Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study

TLDR

Future research should investigate the specific mechanisms of change in these treatments beyond common structures. The study randomized 90 borderline personality disorder patients to one of three yearlong outpatient treatments—dialectical behavior therapy, transference‑focused psychotherapy, or dynamic supportive treatment—and used blind raters to assess suicidal behavior, aggression, impulsivity, anxiety, depression, and social adjustment at baseline and every four months over a year. All three treatments yielded significant gains in depression, anxiety, global functioning, and social adjustment over one year, but transference‑focused psychotherapy and dialectical behavior therapy uniquely reduced suicidality, only transference‑focused psychotherapy and supportive treatment reduced anger, transference‑focused psychotherapy improved impulsivity facets and predicted changes in irritability and assault, and supportive treatment produced fewer domain changes.

Abstract

The authors examined three yearlong outpatient treatments for borderline personality disorder: dialectical behavior therapy, transference-focused psychotherapy, and a dynamic supportive treatment.Ninety patients who were diagnosed with borderline personality disorder were randomly assigned to transference-focused psychotherapy, dialectical behavior therapy, or supportive treatment and received medication when indicated. Prior to treatment and at 4-month intervals during a 1-year period, blind raters assessed the domains of suicidal behavior, aggression, impulsivity, anxiety, depression, and social adjustment in a multiwave study design.Individual growth curve analysis revealed that patients in all three treatment groups showed significant positive change in depression, anxiety, global functioning, and social adjustment across 1 year of treatment. Both transference-focused psychotherapy and dialectical behavior therapy were significantly associated with improvement in suicidality. Only transference-focused psychotherapy and supportive treatment were associated with improvement in anger. Transference-focused psychotherapy and supportive treatment were each associated with improvement in facets of impulsivity. Only transference-focused psychotherapy was significantly predictive of change in irritability and verbal and direct assault.Patients with borderline personality disorder respond to structured treatments in an outpatient setting with change in multiple domains of outcome. A structured dynamic treatment, transference-focused psychotherapy was associated with change in multiple constructs across six domains; dialectical behavior therapy and supportive treatment were associated with fewer changes. Future research is needed to examine the specific mechanisms of change in these treatments beyond common structures.