Skip to main content
SpringerLink
Log in

Effectiveness of Different Psychotherapy Approaches in the Treatment of Borderline Personality Disorder

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Recent clinical trials support the conclusion that patients with borderline personality disorder are best treated with structured and specifically designed forms of psychotherapy. The strongest evidence from clinical trials favors dialectical behavior therapy and mentalization-based treatment. These methods, which have several similarities, could be shortened to make them more accessible. Successful psychotherapy in individuals with borderline personality disorder should not resemble treatment as usual but should offer a predictable structure and methods to promote emotion regulation and problem solving in current life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •  Of importance

  1. Lieb K, Zanarini MC, Schmahl C, et al.: Borderline personality disorder. Lancet 2004, 364:453–461.

    Article  PubMed  Google Scholar 

  2. Paris J: Clinical trials in personality disorders, Psychiatr Clin North Am 2008, 31:517–526.

    Article  PubMed  Google Scholar 

  3. Binks CA, Fenton M, McCarthy L, et al.: Pharmacological interventions for people with borderline personality disorder. Cochrane Database Syst Rev 2006:CD005653.

  4. Binks CA, Fenton M, McCarthy L, et al.: Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2006:CD005652.

  5. Skodol AE, Buckley P, Charles E: Is there a characteristic pattern in the treatment history of clinic outpatients with borderline personality? J Nerv Ment Dis 1983, 171:405–410.

    Article  CAS  PubMed  Google Scholar 

  6. Paris J: Treatment of Borderline Personality Disorder: A Guide to Evidence-based Practice. New York: Guilford Press; 2008.

    Google Scholar 

  7. Paris J: Personality Disorders Over Time. Washington, DC: American Psychiatric Press; 2003.

    Google Scholar 

  8. Skodol AE, Gunderson JG, Shea MT, et al.: The Collaborative Longitudinal Personality Disorders Study (CLPS): overview and implications. J Pers Disord 2005, 19:487–504.

    Article  PubMed  Google Scholar 

  9. Zanarini MC, Frankenburg FR, Hennen J, et al.: The McLean Study of Adult Development (MSAD): overview and implications of the first six years of prospective follow-up. J Pers Disord 2005, 19:505–523.

    Article  PubMed  Google Scholar 

  10. Linehan MM: Dialectical Behavioral Therapy of Borderline Personality Disorder. New York: Guilford Press; 1993.

    Google Scholar 

  11. Linehan MM, Armstrong HE, Suarez A, et al.: Cognitive behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry 1991, 48:1060–1064.

    CAS  PubMed  Google Scholar 

  12. Linehan MM, Heard HL, Armstrong HE: Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Arch Gen Psychiatry 1993, 50:971–974.

    CAS  PubMed  Google Scholar 

  13. Koons CR, Robins CJ, Tweed JL, et al.: Efficacy of dialectical behavior therapy with borderline women veterans: a randomized controlled trial. Behav Ther 2001, 32:371–390.

    Article  Google Scholar 

  14. Verheul R, Van Den Bosch LM, Koeter MW, et al.: Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. Br J Psychiatry 2003, 182:135–140.

    Article  PubMed  Google Scholar 

  15. Bohus M, Haaf B, Simms T, et al.: Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behav Res Ther 2004, 42:487–499.

    Article  PubMed  Google Scholar 

  16. Linehan MM, Comtois KA, Murray AM, et al.: Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 2006, 63:757–766. (Published erratum appears in Arch Gen Psychiatry 2007, 64:1401.)

    Google Scholar 

  17. Stanley B, Brodsky B, Nelson JD, Dulit R: Brief dialectical behavior therapy for suicidality and self-injurious behaviors. Arch Suicide Res 2007, 11:337–341.

    Article  PubMed  Google Scholar 

  18. • McMain SF, Links PS, Gnam WH, et al.: A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. Am J Psychiatry 2009 Sep 15 (Epub ahead of print). This study shows that DBT can be matched by another highly structured psychotherapy.

  19. Oldham JM, Gabbard GO, Goin MK, et al.: American Psychiatric Association Practice Guidelines: Practice Guideline for the treatment of borderline personality disorder. Am J Psychiatry 2001, 158(10 Suppl):1–52.

    Google Scholar 

  20. Bateman A, Fonagy P: Psychotherapy for Borderline Personality Disorder: Mentalization Based Treatment. Oxford: Oxford University Press; 2004.

    Google Scholar 

  21. Bateman A, Fonagy P: Mentalization Based Treatment: A Practical Guide. New York: John Wiley; 2006.

    Google Scholar 

  22. Bateman A, Fonagy P: Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999, 156:1563–1569.

    CAS  PubMed  Google Scholar 

  23. Bateman A, Fonagy P: 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. Am J Psychiatry 2008, 165:631–638.

    Article  PubMed  Google Scholar 

  24. • Bateman A, Fonagy P: Randomized controlled trial of out-patient mentalization based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry 2009 Oct 15 (Epub ahead of print). This study shows that MBT is effective as an outpatient therapy.

