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Meta-Analysis
. 2012 Aug 15;2012(8):CD005652.
doi: 10.1002/14651858.CD005652.pub2.

Psychological therapies for people with borderline personality disorder

Jutta M Stoffers  1 , Birgit A Völlm, Gerta Rücker, Antje Timmer, Nick Huband, Klaus Lieb
Affiliations
Meta-Analysis

Psychological therapies for people with borderline personality disorder

Jutta M Stoffers et al. Cochrane Database Syst Rev. .

Abstract

Background: Psychotherapy is regarded as the first-line treatment for people with borderline personality disorder. In recent years, several disorder-specific interventions have been developed. This is an update of a review published in the Cochrane Database of Systematic Reviews in 2006.

Objectives: To assess the effects of psychological interventions for borderline personality disorder (BPD).

Search methods: We searched the following databases: CENTRAL 2010(3), MEDLINE (1950 to October 2010), EMBASE (1980 to 2010, week 39), ASSIA (1987 to November 2010), BIOSIS (1985 to October 2010), CINAHL (1982 to October 2010), Dissertation Abstracts International (31 January 2011), National Criminal Justice Reference Service Abstracts (15 October 2010), PsycINFO (1872 to October Week 1 2010), Science Citation Index (1970 to 10 October 2010), Social Science Citation Index (1970 to 10 October 2010), Sociological Abstracts (1963 to October 2010), ZETOC (15 October 2010) and the metaRegister of Controlled Trials (15 October 2010). In addition, we searched Dissertation Abstracts International in January 2011 and ICTRP in August 2011.

Selection criteria: Randomised studies with samples of patients with BPD comparing a specific psychotherapeutic intervention against a control intervention without any specific mode of action or against a comparative specific psychotherapeutic intervention. Outcomes included overall BPD severity, BPD symptoms (DSM-IV criteria), psychopathology associated with but not specific to BPD, attrition and adverse effects.

Data collection and analysis: Two review authors independently selected studies, assessed the risk of bias in the studies and extracted data.

Main results: Twenty-eight studies involving a total of 1804 participants with BPD were included. Interventions were classified as comprehensive psychotherapies if they included individual psychotherapy as a substantial part of the treatment programme, or as non-comprehensive if they did not.Among comprehensive psychotherapies, dialectical behaviour therapy (DBT), mentalisation-based treatment in a partial hospitalisation setting (MBT-PH), outpatient MBT (MBT-out), transference-focused therapy (TFP), cognitive behavioural therapy (CBT), dynamic deconstructive psychotherapy (DDP), interpersonal psychotherapy (IPT) and interpersonal therapy for BPD (IPT-BPD) were tested against a control condition. Direct comparisons of comprehensive psychotherapies included DBT versus client-centered therapy (CCT); schema-focused therapy (SFT) versus TFP; SFT versus SFT plus telephone availability of therapist in case of crisis (SFT+TA); cognitive therapy (CT) versus CCT, and CT versus IPT.Non-comprehensive psychotherapeutic interventions comprised DBT-group skills training only (DBT-ST), emotion regulation group therapy (ERG), schema-focused group therapy (SFT-G), systems training for emotional predictability and problem solving for borderline personality disorder (STEPPS), STEPPS plus individual therapy (STEPPS+IT), manual-assisted cognitive treatment (MACT) and psychoeducation (PE). The only direct comparison of an non-comprehensive psychotherapeutic intervention against another was MACT versus MACT plus therapeutic assessment (MACT+). Inpatient treatment was examined in one study where DBT for PTSD (DBT-PTSD) was compared with a waiting list control. No trials were identified for cognitive analytical therapy (CAT).Data were sparse for individual interventions, and allowed for meta-analytic pooling only for DBT compared with treatment as usual (TAU) for four outcomes. There were moderate to large statistically significant effects indicating a beneficial effect of DBT over TAU for anger (n = 46, two RCTs; standardised mean difference (SMD) -0.83, 95% confidence interval (CI) -1.43 to -0.22; I(2) = 0%), parasuicidality (n = 110, three RCTs; SMD -0.54, 95% CI -0.92 to -0.16; I(2) = 0%) and mental health (n = 74, two RCTs; SMD 0.65, 95% CI 0.07 to 1.24 I(2) = 30%). There was no indication of statistical superiority of DBT over TAU in terms of keeping participants in treatment (n = 252, five RCTs; risk ratio 1.25, 95% CI 0.54 to 2.92).All remaining findings were based on single study estimates of effect. Statistically significant between-group differences for comparisons of psychotherapies against controls were observed for BPD core pathology and associated psychopathology for the following interventions: DBT, DBT-PTSD, MBT-PH, MBT-out, TFP and IPT-BPD. IPT was only indicated as being effective in the treatment of associated depression. No statistically significant effects were found for CBT and DDP interventions on either outcome, with the effect sizes moderate for DDP and small for CBT. For comparisons between different comprehensive psychotherapies, statistically significant superiority was demonstrated for DBT over CCT (core and associated pathology) and SFT over TFP (BPD severity and treatment retention). There were also encouraging results for each of the non-comprehensive psychotherapeutic interventions investigated in terms of both core and associated pathology.No data were available for adverse effects of any psychotherapy.

