THE EMPIRICALLY SUPPORTED TREATMENT OF BORDERLINE PERSONALITY DISORDERS

The assessment of efficacy and efficiency of treatment are presently taking on growing importance for the psychiatric practice. For this assessment, scientifically proven therapeutic measures or "Empirically Supported Treatments " are applied using techniques such as randomized controlled trials, the meta-analysis and the "Consumer Reports " studies. The present discussion seeks to evaluate the advantages and disadvantages of these procedures. 1. THE ETIOLOGICAL BASIS FOR CONTEMPORARY THERAPIES Personality disorders involve un-adapted, invasive, and permanent behaviours, deeply ingrained, and which are not due to any physical illness, nor to cultural alterations. The borderline personality disorder, (BPD), is prevalent, (2 % in the general population, 20% among psychiatric in-patients), and has a major impact on health facilities, even if these patients make a poor use of attempts to help them. The term borderline is inadequate, because it describes, above all, impulsiveness, disordered hostility, self-destructive acts, mood swings, and splitting; i.e., it defines symptoms, not traits. The validity of this concept is thus, not high, because although it has been similarly described in many countries, the biological findings remain doubtful, in spite of some reliable neurophysiological findings. The patients with BPD have a significantly increased risk of self-destructive and suicidal behaviour (Brodsky et al., 1997), although this risk decreases in the long-term, as there is a decrease in suicidality (Stone, 1993). Some predictors of increased risk for suicida