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Dialectical behavior, psychodynamic therapy most effective for borderline personality disorder

Results from a meta-analysis indicated that psychotherapies, particularly dialectical behavior therapy and psychodynamic approaches, were effective for borderline personality disorder.

“Trials of direct comparisons of treatments for [borderline personality disorder] reported few differences among them. However, most trials demonstrating effectiveness were conducted with the direct participation of the treatment developer,” Ioana A. Cristea, PhD, of Babe-Bolyai University, Cluj-Napoca, Romania, and colleagues wrote. “Previous meta-analyses of psychotherapeutic treatments for [borderline personality disorder] have been scarce and used focused criteria for assessing effectiveness, avoiding combining treatments.”

To assess efficacy of psychotherapies for borderline personality disorder, researchers conducted a systematic review and meta-analysis of 33 randomized clinical trials among 2,256 individuals.

Psychotherapies were moderately more effective than control interventions for borderline-relevant outcomes combined, including symptoms, self-harm and suicide, in stand-alone and add-on designs.

Psychotherapies exhibited moderate efficacy for individual outcomes, including self-harm, suicide, health service use and general psychopathology.

Odds ratios for treatment retention did not significantly differ between stand-alone (OR = 1.32; 95% CI, 0.87-2) and add-on designs (OR = 1.01; 95% CI, 0.55-1.87).

Thirteen trials reported borderline-relevant outcomes at follow-up. Dialectical behavior therapy and psychodynamic approaches were the only types of therapies that were more effective than controls.

Risk of bias significantly moderated subgroup and meta-regression analyses, according to researchers.

They also found persistent publication bias, particularly for follow-up.

“While the study by Cristea et al will undoubtedly provide a major impetus to future research on the effectiveness of psychotherapy for [borderline personality disorder], their findings make it clear that much remains to be done in terms of the development, evaluation, and implementation in routine clinical care of effective psychotherapy for this highly debilitating condition,” Peter Fonagy, PhD, of University College London, and colleagues wrote in an accompanying editorial. – by Amanda Oldt

Disclosure: Cristea reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.