Early Intervention for Adolescents with Borderline Personality Disorder: Quasi-Experimental Comparison with Treatment as Usual

2009 ◽  
Vol 43 (5) ◽  
pp. 397-408 ◽  
Author(s):  
Andrew M. Chanen ◽  
Henry J. Jackson ◽  
Louise K. McCutcheon ◽  
Martina Jovev ◽  
Paul Dudgeon ◽  
...  
Keyword(s):  
Early Intervention ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Clinical Care ◽  
Borderline Personality ◽  
Experimental Comparison ◽  
Global Functioning ◽  
Treatment As Usual ◽  
Quasi Experimental ◽  
Rate Of Improvement

Objective: The aim of the present study was to compare the effectiveness of specialized team-based early intervention for borderline personality disorder (BPD) with treatment as usual. Method: In a quasi-experimental design, 32 outpatients who received historical treatment as usual (H-TAU) were compared with 78 participants from a recently published randomized controlled trial of cognitive analytic therapy (CAT; n = 41) versus manualized good clinical care (GCC; n = 37), conducted in a specialized early intervention service for BPD (the Helping Young People Early (HYPE) programme). All participants were 15–18-year-old outpatients who fulfilled 2–9 DSM-IV BPD criteria. It was predicted that, compared with H-TAU, HYPE + GCC and HYPE + CAT would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24months. Results: At 24month follow up: (i) HYPE + CAT had lower standardized levels of, and a significantly faster standardized rate of improvement in, internalizing and externalizing psychopathology, compared with H-TAU; and (ii) HYPE + GCC had lower standardized levels of internalizing psychopathology and a faster rate of improvement in global functioning than H-TAU. HYPE + CAT yielded the greatest median improvement on the four continuous outcome measures over 24months. No adverse effects were shown with any of the treatments. Conclusions: Specialized early intervention for subsyndromal or full-syndrome BPD is more effective than TAU, with HYPE + CAT being the most effective intervention. Reform of existing services using the HYPE model might yield substantial improvements in patient outcomes.

Abandonment Psychotherapy and Psychosocial Functioning Among Suicidal Patients With Borderline Personality Disorder: A 3-Year Naturalistic Follow-Up

2019 ◽  
pp. 1-11
Author(s):  
Antonio Andreoli ◽  
Yvonne Burnand ◽  
Laura Frambati ◽  
Donna Manning ◽  
Allen Frances
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Randomized Study ◽  
Borderline Personality ◽  
Psychotic Symptoms ◽  
Global Functioning ◽  
Treatment As Usual ◽  
Treatment Conditions

The authors present the results from a 3-year follow-up among 170 patients who had participated in the original randomized study, which consisted of three treatment conditions: (a) 3-month abandonment psychotherapy (AP) delivered by certified psychotherapists, (b) AP delivered by nurses, and (c) treatment as usual in a psychiatric crisis center. All subjects were recruited at the emergency room after a suicide attempt and met diagnostic criteria for borderline personality disorder and major depression. Psychotic symptoms, bipolar disorder, and mental retardation were exclusion criteria. At 3-year follow-up, 134 (78.8%) subjects had blind, reliable assessment by clinical psychologists. The intent-to-treat analysis indicated that those patients who had received AP during acute treatment had better global functioning, improved work adjustment, and less unemployment/disability at 3-year follow-up. No differences were found as a function of type of therapist delivering AP. The data confirm that short-term AP gains in psychosocial functioning are sustained over the longer term.

scholarly journals Effectiveness of Psychological Treatments for Borderline Personality Disorder and Predictors of Treatment Outcomes: A Multivariate Multilevel Meta-Analysis of Data from All Design Types

2021 ◽  
Vol 10 (23) ◽  
pp. 5622
Author(s):  
Sophie A. Rameckers ◽  
Rogier E. J. Verhoef ◽  
Raoul P. P. P. Grasman ◽  
Wouter R. Cox ◽  
Arnold A. P. van Emmerik ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Dialectical Behavior Therapy ◽  
Treatment Effectiveness ◽  
Meta Analysis ◽  
Borderline Personality ◽  
Effect Sizes ◽  
Sensitivity Analyses ◽  
Treatment As Usual ◽  
Logarithmic Relationship

We examined the effectiveness of psychotherapies for adult Borderline Personality Disorder (BPD) in a multilevel meta-analysis, including all trial types (PROSPERO ID: CRD42020111351). We tested several predictors, including trial- and outcome type (continuous or dichotomous), setting, BPD symptom domain and mean age. We included 87 studies (N = 5881) from searches between 2013 and 2019 in four databases. We controlled for differing treatment lengths and a logarithmic relationship between treatment duration and effectiveness. Sensitivity analyses were conducted by excluding outliers and by prioritizing total scale scores when both subscale and total scores were reported. Schema Therapy, Mentalization-Based Treatment and reduced Dialectical Behavior Therapy were associated with higher effect sizes than average, and treatment-as-usual with lower effect sizes. General severity and affective instability showed the strongest improvement, dissociation, anger, impulsivity and suicidality/self-injury the least. Treatment effectiveness decreased as the age of participants increased. Dichotomous outcomes were associated to larger effects, and analyses based on last observation carried forward to smaller effects. Compared to the average, the highest reductions were found for certain specialized psychotherapies. All BPD domains improved, though not equally. These findings have a high generalizability. However, causal conclusions cannot be drawn, although the design type did not influence the results.