  25. Choi-Kain LW, Gunderson JG: Mentalization: ontogeny, assessment, and application in the treatment of borderline personality disorder. Am J Psychiatry 2008, 165:1127–1135.

    Article  PubMed  Google Scholar 

  26. Brown GK, Newman CF, Charlesworth SE, et al.: An open clinical trial of cognitive therapy for borderline personality disorder. J Pers Disord 2004, 18:257–271.

    Article  PubMed  Google Scholar 

  27. Tyrer P, Thompson S, Schmidt U, et al.: Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study. Psychol Med 2003, 33:969–976.

    Article  CAS  PubMed  Google Scholar 

  28. Davidson K, Norrie J, Tyrer P, et al.: The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the Borderline Personality Disorder Study of Cognitive Therapy (BOSCOT) trial. J Pers Disord 2006, 20:450–465.

    Article  PubMed  Google Scholar 

  29. Davidson K, Tyrer P, Gumley A, et al.: A randomized controlled trial of cognitive behavior therapy for borderline personality disorder: rationale for trial, method, and description of sample. J Pers Disord 2006, 20:431–449.

    Article  PubMed  Google Scholar 

  30. Palmer S, Davidson K, Tyrer P, et al.: The cost-effectiveness of cognitive behavior therapy for borderline personality disorder: results from the BOSCOT trial. J Pers Disord 2006, 20:466–481.

    Article  PubMed  Google Scholar 

  31. Weinberg I, Gunderson JG, Hennen J, Cutter CJ Jr: Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients. J Pers Disord 2006, 20:482–492.

    Article  PubMed  Google Scholar 

  32. Huband N, McMurran M, Evans C, Duggan C: Social problem-solving plus psychoeducation for adults with personality disorder: pragmatic randomised controlled trial. Br J Psychiatry 2007, 190:307–331.

    Article  PubMed  Google Scholar 

  33. Blum N, St. John D, Pfohl B, et al.: Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up. Am J Psychiatry 2008, 165:468–478. (Published erratum appears in Am J Psychiatry 2008, 165:777.)

  34. Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF: Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry 2007, 164:922–928.

    Article  PubMed  Google Scholar 

  35. Young, JE: Cognitive Therapy for Personality Disorders: A Schema Focused Approach, edn 3. Sarasota, FL: Professional Resource Press; 1999.

    Google Scholar 

  36. Giesen-Bloo J, van Dyck R, Spinhoven P, et al.: Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy Arch Gen Psychiatry 2006, 63:649–658. (Published erratum appears in Arch Gen Psychiatry 2006, 63:1008.)

  37. Ryle A, Leighton T, Pollock P: Cognitive Analytic Therapy and Borderline Personality Disorder: The Model and the Method. Hoboken, NJ: John Wiley; 1997.

    Google Scholar 

  38. Chanen AM, Jackson, HJ, McCutcheon LK, et al.: Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial. Br J Psychiatry 2008, 193:477–484. (Published erratum appears in Br J Psychiatry 2009, 194:191.)

    Google Scholar 

  39. Wampold BE: The Great Psychotherapy Debate: Models, Methods, and Findings. Mahwah, NJ: Lawrence Erlbaum Associates; 2001.

    Google Scholar 

  40. Gunderson JG, Links P: Borderline Personality Disorder: A Clinical Guide, edn 2. Washington, DC: American Psychiatric Press; 2008.

    Google Scholar 

  41. Stern A: Psychoanalytic investigation of and therapy in the borderline group of neuroses. Psychoanal Q 1938, 7:467–489.

    Google Scholar 

  42. Koenigsberg H: Neural correlates of borderline personality disorder symptoms. Paper presented at the International Society for the Study of Personality Disorders. New York, NY; August 2009.

  43. Frank JD, Frank JB: Persuasion and Healing, edn 3. Baltimore, MD: Johns Hopkins; 1991.

    Google Scholar 

Download references

Disclosure

No potential conflict of interest relevant to this article was reported.

Author information

Authors and Affiliations

  1. McGill University, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis Jewish General Hospital, 4333 Chemin de la cote Ste. Catherine, Montreal, Quebec, H3T1E4, Canada

    Joel Paris

Authors
  1. Joel Paris
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joel Paris.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Paris, J. Effectiveness of Different Psychotherapy Approaches in the Treatment of Borderline Personality Disorder. Curr Psychiatry Rep 12, 56–60 (2010). https://doi.org/10.1007/s11920-009-0083-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-009-0083-0

Keywords

Search

Navigation