Borderline Personality Disorder Research

Helpful to Borderline Personality Disorder Recovery

January 2003

  omega-3 Fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study.

Am J Psychiatry. 2003 Jan;160(1):167-9
Zanarini MC, Frankenburg FR.
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA 02478, USA. zanarini@mclean.harvard.edu

"OBJECTIVE: The purpose of this study was to compare the efficacy of ethyl-eicosapentaenoic acid (E-EPA) and placebo in the treatment of female subjects with borderline personality disorder...Analyses that used random-effects regression modeling and controlled for baseline severity showed E-EPA to be superior to placebo in diminishing aggression as well as the severity of depressive symptoms. CONCLUSIONS: The results of this study suggest that E-EPA may be a safe and effective form of monotherapy for women with moderately severe borderline personality disorder.

Borderline Personality Disorder Therapy

Clinical Guidelines

March 2000

  Clinical guidelines for psychotherapy for patients with borderline personality disorder.

Psychiatr Clin North Am. 2000 Mar;23(1):193-210, ix. 
Stone MH.
Department of Psychiatry, Columbia College of Physicians & Surgeons, New York, New York, USA.

"In planning a course of psychotherapy for borderline patients, clinicians must take into account the heterogeneity of the clinical presentation in the borderline domain. Borderline personality disorder is usually accompanied, for example, by one or several "symptom disorders," such as an eating disorder, depression, posttraumatic stress disorder, premenstrual tension, dissociative disorder, or anxiety disorder--not to mention one or more other personality disorders. The nature of the "comorbidity" in each patient will determine which medications, if any, are applicable. The accompanying personality disorders will have an impact on amenability to psychotherapy. The main forms of therapy currently in use are supportive, cognitive-behavioral (including dialectical behavioral therapy) and psychodynamic (including transference-focused psychotherapy). Group therapy is often used adjunctively with any of these approaches. The main question is no longer, Which of these approaches is best, overall? but rather, Which approach is best for which type of borderline patient? Contemporary research is addressed to this latter question."

Psychodynamic Treatment

December 2001

  The development of a psychodynamic treatment for patients with borderline personality disorder: a preliminary study of behavioral change.

J Personal Disord. 2001 Dec;15(6):487-95.
Clarkin JF, Foelsch PA, Levy KN, Hull JW, Delaney JC, Kernberg OF.
Personality Disorders Institute, Department of Psychiatry, Weill Medical College of Cornell University, White Plains, NY, USA. jclarkin@med.cornell.edu

"This study examines the effectiveness of a modified psychodynamic treatment called Transference Focused Psychotherapy (TFP) designed specifically for patients, with borderline personality disorder (BPD)... Compared to the year prior to treatment, the number of patients who made suicide attempts significantly decreased, as did the medical risk and severity of medical condition following self-injurious behavior. Compared to the year prior, study patients during the treatment year had significantly fewer hospitalizations as well as number and days of psychiatric hospitalization. The dropout rate was 19.1%. This uncontrolled study is highly suggestive that this structured and manualized psychodynamic treatment modified for borderline patients shows promise for the ambulatory treatment of these patients and warrants further study."

Cognitive Analytic Therapy

March 2001

  Treating personality fragmentation and dissociation in borderline personality disorder: a pilot study of the impact of cognitive analytic therapy.

Br J Med Psychol. 2001 Mar;74(Pt 1):47-55.
Wildgoose A, Clarke S, Waller G.
Islington Community Health Service NHS Trust, UK.

"Recent findings suggest that personality fragmentation may be a core component of borderline personality disorder (BPD) and that successful treatment of BPD may depend on the extent to which this is addressed. Cognitive analytic therapy (CAT) can increase integration by strengthening awareness, and hence control, of the dissociative processes maintaining fragmentation. This pilot study aimed to conduct a systematic evaluation of the impact of CAT on BPD severity and personality integration...By follow-up, CAT had produced reductions in the severity of BPD for all five participants, and three participants showed significant changes in their levels of personality fragmentation. Improvements in comorbid disturbance were less consistent, however. Although the small number of participants involved limits these findings, they have theoretical and clinical interest. They generally support the suggestion that integration should be enhanced with BPD patients, and suggest that CAT may be a useful method to achieve this goal."

June 2000

  Effectiveness of time-limited cognitive analytic therapy of borderline personality disorder: factors associated with outcome.

