To examine recent research on the treatment of borderline personality disorder (BPD).
Method:
A narrative review of all recent controlled trials of therapy for patients with BPD.
Results:
Various psychotherapeutic and psychopharmacological methods can be used to reduce impulsivity and dysphoric mood in this disorder.
Conclusion:
There is strong support for well-structured forms of psychotherapy, but evidence for pharmacotherapy in BPD is mixed. Treatment can usually be carried out in an outpatient setting.
SternA.Psychoanalytic investigation of and therapy in the borderline group of neuroses. Psychoanal Q1938;7:467–89.
2.
ParisJ.Personality disorders over time. Washington (DC): American Psychiatric Press; 2003.
3.
ParisJ.The diagnosis of borderline personality disorder: Problematic but better than the alternatives, Ann Clin Psychiatry2005;17:41–6.
4.
SheaMTPilkonisPABeckhamECollinsJFElikinESotskySM, and others. Personality disorders and treatment outcome in the NIMH Treatment of Depression Collaborative Research Program. Am J Psychiatry1990;147:711–8.
5.
FormanEMBerkMSHenriquesGRBrownGKBeckAT. History of multiple suicide attempts as a behavioral marker of severe psychopathology. Am J Psychiatry2004;161:437–43.
6.
HullJWYeomansFClarkinJLiCGoodmanG.Factors associated with multiple hospitalizations of patients with borderline personality disorder. Psychiatr Serv1996;47:638–41.
7.
GundersonJG. Borderline personality disorder: A clinical guide. Washington (DC): American Psychiatric Press; 2001.
8.
LivesleyWJ. The practical management of personality disorder. New York: Guilford; 2003.
9.
SoloffP.Psychopharmacological treatment of borderline personality disorder. Psychiatric Clin N Am2000;23:169–92.
10.
BlackDWBaumgardCHBellSE. A 16–45 year follow-up of 71 men with antisocial personality disorder. Compr Psychiatry1995;36:130–40.
11.
TyrerPSeivewrightH.Outcome of personality disorders. In: TyrerP, editor. Personality disorders: Diagnosis, management, and course. 2nd ed.Oxford (UK): Butterworth Heinemann; 2000. p 105–25.
12.
ZanariniMCFrankenburgFRHennenJSilkKR. The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. Am J Psychiatry2003;160:274–83.
13.
GundersonJGBenderDSanislowCYenSRettewJBDolan-SewellR, and others. Plausibility and possible determinants of sudden “remissions” in borderline patients. Psychiatry2003;66:111–992.
14.
SkodolAEGundersonJGMcGlashanTHDyckIRStoutRLBenderDS, and others. Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive–compulsive personality disorder. Am J Psychiatry2002;159:276–83.
15.
LinehanMM. Dialectical behavioral therapy of borderline personality disorder. New York: Guilford; 1993.
16.
LinehanMMArmstrongHESuarezAAllmonDHeardH.Cognitive behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry1991;48:1060–4.
17.
LinehanMMHeardHLArmstrongHE. Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patientsArch Gen Psychiatry1993;50:971–4.
18.
ZanariniMCFrankenburgFRKheraGSBleichmarJ.Treatment histories of borderline inpatients. Compr Psychiatry2001;42:144–50.
19.
KoonsCRRobinsCJBishopGKMorseJQTweedJLLynchTR, and others. Efficacy of dialectical behavior therapy with borderline women veterans: A randomized controlled trial. Behav Ther2001;32:371–90.
20.
VerheulRvan den BoschLMCMaartenWJde RidderMAJStijnenTvan den BrinkW.Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. Br J Psychiatry2003;182:135–40.
21.
BohusMHaafBSimmsTLimbergerMFSchmahlCUnckelC, and others. Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: A controlled trial. Behav Res Ther2004;42:487–99.
22.
SimpsonEBYenSCostelloERosenKBeginAPistorelloJ, and others. Combined dialectical behavior therapy and fluoxetine in the treatment of borderline personality disorder. J Clin Psychiatry2004;65:379–85.
23.
LinehanMMSchmidtHIIIDimeffLACraftJCKanterJComtoisKA. Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. Am J Addict1999;8:279–92.
24.
LinehanMM. The application of dialectical behavior therapy (DBT) to chronic suicidality in borderline personality disorder. Presented to the International Society for the Study of Personality Disorders; 2003 October; Florence (IT).
