Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study

• Published in: The American journal of psychiatry Vol. 164; no. 6; pp. 922 - 928
• Main Authors: Clarkin, John F., Levy, Kenneth N., Lenzenweger, Mark F., Kernberg, Otto F.
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Association 01-06-2007
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Aggression - psychology; Ambulatory Care; Anger; Anxiety Disorders - psychology; Behavior modification; Behavior Therapy; Biological and medical sciences; Borderline Personality Disorder - diagnosis; Borderline Personality Disorder - psychology; Borderline Personality Disorder - therapy; Clinical medicine; Cognitive therapy; Depressive Disorder - psychology; Drug therapy; Effectiveness studies; Female; Humans; Impulsive Behavior - psychology; Longitudinal Studies; Male; Medical sciences; Middle Aged; Patients; Personality disorders; Psychiatric Status Rating Scales - statistics & numerical data; Psychoanalytic Therapy; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy; Psychotherapy - methods; Research Design; Social Adjustment; Suicide - psychology; Transference (Psychology); Treatment Outcome; Violence - psychology; Personality disorder; Borderline; Treatment
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/ajp.2007.164.6.922

Objective:
The authors examined three yearlong outpatient treatments for borderline personality disorder: dialectical behavior therapy, transference-focused psychotherapy, and a dynamic supportive treatment.
Method:
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.
Results:
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.
Conclusions:
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.