population: Adults or adolescents diagnosed with BPD (DSM-5, ICD-10/11, or equivalent standardised diagnostic criteria).
    ○
    Intervention: Any intervention deemed innovative (mutual agreement at selection based on treatment development knowledge), including but not limited to novel pharmacological agents, new psychotherapeutic modalities, digital interventions, neuromodulation techniques, or microbiome-based approaches.
    ○
    Publications dated between 1 January 2019 and 28 March 2025.
    ○
    Original empirical studies of the following designs: randomised controlled trials (RCTs), quasi-experimental studies, feasibility or pilot studies, and prospective or retrospective observational cohorts.
    ○
    Language: Full-text articles published in English or French.
  • Exclusion Criteria
    ○
    Mixed-diagnosis populations without separate BPD results.
    ○
    Paediatric samples (<12 years).
    ○
    Non–peer-reviewed material (e.g., protocols, abstracts, editorials, letters, opinion pieces).
    ○
    Reviews without original data.
    ○
    Studies of other personality disorders without separate BPD analyses.

2.3. Search Strategy

An expert in mental health literature searching (MD) conducted comprehensive electronic searches across three databases: PubMed/MEDLINE, PsycINFO, and Embase. The goal was to identify all studies of innovative interventions for BPD published between 2019 and March 2025.
  • Keyword Development (Supplementary Materials)
    –
    Borderline personality disorder: Descriptors: “Borderline Personality Disorder” [Mesh] or keywords (titles abstracts): Borderline personality(ies), Borderline state(s)
    –
    Studies: Descriptors: “Clinical Study” [Publication Type] or keywords (titles abstracts): Clinical trial(s), Clinical study(ies), Randomised-control trial(s), Observational study(ies)
  • Search Documentation and Management
All search results were imported into Covidence, where duplicate records across databases were automatically identified and eliminated. A master list of unique citations was maintained, with each entry annotated based on its database of origin.

2.4. Study Selection

Two reviewers (SS and LC) independently screened all titles and abstracts for potential inclusion. Each reviewer applied the predefined eligibility criteria. Conflicts at the title/abstract stage were resolved by consensus. Studies that passed title/abstract screening underwent a full-text review by SS and LC. During full-text review, reasons for exclusion (e.g., incorrect population, out-of-scope interventions such as non-innovative treatments, non-empirical studies) were documented in a standardised exclusion log. The overall selection process is illustrated in a PRISMA flow diagram (Figure 1).
Brainsci 15 00827 g001
Figure 1. PRISMA flow-chart.

2.5. Data Extraction

A standardised data extraction form was developed in Covidence. A first extraction was performed using ChatGPT 04-mini (prompt in Supplementary Materials), and then manually verified (LC).
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CBT-I in Adults Suffering from Cluster B Personality Disorder and Insomnia: A Feasibility Study (INSOPERSO Study)

Résumé

Introduction

L’insomnie est hautement prévalente parmi les personnes vivant avec un trouble de la personnalité du groupe B (TPB). La thérapie cognitivo-comportementale de l’insomnie (TCC-I) est le traitement le plus recommandé pour l’insomnie persistante, mais aucune étude ne s’est penchée sur l’administration de cette modalité chez les patients avec un TPB. Cette étude vise à évaluer la faisabilité d’un programme de TCC-I pour cette patientèle.

Méthode

Il s’agit d’une étude pilote à devis mixte sans groupe contrôle. Vingt-deux participants souffrant d’insomnie et de TPB ont été recrutés au sein d’un programme spécialisé pour les troubles de la personnalité et ont suivi ce programme de TCC-I conçu spécifiquement pour cette patientèle. Les mesures quantitatives incluaient le taux de recrutement et de rétention ainsi que des questionnaires autorapportés évaluant l’insomnie et des comorbidités qui y sont associées. Les données qualitatives ont été recueillies par une discussion de groupe focalisée et des entrevues semi-structurées effectuées post-traitement.

Résultats

Vingt-deux participants ont été recrutés sur un objectif initial de vingt-quatre. Quatorze participants ont abandonné en cours de traitement pour un taux de rétention de 45 %. Une diminution significative de l’insomnie, de la dépression et de l’anxiété a été observée entre l’inclusion et trois mois après la fin de la thérapie. Par ailleurs, six grands thèmes ont été relevés, lors des entrevues qualitatives, auprès des quatre participants : le contenu, le fonctionnement, le thérapeute, la formule de groupe, l’effet de la thérapie et les facteurs influençant la motivation.

