Psychotherapy for Borderline Personality Disorder

Irving Kuo, MD


October 31, 2007

Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study

Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF.
Am J Psychiatry. 2007;164:922-928.

The efficacy of 3 different psychotherapy treatments for borderline personality disorder were compared:

  • Dialectical behavioral therapy;

  • Transference-focused therapy; and

  • Supportive therapy.

Ninety individuals with a diagnosis of borderline personality disorder were randomized to 1 of the treatment modalities for up to 12 months. Domains of suicidality, aggression, impulsivity, anxiety, depression, and social adjustment were measured at baseline and every 4 months thereafter in the study. All 3 psychotherapies were delivered by experienced therapists supervised by known experts in each therapy field. Patients were also evaluated for need for medications at baseline, with 70% of dialectical behavioral therapy patients, 65% of supportive therapy patients, and 52% of transference-focused therapy patients being placed on medications.

Individual growth curves to determine changes and improvement in each of the measured domains were used. All of the psychotherapies showed significant, positive changes during the course of their treatment. Improvement in suicidality was noted with the dialectical behavioral therapy and transference-focused therapy. Transference-focused and supportive therapies were associated with improvement in anger. Only transference-focused therapy was associated with improvements in:

  • Impulsivity;

  • Irritability; and

  • Both verbal and direct assaults.

Of the 12 variables across the 6 measured domains, transference-focused therapy was associated with improvement of 10 of 12 variables, while supportive therapy and dialectical behavioral therapy were associated with improvement in 6 of 12 and 5 of 12 variables, respectively.

This is the first study to directly compare the efficacy of 3 different types of psychotherapies in the treatment of borderline personality disorder. Each of the psychotherapies has its own characteristics:

  • Dialectical behavioral therapy is based on learning and acquiring new skills to help regulate emotions and behavior;

  • Transference-focused therapy concentrates on the therapist-patient relationship, examining and dealing with the emotions arising from this relationship; and

  • Supportive therapy helps the patient deal with their daily difficulties and manages issues of transference without the use of interpretation.

All treatments were effective to some extent, with transference-focused therapy the most successful in this particular trial. Borderline personality disorder is often difficult to treat; it is refreshing, therefore, to see research evaluating a variety of treatment modalities. Given the chronic nature of borderline personality disorder, future research should focus on which treatment modality might be the best for maintenance treatment.



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