Clinical stage
Definition
Potential interventions
0
Increased risk of severe mood disorder or borderline personality disorder (e.g., family history, exposure to abuse or neglect, substance use)
Mental health literacy
No specific current symptoms
Self-help
1a
Mild or nonspecific symptoms of mood disorder or borderline personality disorder (e.g., disturbances in attention, emotional regulation, and behavior)
Formal mental health literacy
Family psychoeducation, parenting skills
Substance abuse reduction
Supportive counseling/problem solving
1b
Sub-threshold features of mood disorder or borderline personality disorder
1a plus phase-specific psychosocial intervention (e.g., cognitive behavioral therapy, HYPE early intervention for borderline personality disorder [103])
2
First episode of threshold mood disorder or borderline personality disorder
1b and case management, educational/vocational intervention/rehabilitation, family psychoeducation and support, specific time-limited psychotherapy, specific and targeted pharmacotherapy (e.g., mood stabilizer)
3a
Recurrence of sub-threshold mood or borderline personality disorder symptoms
2 and emphasis on maintenance medication and psychosocial strategies for full remission
3b
First threshold relapse of mood disorder or borderline personality disorder
3a and relapse prevention strategies
3c
Multiple relapses of mood disorder or borderline personality disorder
3b and combination mood stabilizers, intensive psychosocial interventions (e.g., dialectical behavior therapy)
4
Persistent unremitting disorder
3c and clozapine and other tertiary therapies, social participation despite disability
Many of the interventions suggested for early stages of disorder already exist, but their outcomes have not been assessed when used in this proposed model. Interventions for stages 1b and 2 are early in their development. Psychosocial interventions in youth include the Helping Young People Early (HYPE) program for borderline personality disorder [103], along with psychosocial interventions for bipolar disorder [104] and unipolar depression [105]. Low toxicity, novel pharmacotherapies might also be appropriate for stages 1b and 2. Examples include N-acetylcysteine for bipolar disorder [106] or omega-3 fatty acids, which have evidence to support their use in both mood and borderline personality disorders from stage 2 onwards [107–109].
This clinical staging model for mood and borderline personality disorders will necessarily evolve and become more sophisticated with evolving knowledge about developmental pathways for these disorders (including indicative biological and endophenotypic markers) and novel interventions. It provides a starting point for both diagnosis and treatment development.
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