Abstract

Background Personality disorders (PD) are common and debilitating psychiatric conditions, often characterized by severe interpersonal and self-dysfunction. Borderline personality disorder (BPD) is the most studied PD, with treatments like Good Psychiatric Management (GPM) demonstrating effectiveness. To address the current state of the personality disorder field, where most evidence-based treatments have been developed using a categorical approach, while the most empirically supported approach is the dimensional one, we developed an adaptation of GPM (GPM-extended) integrating concepts of dimensional personality dysfunction into an established therapeutic framework.

Methods This prospective “here-there” study will compare GPM-extended with standard GPM in two outpatient facilities. Participants (≥18 years) meeting BPD criteria per the SCID-II will be included. The GPM-extended group incorporates a dimensional diagnostic framework focusing on three personality dilemmas (rejection/abandonment fears, self-esteem dysregulation, and perfection/control issues), with tailored psychoeducation and treatment priorities. The standard GPM group will follow the validated GPM protocol, emphasizing interpersonal hypersensitivity and standard psychoeducation. Both groups will receive weekly individual therapy and group interventions for one year. The primary objective is to assess the efficacy of GPM-extended in reducing BPD symptoms after one year. Secondary outcomes include personality functioning, traits, and various clinical dimensions such as impulsivity, emotional regulation, and social functioning.

Discussion This study seeks to evaluate the feasibility and efficacy of integrating dimensionality into GPM, offering a pragmatic pathway to improve PD treatment and bridging gaps between evidence-based conceptualizations and treatments of PD.

Clinical trial number NCT06913738

Competing Interest Statement

The authors have declared no competing interest.

Clinical Trial

Clinical trial number: NCT06913738.

Funding Statement

The author(s) received no specific funding for this work.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study protocol was submitted and validated by the Comité de Protection des Personnes Ile de France III (N°ID-RCB = 2024-A00475-42).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion

4. AbbreviationsAMPDAlternative Model of Personality DisordersBPDBorderline Personality DisorderBSL-23Borderline Symptom List – 23 ItemsDBTDialectical Behavioral TherapyDERSDifficulties in Emotion Regulation ScaleDMRS-SRDefense Mechanism Rating Scales Self-ReportECR-RExperience in Close Relationships – RevisedGPM-DASGPM Dilemma Assessment ScaleICD-11International Classification of Diseases, 11th VersionLPFS-BFLevel of Personality Functioning Scale - Brief FormMBTMentalization-Based TherapyMentSMentalization ScaleMINIMini-International Neuropsychiatric Interview 7th VersionNPDNarcissistic Personality DisorderOCPDObsessive-Compulsive Personality DisorderPDPersonality DisorderPESPsychological Entitlement ScalePID-5-BFPersonality Inventory for DSM-5—Brief FormPNI-BPathological Narcissism Inventory - Brief FormPOPSPathological Obsessive-Compulsive Personality ScaleQFSQuestionnaire de Fonctionnement SocialSBBDM-SSuicidal Behaviors and Body Damage and Modifications ScaleSCID-IIStructured Clinical Interview DSM–IV Axis II Personality DisordersSDSSheehan Disability ScaleTAS-20Toronto Alexithymia Scale – 20 ItemsUPPSUPPS-P Impulsive Behavior ScaleWAI-SRWorking Alliance Inventory – Short Form RevisedZAN-BPDZanarini Rating Scale for Borderline Personality Disorder