Cristea IA, Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2017;74(4):319–328.

Link to article

I chose the article summarized below because of the patient, L.H., which I wrote about for my third history and physical for my psychiatry rotation. She had a past psychiatric history of borderline personality disorder, amongst other psychiatric illnesses. While it is not possible to diagnose or necessarily see the entirety of a patient’s personality disorder in the psychiatric emergency department, it was clear through her history of a difficult relationship with her boyfriend, no friends and no family relations, that this patient had characteristics of the personality disorder she stated she was previously diagnosed with. The psychiatrist I was working with mentioned to the patient the benefit of dialectical behavior therapy for this disorder and thus, I wanted to research what therapies are available and effective for borderline personality disorder.

This article is a systematic review and meta-analysis of randomized clinical trials of various psychotherapies and their efficacy on borderline personality disorder. It included thirty-three trials with 2,256 patients with borderline personality disorder. The first aspect of the article discussed borderline personality disorder and how it is a mental disorder that affects relationships and identity and often is associated with parasuicide and suicide. Since borderline personality disorder is such a debilitating disorder, therapies are important in aiding in treating and stabilizing these patients. Such therapies include cognitive behavioral therapy, dialectical behavior therapy and psychodynamic treatment.

The authors used PubMed, PsychINFO, EMBASE and Cochrane Central Register of Controlled Trials to find articles relating to borderline personality. They included studies that were randomized controlled trials comparing a psychotherapy to a control condition in borderline personality disorder adult patients. In order to assess the variety of different outcomes, the authors grouped them into various groups such as borderline relevant, borderline symptoms, health service use etc.. As mentioned above, thirty-three trials were included with 1,169 participants in the treatment group and 1,087 in the control group.

This review found that there were significant results and effects for all of the outcome groups, such that therapy provided significant benefit in reducing borderline personality symptoms, parasuicidal behavior, suicidal behavior, hospitalizations, use of emergency services and so on. As most of the trials in this analysis utilized dialectical behavioral therapy, it is promising that this type of therapy is effective in improving symptoms in borderline patients and providing positive outcomes. Interestingly, this review did not find a significant difference in the experimental and control groups in terms of treatment retention, which is surprising as it would be expected that those improving with psychotherapy would be more likely to remain in treatment as compared to the control groups. While this study did have limitations, such as additional medication not being standardized, which could have confounded the effects of psychotherapy, this review identifies that psychotherapy, especially dialectical behavioral therapy, does have positive effects on borderline personality disorder.