Psychotherapies specifically designed for borderline personality disorder (BPD) are the most effective form of treatment for this population, but these modalities are not easily accessible.
Method
Narrative review.
Results
Although research shows that such therapies are effective, the best-known methods are lengthy, expensive, and difficult for patients to access.
Conclusions
This review recommends that interventions for patients with BPD should be briefer, less costly, and more accessible.
Get full access to this article
View all access options for this article.
References
1.
SternA.Psychoanalytic investigation of and therapy in the borderline group of neuroses. Psychoanal Q.1938;7:467–489.
2.
GundersonJG.Borderline personality disorder: ontogeny of a diagnosis. Am J Psychiatry. 2009;166:530–539.
3.
LinehanMM.Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford; 1993.
4.
CrowellSE, BeauchaineT, LinehanMM.A biosocial developmental model of borderline personality: elaborating and extending Linehan's theory. Psychol Bull. 2009;135:495–510.
5.
LinehanMM, ArmstrongHE, SuarezA, . Cognitive behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991;48:1060–1064.
6.
LinehanMM, HeardHL, ArmstrongHE.Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1993;50:971–974.
7.
LinehanMM, ComtoisKA, MurrayAM, . 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.
8.
ZanariniMC.Psychotherapy of borderline personality disorder. Acta Psychiatr Scand. 2009;120: 373–377.
9.
ParisJ.Effectiveness of differing psychotherapy approaches in the treatment of borderline personality disorder. Curr Psychiatry Rep. 2010;12:56–60.
10.
McMainSF, LinksPS, GnamW, . A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. Am J Psychiatry. 2009;166:1365–1374.
11.
McMainSF, GuimondT, StreinerD, . Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: clinical outcomes and functioning over a 2-year follow-up. Am J Psychiatry. 2012;169:650–661.
12.
StanleyB, BrodskyB, NelsonJ, . Brief dialectical behavior therapy for suicidality and self-injurious behaviors. Arch Suicide Res. 2007;11:337–341.
13.
ZanariniMC, FrankenburgF, ReichB, . Attainment and stability of sustained symptomatic remission and recovery among borderline patients and Axis II comparison subjects: A 16-year prospective follow-up study. Am J Psychiatry. 2012;169:476–483.
14.
LinehanMM, KorslundKE, HarnedMS, . Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry. 2015;72:475–482.
15.
ZanariniMC, FrankenburgF.A preliminary, randomized trial of psychoeducation for women with borderline personality disorder. J Pers Disord. 2008; 22:284–290.
16.
DavidsonK, NorrieJ, TyrerP, . 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.
17.
LambertMJ, ed. Bergin and Garfield's handbook of psychotherapy and behavior change. New York, NY: Wiley; 2013.
18.
LeichsenringF, RabungS, LeibingE.The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. Arch Gen Psychiatry. 2004;61:1208–1216.
19.
BatemanA, FonagyP.Mentalization-based treatment for borderline personality disorder: a practical guide. New York, NY: John Wiley; 2006.
20.
BatemanA, FonagyP.Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry. 1999;156:1563–1569.
21.
BatemanA, FonagyP.Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry. 2009;166:1355–1364.
22.
BatemanA, FonagyP.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.
23.
JørgensenCR, FreundC, BøyeR, . Outcome of mentalization-based and supportive psychotherapy in patients with borderline personality disorder: a randomized trial. Acta Psychiatr Scand. 2013;127:305–317.
24.
Giesen-BlooJ, van DyckR, SpinhovenP, . Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry. 2006;63:649–658.
25.
ClarkinJ F, LevyKN, LenzenwegerM F, . Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry. 2007; 164:922–928.
26.
DoeringS, HörzS, RentropM, . Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomized controlled trial. Br J Psychiatry. 2010;196:389–395.
27.
BlumN, St JohnD, PfohlB, . 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.
28.
BosEH, van WelEB, AppeloMT, . A randomized controlled trial of a Dutch version of Systems Training for Emotional Predictability and Problem Solving for borderline personality disorder. J Nerv Ment Dis. 2010;198:299–304.
29.
BlumN, St. JohnD.STAIRWAYS: the next step in treatment for borderline personality disorder. Coralville, IA: Level One Publishing; 2009.
30.
GabbardGO, LazarSG, HornbergerJ, . The economic impact of psychotherapy: a review. Am J Psychiatry. 1997;154:147–155.
31.
PalmerS, DavidsonK, TyrerP, . The cost-effectiveness of cognitive behavior therapy for borderline personality disorder: results from the BOSCOT trial. J Pers Disord. 2006;20:466–481.
32.
ParisJ.Treatment of borderline personality disorder: a guide to evidence-based practice. New York, NY: Guilford Press; 2008.
33.
ParisJ.A concise guide to personality disorders. Washington DC: American Psychological Association; 2015.
34.
CarlatDJ.Unhinged. New York, NY: Free Press; 2010.
35.
PatelV, TharaR, eds. Meeting the mental health needs of developing countries. Berkeley, CA: Sage; 2003.
36.
SulzSK, HagspielS.Questions and answers about psychotherapy training in some European Union countries. European Psychotherapy. 2011;10:161–175.
37.
ClarkD.Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. Int Rev Psychiatry. 2011;23:318–327.
38.
ParisJ, GoldbloomD, KurdyakP.Moving out of the office: problems in access to psychiatry. Can J Psychiatry. 2015;60:403–406.
39.
ZimmermanM, MattiaJ.Differences between clinical and research practices in diagnosing borderline personality disorder. Am J Psychiatry. 1999;156:1570–1574.
ParisJ.Stepped care: an alternative to routine extended treatment for patients with borderline personality disorder. Psychiatr Serv. 2013;64:1035–1037.
42.
RichardsDA.Stepped care: a method to deliver increased access to psychological therapies. Can J Psychiatry. 2012;57:210–215.
43.
NorcrossJC, GoldfriedMR.Handbook of psychotherapy integration, 2nd ed.New York, NY: Oxford University Press; 2005.
44.
LivesleyWJ.Moving beyond specialized therapies or borderline personality disorder: the importance of integrated domain-focused treatment. Psychodyn Psychiatry. 2012;40:47–74.
45.
ParisJ.Applying the principles of psychotherapy integration to the treatment of borderline personality disorder. Journal of Psychotherapy Integration. 2015;25:13–19.
46.
StoffersJM, VöllmBA, RückerG, . Psychological therapies for people with borderline personality. Cochrane Database Syst Rev. 2012;8:CD005652.