25.
ScheelKR. The empirical basis of dialectical behavior therapy: Summary, critique, and implications. Clin Psychol Sci Pract2000;7:68–86.
26.
TyrerPThompsonSSchmidtUJonesVKnappMDavidsonK, and others. Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: The POPMACT study. Psychol Med2003;33:969–76.
27.
BrownGKNewmanCFCharlesworthSECrits-CristophPBeckA.An open clinical trial of cognitive therapy for borderline personality disorder. J Personal Disord2004;8:257–71.
28.
YoungJE. Cognitive therapy for personality disorders: A schema focused approach. 3rd ed.Sarasota (FL): Professional Resource Press; 1999.
29.
BlumNPfohlBJohnDSMonahanPBlackDW. STEPPS: A cognitive-behavioral systems-based group treatment for outpatients with borderline personality disorder—a preliminary report. Compr Psychiatry2002;43:301–10.
30.
GundersonJGFrankAFRonningstamEFWahterSLynchVJWolfPJ. Early discontinuance of borderline patients from psychotherapy. J Nerv Ment Dis1989;l77:38–42.
31.
SkodolAEBuckleyPCharlesE.Is there a characteristic pattern in the treatment history of clinic outpatients with borderline personality?J Nerv Ment Dis1983;171:405–10.
32.
StevensonJMearesR.An outcome study of psychotherapy for patients with borderline personality disorder. Am J Psychiatry1992;149:358–62.
33.
BatemanAFonagP.Effectiveness of partial hospitalization in the treatment of borderline personality disorder: A randomized controlled trial. Am J Psychiatry1999;156:1563–9.
34.
BatemanAFonagyP.Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: An 18-month follow up. Am J Psychiatry2001;158:36–42.
35.
BatemanAFonagyP.Psychotherapy for borderline personality disorder: Mentalization based treatment. Oxford (UK): Oxford University Press; 2004.
36.
AdlerG.The myth of the alliance with borderline patients. Am J Psychiatry1979;136:642–5.
37.
SafranJDSegalZV. Interpersonal process in cognitive therapy. Northvale (NJ): Jason Aronson; 1990.
38.
PiperWERosieJSJoyceAS. Time-limited day treatment for personality disorders: Integration of research and practice in a group program. Washington (DC): American Psychological Association; 1996.
39.
FonagyP.An update of on BPD treatment evaluation research in England. Presented to the NIMH International Think Tank for the More Effective Treatment of Borderline Personality Disorder; 2004 July; Lincthinum (MD).
40.
ClarkinJFLevyKNLenzenwegerMFKernbergOF. The Personality Disorders Institute/Borderline Personality Disorder Research Foundation randomized control trial for borderline personality disorder: Rationale, methods, and patient characteristics. J Personal Disord2004;18:52–72.
41.
LevyKN. Past research, current findings, and future directions in borderline personality disorder research. Presented at the conference of the National Educational Association for Borderline Personality Disorder; 2004 October; Hamilton (ON).
42.
DawsonDMacMillanHL. Relationship management of the borderline patient: From understanding to treatment. New York: Brunner/Mazel; 1993.
43.
Munroe-BlumHMarzialiE.A controlled trial of short-term group treatment for borderline personality disorder. J Personal Disord1995;9:190–8.
44.
PerryJCBanonEIanniF.Effectiveness of psychotherapy for personality disorders. Am J Psychiatry1999;156:1312–21.
45.
SoloffPHCorneliusJGeorgeANathanSPerelJMUlrichRF. Efficacy of phenelzine and haloperidol in borderline personality disorder. Arch Gen Psychiatry1993;50:377–85.
46.
ZanariniMCFrankenburgFR. Olanzapine treatment of female borderline personality disorder patients: A double-blind, placebo-controlled pilot study. J Clin Psychiatry2001;62:849–54.
47.
ZanariniMCFrankenburgFRParachiniEA. A preliminary, randomized trial of fluoxetine, olanzapine, and the olanzapine-fluoxetine combination in women with borderline personality disorder. J Clin Psychiatry2004;65:903–7.
48.
BogenschutzMPNurnbergGH. Olanzapine versus placebo in the treatment of borderline personality disorder. J Clin Psychiatry2004;65:104–9.
49.
ZanariniMC. Obesity and drug treatment of BPD. Presented to the NIMH International Think Tank for the More Effective Treatment of Borderline Personality Disorder; 2004 July; Lincthinum (MD).