Conclusion

La présente étude pilote a permis d’établir qu’un protocole de TCC-I en groupe de courte durée pour cette clientèle est faisable, mais partiellement acceptable. Par ailleurs, les résultats préliminaires concernant l’évolution clinique sont prometteurs et concordent avec les données probantes existantes. Des améliorations méthodologiques sont prévues pour les recherches subséquentes, notamment l’intégration d’un groupe contrôle afin de renforcer la validité interne des conclusions.

Abstract

Introduction

Insomnia is highly prevalent among individuals with Group B personality disorders (GBPD). Cognitive-behavioral therapy for insomnia (CBT-I) is the most recommended treatment for chronic insomnia; however, no study has examined this approach in patients with GBPD. This study aimed to assess the feasibility of a CBT-I program for this patient population, focusing on acceptability, gathering preliminary measures 
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Targeting cognitive impairments in borderline personality disorder: A cognitive remediation approach

Résumé

Problématique

Plusieurs études rapportent la présence d’atteintes neuropsychologiques chez les personnes vivant avec un trouble de la personnalité limite (TPL). Ces atteintes seraient associées à la sévérité des symptômes, l’automutilation, le dysfonctionnement psychosocial et l’adhésion au traitement. Actuellement, aucune intervention spécifique pour le TPL ne cible ces déficits. La remédiation cognitive (RC) a démontré son intérêt sur ces aspects dans plusieurs troubles mentaux. Une RC spécialisée pour le TPL permettrait d’améliorer le pronostic fonctionnel des personnes.

Objectif

L’objectif de cet article est de présenter la démarche conceptuelle entreprise ainsi que le programme de RC conçu.

Méthodologie

Le développement du programme a suivi les phases 0 à 2 du Medical Research Council (MRC) du Royaume-Uni pour les interventions complexes. La phase 0 a consisté en une revue de portée sur le profil neurocognitif TPL et les interventions de RC existantes, la phase 1 en la définition des composantes de l’intervention via des consultations avec neuf professionnels de la santé et la phase 2 en un essai clinique exploratoire avec cinq participantes avec un TPL, pour évaluer la faisabilité et l’acceptabilité de l’intervention.

Résultats

Les résultats ont démontré la faisabilité et l’acceptabilité de l’intervention pour un groupe de 3 à 5 participantes, avec des ajustements nécessaires (ajouts d’exemples, d’explications, de questions de discussions). Le taux d’abandon s’élevait à 40 %. Le programme RC révisé s’étend sur 8 semaines, avec des séances hebdomadaires de deux heures où les participants identifient des objectifs, entraînent leurs fonctions cognitives, reçoivent de l’éducation psychologique, et apprennent des stratégies d’adaptation. Chaque séance aborde des thèmes spécifiques comme les habitudes de vie, l’impulsivité, l’attention, la mémoire, les fonctions exécutives, la motivation, et la procrastination.

Discussion

Ce programme se distingue par sa durée et son intensité réduites par rapport aux études antérieures. Il cible les déficits cognitifs spécifiques au TPL et intègre des stratégies métacognitives. Bien que les résultats soient prometteurs, d’autres études seront nécessaires afin d’évaluer son efficacité.

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What strategies do people with borderline personality disorder use to maintain their well-being and performance at work?

Abstract

Background

People with borderline personality disorder (BPD) often experience instability in their career paths. Previous studies have mainly focused on their challenges in work participation. There has been limited attention on their job tenure strategies. This qualitative study aimed to identify job tenure strategies of people with BPD who are currently employed.

Methods

Between November 2021 and March 2024, participants completed an online survey combining questionnaires and qualitative open-ended questions covering eleven themes, such as task management, adherence to workplace rules and self-perception of competence. The sample comprised 103 women, 22 men, and five non-binary persons, with an average age of 35. In addition to BPD, about half of the participants reported co-occurring diagnoses, such as anxiety disorders. For 54% of participants, their current primary job was aligned with their formal training. For 65%, it corresponded to their personal interests, and for 83%, with their competencies.

Results

To maintain well-being and performance at work, participants reported using strategies that involved balancing work and daily life through stable routines and health-supporting lifestyle habits. Key strategies enabling work functioning focused on self-regulation, cultivating positive workplace relationships, as well as task and time management. Organizing a calm work environment that facilitates concentration, using stress reduction and emotional regulation techniques, and seeking support from colleagues and managers were frequent examples.

Conclusions

The findings highlight a variety of self-directed, interpersonal and task-related actions that people with BPD use to maintain job tenure when employed. These personalized strategies can enrich the development of sustainable work reintegration interventions. Future research should examine the empirical effectiveness of these strategies and explore additional job tenure factors, such as work accommodations tailored to the needs of people with BPD.

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Seeking help from individuals living with borderline personality disorder across ages: specific profiles and evolving needs

Ihsane Zahiri’s affiliation is different from where the work was carried out.

Disclosure: The authors declare no conflict of Interest for this article.

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