The goal of this clinical trial is to evaluate whether a dimensional adaptation of Good Psychiatric Management (called GPM-extended) is more effective than classic Good Psychiatric Management (GPM) in treating adult patients with borderline personality disorder (BPD). Briefly, the GPM-extended model integrates elements from existing adaptations of GPM for narcissistic and obsessive-compulsive personality disorders. It aims to provide a more personalized and dimensional approach to treatment, tailored to each patient's specific personality dysfunction and interpersonal triggers.
The main questions it aims to answer are:
* Does GPM-extended improve overall BPD symptom severity more than classic GPM after one year of treatment? * Does GPM-extended lead to better outcomes in related clinical domains (e.g., personality functioning, emotional regulation, social functioning...) ?
Researchers will compare two groups:
* Patients treated in a center using the GPM-extended program. * Patients treated in a center using the classic GPM program. In each group, patients will receive weekly outpatient psychiatric care for one year.
In terms of evaluation, patients will be evaluated at baseline, 4 months, 8 months, and 1 year. They will undergo both clinician-administered and self-report assessments to measure BPD symptoms and other relevant psychological dimensions.
This study hopes to contribute to the development of dimensional evidence-based treatments for personality disorders.
Adults (≥18 years old)
Diagnosis of borderline personality disorder according to the SCID-II (≥5 out of 9 criteria)
Provision of written informed consent
Affiliated with or beneficiary of the French national health insurance system
Age under 18 years
Presence of a comorbid psychotic disorder, intellectual disability, severe antisocial traits, major substance use disorder incompatible with intensive therapy without abstinence, anorexia nervosa with somatic risk, or bipolar disorder in acute manic phase
Individuals under legal protection (e.g., guardianship or legal safeguard)
Individuals unable to cooperate or complete self- or clinician-administered questionnaires
Parallel
GPM-Extended
BehavioralGPM-extended is a dimensional adaptation of Good Psychiatric Management (GPM) that retains its core principles-validation, real-life focus, alliance building-while enhancing flexibility and personalization. It emphasizes diagnostic clarity, treatment prioritization, and individualized psychoeducation based on three key personality dilemmas: fear of abandonment, self-esteem dysregulation, and control dependency. These dilemmas guide the focus of therapy and case management. Treatment goals are collaboratively set and regularly reassessed to align with the patient's evolving needs. The intervention includes weekly individual therapy and tailored group programs, with clinical strategies adapted to each dominant dilemma.
Classic GPM
BehavioralThe classic GPM group follows the validated and manualized version of Good Psychiatric Management (GPM) for BPD. It emphasizes symptom stabilization through weekly individual therapy and pragmatic case management every 3 weeks. Unlike GPM-extended, it uses a uniform therapeutic framework rather than tailoring treatment to individual personality dilemmas,.The intervention includes weekly individual therapy and standardized group programs, with clinical strategies applied uniformly across patients, centered on interpersonal hypersensitivity and building stable life roles.
Change in BPD symptom severity (ZAN-BPD total score)
Difference in mean change in total score on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), a clinician-rated instrument assessing the severity of borderline symptoms. Scores range from 0 to 36, with higher scores indicating greater severity of borderline symptoms.
Change in BPD symptom dimensions (ZAN-BPD subscales)
Difference in mean change in ZAN-BPD subscale scores (affective, cognitive, impulsive, interpersonal), a clinician-rated instrument assessing the severity of borderline symptoms. The subscores assess subdimensions of borderline psychopathology, and range from 0 to 8 (for cognitive, impulsive, and interpersonal subscores), and from 0 to 12 (for affective subscore only). Higher scores indicating greater severity.
Change in personality functioning (LPFS-BF)
Change in total score and subscores (self and interpersonal functioning) on the Level of Personality Functioning Scale - Brief Form (LPFS-BF), a self-report tool assessing personality functioning impairment. Scores range from 12 to 48 (for total score), and from 6 to 24 (for both subscores). Higher scores indicates greater personality dysfunction.
Change in disability level (SDS)
Change in total and domain scores (work/school, social life, family life) on the Sheehan Disability Scale (SDS), a self-report measure of functional impairment. Scores range from 0 to 30 (for total score), and from 0 to 10 (for each subscore). Higher scores indicate greater disability.
Change in social functioning (QFS)
Change in frequency and satisfaction subscores on the Questionnaire de Fonctionnement Social (QFS), a self-report tool assessing social engagement and satisfaction. Scores range from 8 to 40 for both subscores. Higher scores indicate better social functioning.
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AddiPsy
Lead sponsor
Clinique Caradoc
Collaborator