50.
SalzmanCWolfsonANSchatzbergALooperJHenkeRAlbaneseM, and others. Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. J Clin Psychopharmacol1995;15:23–9.
51.
RinneTvan den BrinkWWoutersLvan DyckR.SSRI treatment of borderline personality disorder: A randomized, placebo-controlled clinical trial for female patients with borderline personality disorder. Am J Psychiatry2002;159:2048–54.
52.
ZanariniMCFrankenburgFRParachiniEA. A preliminary, randomized trial of fluoxetine, olanzapine, and the olanzapine-fluoxetine combination in women with borderline personality disorder. J Clin Psychiatry2004;65:903–7.
53.
CoccaroEFKavoussiRJ. Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Arch Gen Psychiatry1997;54:1081–8.
54.
MarkowitzPJ. Pharmacotherapy of impulsivity, aggression, and related disorders. In: HollanderESteinDJ, editors. Impulsivity and aggression. New York: John Wiley; 1995. p 263–86.
55.
CowdryRWGardnerDL. Pharmacotherapy of borderline personality disorder: Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine. Arch Gen Psychiatry1988;45:111–19.
56.
SoloffPHGeorgeANathanSSchulzPMCorneliusJRHerringJ, and others. Amitriptyline versus haloperidol in borderlines: Final outcomes and predictors of response. J Clin Psychopharmacol1989;9:238–46.
57.
LinksPSSteinerMBoiagoIIrwinD.Lithium therapy for borderline patients: Preliminary findings. J Personal Disord1990;4:173–81.
58.
HollanderETracyKASwannACCoccaroEFMcElroySLWozniakP, and others. Divalproex in the treatment of impulsive aggression: Efficacy in cluster B personality disorders. Neuropsychopharmacology2003;28:1186–97.
59.
HollanderESwannACCoccaroEFJiangPSmithTB. Impact of trait impulsivity and state aggression on divalproex versus placebo response in borderline personality disorder. Am J Psychiatry2005;162:621–4.
60.
KavoussiRJCoccaroEF. Divalproex sodium for impulsive aggressive behavior in patients with personality disorder. J Clin Psychiatry1998;59:676–80.
61.
FrankenburgFRZanariniMC. Divalproex sodium treatment of women with borderline personality disorder and bipolar II disorder: A double-blind placebo-controlled pilot study. J Clin Psychiatry2002;63:442–6.
62.
TrittKNickelCLahmannCLeiberichPKRotherWKLoewTH, and others. Lamotrigine treatment of aggression in female borderline patients: A randomized, double-blind, placebo-controlled study. J Psychopharmacology2005;19:287–91.
63.
NickelMKNickelCMitterlehnerFOTrittKLahmannCLeiberichPK, and others. Topiramate treatment of aggression in female borderline personality disorder patients: A double-blind, placebo-controlled study. J Clin Psychiatry2004;65:1515–9.
64.
HenryCMitropoulouVNewASKoenigsbergHWSilvermanJSieverLJ. Affective instability and impulsivity in borderline personality and bipolar II disorders: Similarities and differences. J Psychiatr Res2001;35:307–12.
65.
ParisJ.Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders. Harv Rev Psychiatry2004;12:140–5.
66.
ZanariniMCFrankenburgFR. Omega-3 fatty acid treatment of women with borderline personality disorder: A double-blind, placebo-controlled pilot study. Am J Psychiatry2003;160:167–9.
67.
OldhamJMGabbardGOGoinMKGundersonJSoloffPSpiegelD, and others. Practice guideline for the treatment of borderline personality disorder. Am J Psychiatry2001;158(Suppl):1–52.
68.
StoneMH. The fate of borderline patients. New York: Guilford; 1990.
69.
ParisJZweig-FrankH.A twenty-seven year follow-up of borderline patients. Compr Psychiatry2001;42:482–7.
70.
ParisJ.Is hospitalization useful for suicidal patients with borderline personality disorder?J Personal Disord2004;18:240–7.
71.
LeichsenringFLeibingE.The effectiveness or psychodynamic therapy and cognitive therapy in the treatment of personality disorders: A meta-analysis. Am J Psychiatry2003:160:1223–32.
72.
WampoldBE. The great psychotherapy debate: Models, methods, and findings. Mahwah (NJ): Lawrence Erlbaum Associates; 2001.