Authors' conclusions: There are indications of beneficial effects for both comprehensive psychotherapies as well as non-comprehensive psychotherapeutic interventions for BPD core pathology and associated general psychopathology. DBT has been studied most intensely, followed by MBT, TFP, SFT and STEPPS. However, none of the treatments has a very robust evidence base, and there are some concerns regarding the quality of individual studies. Overall, the findings support a substantial role for psychotherapy in the treatment of people with BPD but clearly indicate a need for replicatory studies.

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Conflict of interest statement

Jutta M Stoffers is a board‐certified psychologist (cognitive behaviour therapy), who has worked on a Dialectical Behaviour Therapy (DBT) ward, and attended courses on DBT and Schema‐focused therapy (SFT). Birgit A Völlm — none known. Gerta Rücker — none known. Antje Timmer — none known. Nick Huband was employed as a Clinical Research Fellow with the Institute of Mental Health, Nottingham and Nottinghamshire Healthcare NHS Trust during the production of this review. Klaus Lieb is an Editor with Cochrane Developmental, Psychosocial and Learning Problems. He is a board‐certified cognitive behaviour therapist with a special interest in schema therapy. KL has been involved in trials investigating inpatient DBT (Bohus 2004) and inpatient schema‐focused therapy (Reiss 2014).

Figures

1
1
Study flow diagram
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study
4
4
Funnel plot of comparison of all controlled comparisons for the outcome of parasuicidality
1.1
1.1. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 1: BPD total severity
1.2
1.2. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 2: Inappropriate anger
1.3
1.3. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 3: Affective instability
1.4
1.4. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 4: chronic feelings of emptiness
1.5
1.5. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 5: Impulsivity
1.6
1.6. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 6: Suicidality
1.7
1.7. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 7: Suicidality
1.8
1.8. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 8: Parasuicidality
1.9
1.9. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 9: Parasuicidality
1.10
1.10. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 10: Interpersonal problems
1.11
1.11. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 11: Avoidance of abandonment
1.12
1.12. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 12: Identity disturbance
1.13
1.13. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 13: Dissociation/psychoticism
1.14
1.14. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 14: Depression
1.15
1.15. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 15: Anxiety
1.16
1.16. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 16: General psychopathology
1.17
1.17. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 17: Mental health status/functioning
1.18
1.18. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 18: Leaving the study early
1.19
1.19. Analysis
Comparison 1: Comprehensive psychotherapies: active vs. control conditions, Outcome 19: Leaving the study early: sensitivity analysis (non‐rural areas only)
2.1
2.1. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 1: BPD total severity
2.2
2.2. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 2: Inappropriate anger
2.3
2.3. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 3: Affective instability
2.4
2.4. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 4: Chronic feelings of emptiness
