Clinicians can use adapted general psychiatric management (GPM) techniques to successfully manage adolescents who have both borderline personality disorder and an eating disorder, according to a report issued in The American Journal of Psychotherapy.
“Although specialized adolescent-focused interventions for borderline personality pathology can be adapted for these individuals, the availability of those treatments is unlikely to meet the public health demand,” wrote Marcos S. Croci, M.D., from the University of São Paulo, Brazil, and colleagues. “Therefore, developing a generalist early intervention is imperative.”
GPM—also known as good psychiatric management—is a treatment for borderline personality disorder that empowers patients through psychoeducation, life-building activities, conservative psychopharmacology, and accountability. Croci and colleagues propose that some best practices for eating disorder treatment can be integrated into the GPM framework and address the core psychopathologies of both disorders.
The researchers call their approach GPM-AED, for general psychiatric management for adolescents with borderline personality disorder and an eating disorder. They said that GPM-AED allows nonspecialists “to help adolescents with borderline personality pathology to build a life independent of eating disorder symptoms… while remaining focused on the assessment and safety considerations that are crucial in caring for these patients.”
This will allow specialized treatments to be reserved for those who do not respond to first-line interventions or for individuals with severe symptoms, according to Croci and colleagues.
General principles of GPM-AED include:
- Provide earlier care: Beginning treatment of borderline personality and eating disorders during adolescence is key, when prognoses are better.
- Disclose diagnoses, engage in psychoeducation: Disclosing diagnosis and sharing knowledge and patient literature about the biology, symptoms, course, treatment, and possible medical complications can help destigmatize these disorders and help patients form a new opinion about them.
- Focus beyond treatment, set goals: Helping patients to invest in life outside of treatment is the primary goal of the therapy, by encouraging them to engage in activities that resonate with their dreams, desires, and values.
- Involve the family as allies: This means instructing parents to serve as allies, schedule mealtimes, avoid difficult conversational topics while eating, not follow a restricted diet, or make comments on the patients’ or others’ eating habits (“fat talk”). Clinicians should avoid blaming the parents.
- Manage safety: Monitoring for suicidality and safety planning are critical because suicide rates among youths with borderline personality disorder and eating disorders are high.
- Refer high-risk patients: Individuals with life-threatening behavior, for example, laxative misuse or vomiting when at low weight, severe malnutrition, rapid weight loss, or weight-restoration failure should be referred to higher levels of care.
For related information, see APA’s draft “Practice Guideline for the Treatment of Patients With Borderline Personality Disorder.”
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