A preliminary study of the naturalistic course of non-manualized psychotherapy for outpatients with borderline personality disorder: Patient characteristics, attrition and outcome

Abstract

Background: Psychotherapy is an effective treatment for borderline personality disorder (BPD), but little is known about the long-term effect of non-manualized psychotherapy for these patients.

Aims: The aim of the preliminary study was to investigate the long-term effect of non-manualized psychotherapy on an outpatient sample (n = 32) with a primary diagnosis of BPD.

Methods: The current study was based on an open-ended naturalistic design with a 2-year follow-up. Assessment at intake, discharge and follow-up comprised the Structured Clinical Interview for DSM-IV Axis I, II and V, and the general level of self-reported symptomatic (SCL-90R) and interpersonal distress (IIP-64C).

Results: Patients with BPD respond well to non-manualized psychotherapy as intent-to-treat analyses estimate that 62% no longer met the DSM-IV criteria for a BPD diagnosis at discharge, 66% at 2-year follow-up. In addition, significant improvement with large effect sizes was found for all outcome variables at both discharge and at follow-up. Attrition was associated with patient-therapist gender mismatch, low occupational status and the presence of post-traumatic stress disorder.

Conclusion: The results imply that the natural course of non-manualized psychotherapy is overall beneficial for outpatients with BPD.