2.5
2.5. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 5: Impulsivity
2.6
2.6. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 6: Impulsivity
2.7
2.7. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 7: Suicidality
2.8
2.8. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 8: Parasuicidality
2.9
2.9. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 9: Parasuicidality
2.10
2.10. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 10: Interpersonal problems
2.11
2.11. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 11: Dissociation/psychoticism
2.12
2.12. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 12: Depression
2.13
2.13. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 13: Anxiety
2.14
2.14. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 14: General psychopathology
2.15
2.15. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 15: Mental health status/functioning
2.16
2.16. Analysis
Comparison 2: Non‐comprehensive psychotherapeutic interventions: active vs. control conditions, Outcome 16: Leaving the study early
3.1
3.1. Analysis
Comparison 3: Comprehensive psychotherapies: active vs. active conditions, Outcome 1: BPD total severity
3.2
3.2. Analysis
Comparison 3: Comprehensive psychotherapies: active vs. active conditions, Outcome 2: Inappropriate anger
3.3
3.3. Analysis
Comparison 3: Comprehensive psychotherapies: active vs. active conditions, Outcome 3: Impulsivity
3.4
3.4. Analysis
Comparison 3: Comprehensive psychotherapies: active vs. active conditions, Outcome 4: Suicidality
3.5
3.5. Analysis
Comparison 3: Comprehensive psychotherapies: active vs. active conditions, Outcome 5: Parasuicidality
3.6
3.6. Analysis
Comparison 3: Comprehensive psychotherapies: active vs. active conditions, Outcome 6: Psychoticism
3.7
3.7. Analysis
Comparison 3: Comprehensive psychotherapies: active vs. active conditions, Outcome 7: Depression
3.8
3.8. Analysis
Comparison 3: Comprehensive psychotherapies: active vs. active conditions, Outcome 8: Anxiety
3.9
3.9. Analysis
Comparison 3: Comprehensive psychotherapies: active vs. active conditions, Outcome 9: General psychopathology
3.10
3.10. Analysis
Comparison 3: Comprehensive psychotherapies: active vs. active conditions, Outcome 10: Mental health status/functioning
3.11
3.11. Analysis
Comparison 3: Comprehensive psychotherapies: active vs. active conditions, Outcome 11: Leaving the study early
4.1
4.1. Analysis
Comparison 4: Non‐comprehensive psychotherapeutic interventions: active vs. active conditions, Outcome 1: BPD total severity
4.2
4.2. Analysis
Comparison 4: Non‐comprehensive psychotherapeutic interventions: active vs. active conditions, Outcome 2: Affective instability
4.3
4.3. Analysis
Comparison 4: Non‐comprehensive psychotherapeutic interventions: active vs. active conditions, Outcome 3: Suicidality
4.4
4.4. Analysis
Comparison 4: Non‐comprehensive psychotherapeutic interventions: active vs. active conditions, Outcome 4: Parasuicidality
4.5
4.5. Analysis
Comparison 4: Non‐comprehensive psychotherapeutic interventions: active vs. active conditions, Outcome 5: Interpersonal problems
4.6
4.6. Analysis
Comparison 4: Non‐comprehensive psychotherapeutic interventions: active vs. active conditions, Outcome 6: Identity disturbance
4.7
4.7. Analysis
Comparison 4: Non‐comprehensive psychotherapeutic interventions: active vs. active conditions, Outcome 7: Leaving the study early
5.1
5.1. Analysis
Comparison 5: Funnel plot, Outcome 1: Parasuicidality
5.2
5.2. Analysis
Comparison 5: Funnel plot, Outcome 2: By sample size ‐ parasuicidality
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