Br J Med Psychol. 2000 Jun;73 ( Pt 2):197-210. 
Ryle A, Golynkina K.
King's College, London, UK.

"Most patients with borderline personality disorder receive no formal treatment for their personality disorder and psychotherapy is widely believed to be necessarily intensive, of long duration and of uncertain effect. This study seeks to demonstrate the scope and limits of time-limited outpatient cognitive analytic psychotherapy...The patients classified as improved no longer met diagnostic criteria for borderline personality disorder. The two-thirds still traceable were re-tested at 18 months. These groups were compared in terms of a number of pre-therapy measures and features. Poorer outcome was associated with greater severity of borderline features, a history of self-cutting, alcohol abuse and unemployment."

Hospitalization

October 1999

  Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial.

Am J Psychiatry 1999 Oct;156(10):1563-9
Bateman A, Fonagy P.
Halliwick Day Unit, St. Ann's Hospital.

"Psychoanalytically oriented partial hospitalization is superior to standard psychiatric care for patients with borderline personality disorder. Replication is needed with larger groups, but these results suggest that partial hospitalization may offer an alternative to inpatient treatment."

Schema-focused Therapy

Spring 1997

  Treatment of borderline personality disorder with the schema-focused approach

Sante Ment Que. 1997 Spring;22(1):87-105. 
Cousineau P, Young JE.
Cognitive Therapy Centers of New York, USA.

"The treatment of Borderline Personality Disorder has been a challenge for Cognitive Therapy (CT): some modifications to the CT basic model had to be implemented in order to intervene with BPD patients. Young's schema-focused approach offers an intervention model which relies on early maladaptive schemas and modes concepts. According to this model, the BDP presents four dysfunctional modes: the Abandoned Child mode, the Detached Protector mode, the Punitive Parent mode, the Angry Child mode. The therapist must identify the presence of these modes and implement therapeutic strategies specific to each of them. There are four different kinds of therapeutic strategies: interpersonal (therapy relationship), experiential, cognitive and behavioral."

Dialectical Behavior Therapy

Winter 2003

  Pharmacokinetics and drug interactions of the sedative hypnotics.

Psychopharmacol Bull. 2003 Winter;37(1):30-46.
Gagliardi JP, Krishnan RR.
Departments of Internal Medicine and Psychiatry, Duke University Medical Center, Durham, North Carolina, USA.

"...Psychotherapeutic and pharmacological strategies have been investigated, and a few have shown promise. Dialectical behavior therapy (DBT) may be helpful in decreasing suicidal behavior and improving symptomatology, although the data are not strong, and the actual "type" of DBT employed may influence the outcomes..."

Swenson CR Torrey WC Koerner K, Implementing dialectical behavior therapy.
Psychiatr Serv 2002 Feb; 53:171-8
Even though the initial studies have been promising, there has not been enough empirical evidence to say that DBT should be the main mode of therapy for BPD.

April 2003

  A dialectical behavior therapy program for people with an eating disorder and borderline personality disorder--description and outcome.

Int J Eat Disord. 2003 Apr;33(3):281-6.
Palmer RL, Birchall H, Damani S, Gatward N, McGrain L, Parker L.
Department of Psychiatry, Leicester Warwick Medical School, Brandon Mental Health Unit, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom.

"...Full DBT is an expensive and demanding treatment but deserves consideration for patients with an eating disorder and co-morbid borderline personality disorder and self-harm. There is a need for a more systematic and thorough evaluation..."

February 2003

  Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands.

Br J Psychiatry. 2003 Feb;182:135-40.
Verheul R, Van Den Bosch LM, Koeter MW, De Ridder MA, Stijnen T, Van Den Brink W.
DeViersprong Center of Psychotherapy, University of Amsterdam, Halsteren, The Netherlands. roel.verheul@deviersprong.net

"RESULTS: Dialectical behaviour therapy resulted in better retention rates and greater reductions of self-mutilating and self-damaging impulsive behaviours compared with usual treatment, especially among those with a history of frequent self-mutilation. CONCLUSIONS: Dialectical behaviour therapy is superior to usual treatment in reducing high-risk behaviours in patients with BPD."

