Several psychotherapies designed to help for borderline personality disorder were compared using a systematic review of previous studies and analysis of randomized clinical trials. Although the effects were small, dialectical behavior therapy and psychodynamic approaches were both found to be effective.

Borderline personality disorder (BPD) is a crippling mental condition defined by emotional instability, volatile relationships and a compromised ability to control one’s behavior. In addition, people with BPD are also prone to self-harm as well as suicide.

More than one psychotherapy approach has been developed specifically for BPD. Examples include dialectical behavior therapy (DBT), cognitive behavior therapy (CBT), and psychodynamic treatments such as mentalization-based therapy and transference-focused psychotherapy. While each of these appears to be better than standard therapies not designed especially for BPD, direct comparisons among them have shown few differences in their effectiveness.

Dr. Ioana A. Cristea and her colleagues conducted an updated systematic review and analysis of randomized clinical trials to determine the effectiveness of help for borderline personality disorder-specific psychotherapies. Their results were published in the Journal of the American Medical Association Psychiatry. A total of 33 trials (2256 subjects) were included in the study and examined for disorder-specific outcomes such as BPD symptoms, self-harm, and suicide, as well as other more general outcomes.

Dr. Cristea found that dialectical behavior therapy and psychodynamic approaches are both effective for borderline symptoms, however, the effects are small. To their surprise, CBT was not found to be superior to non-BPD specific therapies. The authors point out that one factor that seems to improve therapy outcomes is the use of a manual or workbook. It is also noteworthy that use of medication was not standardized nor consistently reported, so the possible effects of medication cannot be accounted for.

BPD-specific therapies have significant yet modest benefits over non-BPD-specific therapies. However, there is a need for well-conducted, independent studies to define the strength and realistic importance of their results.

Written By: Sean Manning, BA, DC, MWC