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    1. ISRCTN02634417. Evaluating the clinical and health services impact of dialectical behaviour therapy (DBT) in individuals with borderline personality disorder: a randomised controlled trial. www.controlled-trials.com/ISRCTN02634417/02634417 (accessed 02 November 2010).
    1. McMain SF, Links PS, Gnam WH, Guimond T, Cardish RJ, Korman L, et al. A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry 2009;166:1365-74. - PubMed
    1. McMain Shelley F. Dialectical behavior therapy versus general psychiatric management in the treatment of borderline personality disorder: reply. The American Journal of Psychiatry Apr 2010;167(4):475-6. - PubMed
    1. NCT00154154. Hope for the chronically suicidal patient. http://clinicaltrials.gov/ct2/show/NCT00154154?term=NCT00154154&rank=1 (accessed 09 August 2011).
Morey 2010 {published data only}
    1. Morey LC, Lowmaster SE, Hopwood CJ. A pilot study of manual-assisted cognitive therapy with a therapeutic assessment augmentation for borderline personality disorder. Psychiatry Research 2010;178(3):531-5. - PubMed
Nadort 2009 {published data only}
    1. NTR1781. Implementation of out-patient schema-focused therapy for borderline personality disorder in regular mental healthcare. www.trialregister.nl/trialreg/admin/rctview.asp?TC=1781 (accessed 09 December 2010).
    1. Nadort M, Arntz A, Smit JH, Giesen-Bloo J, Eikelenboom J, Spinhoven P, et al. Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: a randomized trial. Behaviour Research and Therapy 2009;47(11):961-73. - PubMed
    1. Nadort M, Arntz A, Smit JH, Giesen-Bloo J, Eikelenboom M, Spinhoven P, et al. Implementation of outpatient schema therapy for borderline personality disorder: study design. BMC Psychiatry 2009;9:64. - PMC - PubMed
Soler 2009 {published data only}
    1. Soler J, Pascual JC, Tiana T, Cebrià A, Barrachina J, Campins MJ, et al. Dialectical behaviour therapy skills training compared to standard group therapy in borderline personality disorder: a 3-month randomised controlled clinical trial. Behaviour Research and Therapy 2009;47(5):353-8. - PubMed
    1. Soler J. Question regarding your BPD trials [personal communication]. Email to: J Stoffers. 15 December 2010.
Steil 2010 {unpublished data only}
    1. DBT working group at the Central Institute for Mental Health, Mannheim, Germany. Requested supplementary data (as supplied 1 October 2010). Data on file.
    1. Steil R, Dyer A, Priebe K, Kleindienst N, Bohus M. Dialectical Behavior Therapy for Posttraumatic Stress Disorder related to childhood sexual abuse: a pilot study of an intensive treament program. submitted 2010. - PubMed
Turner 2000 {published data only}
    1. Turner RM. Naturalistic evaluation of dialectical behavior therapy-oriented treatment for borderline personality disorder. Cognitive and Behavioral Practice 2000;7:413-9.
Van den Bosch 2005 {published data only}
    1. Van den Bosch LM, Verheul R, Schippers GM, Van den Brink W. Dialectical Behavior Therapy of borderline patients with and without substance use problems. Implementation and long-term effects. Addictive Behaviors 2002;27:911-23. - PubMed
    1. Van den Bosch LMC, Koeter MWJ, Stijnen T, Verheul R, Van den Brink W. Sustained efficacy of dialectical behaviour therapy for borderline personality disorder. Behaviour Research and Therapy 2005;43(9):1231-41. - PubMed
    1. Van den Bosch LMC. Efficacy of dialectical behaviour therapy in the treatment of female borderline patients with and without substance abuse problems: results of a Dutch study [Dialectische gedragstherapie bij nederlandse vrouwen met een borderline persoonlijkheidsstoornis, met en zonder verslavingsproblemen]. Tijdschrift voor psychiatrie 2005;47(3):127-37.
    1. Verheul R, Van den Bosch LM, Koeter MW, De Ridder MA, Stijnen T, Van den Brink W. Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. British Journal of Psychiatry 2003;182:135-40. - PubMed
Weinberg 2006 {published data only}
    1. Weinberg I, Gunderson JG, Hennen J, Cutter Jr CJ. Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients. Journal of Personality Disorders 2006;20(5):482-92. - PubMed
Zanarini 2008 {published data only}
    1. Zanarini MC, Frankenburg FR, editors(s). A randomized trial of psychoeducation for patients with BPD. Proceedings of the 57th annual meeting of the American Psychiatry Association; 1-6 May 2004. New York: American Psychiatric Association, 2004.
    1. Zanarini MC, Frankenburg FR. A preliminary, randomized trial of psychoeducation for women with borderline personality disorder. Journal of Personality Disorders 2008;22(3):284-90. - PubMed

