Avances en el tratamiento del trastorno límite de la personalidad de larga evolución

Abstract

Borderline personality disorder (BPD) often shows a symptomatic remission over time; however, a substantial subgroup of patients continues to experience persistent affective symptoms, social isolation and functional impairment. This subgroup, conceptualized as “BPD with long-lasting symptoms” (BPD-LLS), represents a growing clinical challenge for which evidence-based interventions are lacking. Psychotherapy remains the first-line treatment for BPD, with dialectical behavior therapy (DBT) as one of the best-established approaches. Yet, research has primarily focused on Stages I and II of DBT, while the needs of BPD-LLS patients align more closely with Stages III and IV -where personal recovery, well-being and functioning are prioritized-. Given that pharmacotherapy is discouraged as a primary intervention for BPD according to clinical guidelines, its widespread use is clinically concerning. In a Spanish clinical sample, most patients were prescribed at least one psychotropic medication (84%), and nearly half (49.6%) met criteria for polypharmacy. Observational data showed that participation in DBT skills-training (DBT-ST) was associated with a significant reduction in polypharmacy, including among BPD-LLS patients, who are characterized by high rates of affective comorbidity and medication use. Furthermore, BPD-LLS prevalence has risen markedly in recent decades, highlighting the need of tailored interventions. Building on this evidence, we developed a contextual-based training group combining DBT skills with positive psychology, self-compassion (SC) and acceptance and commitment therapy techniques. Feasibility and acceptability were confirmed through iterative patient feedback, leading to a 12-week contextual-based protocol. In a randomized controlled trial this intervention significantly improved well-being and depressive symptoms compared to treatment as usual, with effects maintained -and in some cases enhanced- at three-month follow up. No changes were observed in BPD severity, SC or self-criticism. Taken together, these findings underscore the clinical relevance of targeting recovery-oriented outcomes in BPD-LLS. While DBT remains essential for addressing core symptoms, adjunctive contextual interventions may enhance well-being and functional recovery in this emerging patient population._x000D_ _x000D_ Keywords: borderline personality disorder; long-lasting symptoms; polypharmacy; compassion; well-being; contextual therapy; dialectical behavior therapy.

Date of Award	18 Feb 2026
Original language	Spanish
Awarding Institution	Universitat Autònoma de Barcelona (UAB)
Supervisor	Juan Carlos Pascual Mateos (Director) & Joaquin Soler Ribaudi (Director)