November & December 2002

  Dialectical Behavior Therapy of borderline patients with and without substance use problems. Implementation and long-term effects

Addict Behav. 2002 Nov-Dec;27(6):911-23. 
van den Bosch LM, Verheul R, Schippers GM, van den Brink W.
Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, Netherlands. wiesvdbosch@wxs.nl

"RESULTS: Standard DBT can be applied in a group of borderline patients with and without comorbid SA [sexual abuse]. Major implementation problems did not occur. DBT resulted in greater reductions of severe borderline symptoms than TAU [treatment-as-usual], and this effect was not modified by the presence of comorbid SA. Standard DBT, as it was delivered in our study, however, had no effect on SA problems. CONCLUSIONS: Standard DBT can be effectively applied with borderline patients with comorbid SA problems, as well as those without. Standard DBT, however, is not more efficacious than TAU in reducing substance use problems. We propose that, rather than developing separate treatment programs for dual diagnosis patients, DBT should be "multitargeted." This means that therapists ought to be trained in addressing a range of severe manifestations of personality pathology in the impulse control spectrum, including suicidal and self-damaging behaviors, binge eating, and SA."

September 2002

  Predictors of relapse following successful dialectical behavior therapy for binge eating disorder.

Int J Eat Disord. 2002 Sep;32(2):155-63. 
Safer DL, Lively TJ, Telch CF, Agras WS.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305-5722, USA. dlsafer@stanford.edu

"OBJECTIVE: To identify predictors of relapse at 6-month follow-up for women with binge eating disorder (BED)... RESULTS: The largest effect sizes for predicting relapse were found with early onset of binge eating and higher EDE [eating disorders examination]. Restraint scores. DISCUSSION: Previous findings that earlier age of onset (age 16 years or younger) is linked to less successful treatment outcome are now extended to the 6-month follow-up assessment. The finding that higher restraint scores after treatment predict relapse adds to the literature concerning the role of restraint in patients with BED."

Summer 2002

  Dialectical behavior therapy adapted for suicidal adolescents.

Suicide Life Threat Behav. 2002 Summer;32(2):146-57. 
Rathus JH, Miller AL.
Department of Psychology, Long Island University, Brookville, NY 11548, USA. jill.rathus@liu.edu

"DBT appears to be a promising treatment for suicidal adolescents with borderline personality characteristics."

June 2002

  Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder.

Drug Alcohol Depend. 2002 Jun 1;67(1):13-26. 
Linehan MM, Dimeff LA, Reynolds SK, Comtois KA, Welch SS, Heagerty P, Kivlahan DR.
Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195-1525, USA. linehan@u.washington.edu

"...participants assigned to DBT maintained reductions in mean opiate use through 12 months of active treatment while those assigned to CVT [Comprehensive Validation Therapy] + 12S [12 step programs] significantly increased opiate use during the last 4 months of treatment. Second, CVT + 12S retained all 12 participants for the entire year of treatment, compared to a 64% retention rate in DBT. Third, at both post-treatment and at the 16-month follow-up assessment, subjects in both treatment conditions showed significant overall reductions in level of psychopathology relative to baseline. A noteworthy secondary finding was that DBT participants were significantly more accurate in their self-report of opiate use than were those assigned to CVT + 12S."

February 2002

  Implementing dialectical behavior therapy.

Psychiatr Serv. 2002 Feb;53(2):171-8. 
Swenson CR, Torrey WC, Koerner K.
University of Massachusetts Medical School, Worcester, USA. crobert01@aol.com

"Early empirical results are promising, although they are not sufficient to establish DBT as an evidence-based practice in community settings."

February 2002

  Suicidal and self-injurious behavior in personality disorder: controversies and treatment directions.

Curr Psychiatry Rep. 2002 Feb;4(1):30-8. 
Gerson J, Stanley B.
New York State Psychiatric Institute, Department of Neuroscience, 1051 Riverside Drive, New York, NY 10032, USA.

"With respect to treatment of self-injury in personality disorders, some recent pharmacotherapy trials have been conducted, though efficacy is often unclear. Findings with respect to psychotherapy, particularly dialectical behavior therapy, a form of cognitive behavioral treatment, are promising."

October 2001

  Dialectical behavior therapy for patients with borderline personality disorder.

J Psychosoc Nurs Ment Health Serv. 2001 Oct;39(10):38-45. 
Alper G, Peterson SJ.
Anoka Metro Regional Treatment Center, 3301 Seventh Avenue North, Anoka, MN 55303, USA.

Over a 4 week period, "the self-injurious behaviors decreased by almost 50%."