References to studies excluded from this review

Abbass 2008 {published data only}
    1. Abbass A, Sheldon A, Gyra J, Kalpin A. Intensive short-term dynamic psychotherapy for DSM-IV personality disorders - a randomized controlled trial. The Journal of Nervous and Mental Disease 2008;196(3):211-6. - PubMed
Arnevik 2009 {published data only}
    1. Arnevik E, Wilberg T, Urnes Ø, Johansen M, Monsen JT, Karterud S. Psychotherapy for personality disorders: short-term day hospital psychotherapy versus outpatient individual therapy - a randomized controlled study. European Psychiatry 2009;24(2):71-8. - PubMed
Ball 2007 {published data only}
    1. Ball SA. Comparing individual therapies for personality disordered opioid dependent patients. Journal of Personality Disorders 2007;21(3):305-21. - PubMed
Beecham 2006 {published data only}
    1. Beecham J, Sleed M, Knapp M, Chiesa M, Drahorad C. The costs and effectiveness of two psychosocial treatment programmes for personality disorder: a controlled study. European Psychiatry 2006;21(2):102-9. - PubMed
Bellino 2005 {published data only}
    1. Bellino S, Zizza M, Di Lorenzo R, Rinaldi C, Bogetto F. Combined therapy with interpersonal psychotherapy of major depressed patients: comparison between patients with borderline personality disorder and patients with other personality disorders [La terapie combinata con psicoterapia interpersonale della depressione maggiore: confronto tra pazienti con disturbo boderline di personalità e pazienti con altre diagnosi di asse II]. Giornale Italiano di Psicopatologia 2005;11:157-64.
Berget 2008 {published data only}
    1. Berget B, Ekeberg Ø, Braastad BO. Animal-assisted therapy with farm animals for persons with psychiatric disorders: effects on self-efficacy, coping ability yand quality of life, a randomized controlled trial. Clinical Practice and Epidemiology in Mental Health 2008;4:9. - PMC - PubMed
Blum 2002 {published data only}
    1. Blum N, Pfohl B, St John D, Monahan P, Black D. STEPPS: a cognitive-behavioral systems-based group treatment for outpatients with borderline personality disorder - a preliminary report. Comprehensive Psychiatry 2002;43:301-10. - PubMed
Bohus 2000 {published data only}
    1. Bohus M, Haaf B, Stiglmayr C, Pohl U, Böhme R, Linehan M. Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder - a prospective study. Behaviour Research and Therapy 2000;38:875-87. - PubMed
Bohus 2004 {published data only}
    1. Bohus M, Haaf B, Simms T, Limberger MF, Schmahl C, Unckel C, et al. Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behaviour Research and Therapy 2004;42:487-99. - PubMed
Brassington 2006 {published data only}
    1. Brassington J, Krawitz R. Australasian dialectical behaviour therapy pilot outcome study: effectiveness, utility and feasibility. Australasian Psychiatry 2006;14:313-9. - PubMed
Brown 2004 {published data only}
    1. Brown GK, Newman CF, Charlesworth SE, Crits-Christoph P, Beck AT. An open clinical trial of cognitive therapy for borderline personality disorder. Journal of Personality Disorders 2004;18:257-71. - PubMed
Carter 2007 {published data only}
    1. Carter GL, Clover K, Whyte IM, Dawson AH, D'Este C. Postcards from the EDge: 24-month outcomes of a randomised controlled trial for hospital-treated self-poisoning. British Journal of Psychiatry 2007;191:548-53. - PubMed
Chanen 2008 {published data only}
    1. Chanen AM, Jackson HJ, McCutcheon LK, Jovev M, Dudgeon P, Yuen HP, et al. Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial. The British Journal of Psychiatry 2008;193:477-84. - PubMed
Chiesa 2000 {published data only}
    1. Chiesa M, Fonagy P. Cassel Personality Disorder Study. British Journal of Psychiatry 2000;176:485-91. - PubMed
Clarkin 2007 {published data only}
    1. Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF. Evaluating three treatments for borderline personality disorder: a multiwave study. American Journal of Psychiatry 2007;164:922-8. - PubMed
    1. Clarkin JF, Levy KN, Lenzenweger MF, Kernberg OF. The Personality Disorders Institute/Borderline Personality Disorder Research Foundation randomized control trial for borderline personality disorder: rationale, methods, and patient characteristics. Journal of Personality Disorders 2004;18:52-72. - PubMed
Colom 2004 {published data only}
    1. Colom F, Vieta E, Sánchez-Moreno J, Martínez-Arán A, Torrent C, Reinares M, et al. Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disorders 2004;6:294-8. - PubMed
Dolan 1997 {published data only}
    1. Dolan B, Warren F, Norton K. Change in borderline symptoms one year after therapeutic community treatment for severe personality disorder. British Journal of Psychiatry 1997;171:274-9. - PubMed
Evans 1999a {published data only}
    1. Evans K, Tyrer P, Catalan J, Schmidt U, Davidson K, Dent J, et al. Manual-assisted cognitive-behaviour therapy (MACT): a randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological Medicine 1999;29:19-25. - PubMed
