Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial

TLDR

No accepted intervention exists for borderline personality disorder in adolescence, and larger studies are needed to determine CAT’s specific value. The study aimed to compare up to 24 sessions of CAT versus manualised GCC, predicting that CAT would yield greater reductions in psychopathology, parasuicidal behaviour, and better global functioning over 24 months. A randomized controlled trial compared CAT and GCC in 15–18‑year‑old out‑patients meeting 2–9 DSM‑IV criteria for borderline personality disorder. At 24 months, there was no significant difference between CAT and GCC on primary measures, though CAT showed faster improvement; both treatments were safe and reduced externalising psychopathology in adolescents with borderline personality disorder.

Abstract

Background No accepted intervention exists for borderline personality disorder presenting in adolescence. Aims To compare the effectiveness of up to 24 sessions of cognitive analytic therapy (CAT) or manualised good clinical care (GCC) in addition to a comprehensive service model of care. Method In a randomised controlled trial, CAT and GCC were compared in out-patients aged 15–18 years who fulfilled two to nine of the DSM–IV criteria for borderline personality disorder. We predicted that, compared with the GCC group, the CAT group would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24 months. Results Eighty-six patients were randomised and 78 (CAT n =41; GCC n =37) provided follow-up data. There was no significant difference between the outcomes of the treatment groups at 24 months on the pre-chosen measures but there was some evidence that patients allocated to CAT improved more rapidly. No adverse effect was shown with either treatment. Conclusions Both CAT and GCC are effective in reducing externalising psychopathology in teenagers with sub-syndromal or full-syndrome bipolar personality disorder. Larger studies are required to determine the specific value of CAT in this population.