scholarly journals Specialized psychotherapies for adults with borderline personality disorder: A systematic review and meta-analysis

2018 ◽  
Vol 52 (10) ◽  
pp. 949-961 ◽  
Author(s):  
Matthijs Oud ◽  
Arnoud Arntz ◽  
Marleen LM Hermens ◽  
Rogier Verhoef ◽  
Tim Kendall
Keyword(s):  
Systematic Review ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Confidence Interval ◽  
Dialectical Behavior Therapy ◽  
Borderline Personality ◽  
Medium Effect ◽  
Treatment As Usual ◽  
Standardized Mean Difference ◽  
Quality Evidence

Objective: Borderline personality disorder affects up to 2% of the population and is associated with poor functioning, low quality of life and increased mortality. Psychotherapy is the treatment of choice, but it is unclear whether specialized psychotherapies (dialectical behavior therapy, mentalization-based treatment, transference-focused therapy and schema therapy) are more effective than non-specialized approaches (e.g. protocolized psychological treatment, general psychiatric management). The aim of this systematic review is to investigate the effectiveness of these psychotherapies. Methods: PubMed, PsycINFO, CINAHL, EMBASE and CENTRAL were searched from inception to November 2017. Included randomized controlled trials were assessed on risk of bias and outcomes were meta-analyzed. Confidence in the results was assessed using the Grading of Recommendations Assessment, Development and Evaluation method. The review has been reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: A total of 20 studies with 1375 participants were included. Specialized psychotherapies, when compared to treatment as usual or community treatment by experts, were associated with a medium effect based on moderate quality evidence on overall borderline personality disorder severity (standardized mean difference = –0.59 [95% confidence interval: –0.90, –0.28]), and dialectical behavior therapy, when compared to treatment as usual, with a small to medium effect on self-injury (standardized mean difference = –0.40 [95% confidence interval: –0.66, –0.13]). Other effect estimates were often inconclusive, mostly due to imprecision. Conclusion: There is moderate quality evidence that specialized psychotherapies are effective in reducing overall borderline personality disorder severity. However, further research should identify which patient groups profit most of the specialized therapies.

Forensic Issues in Borderline Personality Disorder

2017 ◽  
Author(s):  
Alexander L. Chapman ◽  
André Ivanoff
Keyword(s):  
Mental Health ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Behavioral Problems ◽  
Mental Health Treatment ◽  
Clinical Care ◽  
Borderline Personality ◽  
Comprehensive Treatment ◽  
Psychopharmacological Treatment ◽  
Correctional Settings

Borderline personality disorder (BPD) is a severe, complex, and costly disorder requiring comprehensive treatment. Correctional settings commonly include mental health treatment and on-site mental health clinicians providing psychosocial and psychopharmacological treatment; however, the mandate of prison settings in particular often conflicts directly with providing clinical care to those with complex mental health needs. The necessary emphasis on security, safety, and, in some cases, retribution, can create invalidating environments that both elicit and reinforce the serious behavioral problems often observed among those with BPD, such as self-injury and suicidal behavior. When effective treatments are available, considerable challenges emerge with regard to the training and preparation of clinical staff to treat and line staff to manage inmates with BPD. This chapter discusses these and other issues and provides suggestions for continued work to better understand and treat individuals with BPD in forensic settings.

Meeting the Clinical Challenges of Managing Borderline Personality Disorder

2017 ◽  
Author(s):  
Beth S. Brodsky
Keyword(s):  
Mental Health ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mental Health Treatment ◽  
Borderline Personality ◽  
Mental Health Providers ◽  
Health Providers ◽  
Treatment As Usual ◽  
Technical Modifications ◽  
Positive Engagement

Individuals diagnosed with borderline personality disorder (BPD) are high utilizers of mental health treatment and comprise a large percentage of both inpatient and outpatient psychiatric populations. Not only do they exhibit extreme interpersonal sensitivity and are quick to feel invalidated, rejected, and abandoned, they also present clinically with very challenging symptoms that have contributed to a stigmatization of the BPD diagnosis and the misconception that BPD is not treatable. Recently developed BPD-specific evidence-based psychotherapies incorporating theoretical and technical modifications to “treatment as usual” contribute to the destigmatization of the BPD diagnosis and to increased effectiveness in clinical management of the disorder. This chapter reviews the conceptualizations and interventions that facilitate the capacity for mental health providers to maintain an empathic therapeutic stance toward and positive engagement with BPD patients in order to keep patients engaged with and making progress toward their goals in treatment.

Generalist psychiatric treatments for borderline personality disorder: the evidence base and common factors

2015 ◽  
Author(s):  
Anthony W. Bateman ◽  
Roy Krawitz
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Clinical Management ◽  
Clinical Care ◽  
Relevant Literature ◽  
Common Factors ◽  
Evidence Base ◽  
Borderline Personality ◽  
Outcome Studies ◽  
Supportive Psychotherapy

Chapter 2 discusses generalist psychiatric treatments for borderline personality disorder (BPD). It introduces the rationale for seeking common factors in treatment and provide a brief overview of some relevant literature, outlines the four generalist treatments that have been shown to be effective (structured clinical management (SCM), general psychiatric management (GPM), good clinical care (GCC), and supportive psychotherapy (SP)), describes the outcome studies of the four treatments, and reviews commonalities of the treatments.

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