Evans 1999b {published data only}
    1. Evans MO, Morgan HG, Hayward A, Gunnell DJ. Crisis telephone consultation for deliberate self-harm patients: effects on repetition. British Journal of Psychiatry 1999;175:23-7. - PubMed
Gabbard 2000 {published data only}
    1. Gabbard GO, Coyne L, Allen JG, Spohn H, Colson DB, Vary M. Evaluation of intensive inpatient treatment of patients with severe personality disorders. Psychiatric Services 2000;51:893-8. - PubMed
Guthrie 2001 {published data only}
    1. Guthrie E, Kapur N, Mackway-Jones K, Chew-Graham C, Moorey J, Mendel E, et al. Randomised controlled trial of brief psychological intervention after deliberate self poisoning. BMJ 2001;323:1-5. - PMC - PubMed
Hagen 2005 {published data only}
    1. Hagen R, Nordahl HM, Kristiansen L, Morken G. A randomized trial of cognitive group therapy vs. waiting list for patients with co-morbid psychiatric disorders: effect of cogniitve group therapy after treatment and six and twelve months follow-up. Behavioural and Cognitive Psychotherapy 2005;33:33-44.
Huband 2007 {published data only}
    1. Huband N, McMurran M, Evans C, Duggan C. Social problem-solving plus psychoeducation for adults with personality disorders. British Journal of Psychiatry 2007;190:307-13. - PubMed
Kool 2003 {published data only}
    1. Kool S, Dekker J, Duijsens IJ, De Jonghe F, Puite B. Changes in personality pathology after pharmacotherapy and combined therapy for depressed patients. Journal of Personality Disorders 2003;17:60-72. - PubMed
Korner 2006 {published data only}
    1. Korner A, Gerull F, Meares R, Stevenson J. Borderline personality disorder treated with the conversational model: a replication study. Comprehensive Psychiatry 2006;47:406-11. - PubMed
Kröger 2006 {published data only}
    1. Kröger C, Schwieger U, Sipos V, Arnold R, Kahl KG, Schunert T, et al. Effectiveness of dialectical behaviour therapy for borderline personality disorder in an inpatient setting. Behaviour Research and Therapy 2006;44:1211-7. - PubMed
Linehan 1999 {published data only}
    1. Linehan MM, Schmidt H III, Dimeff LA, Craft JC, Kanter J, Comtois KA. Dialectical behavior therapy for patients with personality disorder and drug-dependence. The American Journal on Addictions 1999;8:279-92. - PubMed
Linehan 2002 {published data only}
    1. Linehan MM, Dimeff LA, Reynolds SK, Comtois KA, Welch SS, Heagerty P, et al. Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence 2002;67:13-26. - PubMed
López 2004 {published data only}
    1. López D, Cuevas P, Gómez A, Mendoza J. Transference-focused psychotherapy in borderline personality disorder [Psicoterapia focalizada en la transferencia para el trastorno límite de la personalidad]. Salud Mental 2004;27:44-54.
Lynch 2007 {published data only}
    1. Lynch TR, Cheavens JS, Cukrowicz KC, Thorp SR, Bronner L, Beyer J. Treatment of older adults with co-morbid personality disorder and depression: a dialectical behavior therapy approach. International Journal of Geriatric Psychiatry 2007;22:131-43. - PubMed
McQuillan 2005 {published data only}
    1. McQuillan A, Nicastro R, Guenot F, Girard M, Lissner C, Ferrero F. Intensive dialectical behavior therapy for outpatients with borderline personality disorder who are in crisis. Psychiatric Services 2005;56:193-7. - PubMed
Meares 1999 {published data only}
    1. Meares R, Stevenson J, Comerford A. Psychotherapy with borderline patients: a comparison between treated and untreated cohorts. Australian and New Zealand Journal of Psychiatry 1999;33:467-72. - PubMed
Mueser 2004 {published data only}
    1. Mueser KT, Clark RE, Haines M, Drake RE, McHugo GJ, Bond GR, et al. The Hartford Study of supported employment for persons with severe mental illness. Journal of Consulting and Clinical Psychology 2004;72:479-90. - PubMed
Munroe‐Blum 1995 {published data only}
    1. Munroe-Blum H, Marziali E. A controlled trial of short-term group treatment for borderline personality disorder. Journal of Personality Disorders 1995;9:190-8.
Muran 2009 {published data only}
    1. Muran JC, Safran JD, Gorman BS, Samstag LW, Eubanks-Carter C, Winston A. The relationship of early alliance ruptures and their resolution to process and outcome in three time-limited psychotherapies for personality disorders. Psychotherapy Theory, Research, Practice, Training 2009;46:233-48. - PubMed
Petersen 2008 {published data only}
    1. Petersen B, Toft J, Christensen NB, Foldager L, Munk-Jörgensen P, Lien K, et al. Outcome of a psychotherapeutic programme for patients with severe personality disorders. Nordic Journal of Psychiatry 2008;62:450-6. - PubMed
Ranger 2009 {published data only}
    1. Ranger M, Tyrer P, Miloseska K, Fourie H, Khaleel I, North B, et al. Cost-effectiveness of nidotherapy for comorbid personality disorder and severe mental illness: randomized controlled trial. Epidemiologia e Psichiatria Sociale 2009;18:128-36. - PubMed
Rathus 2002 {published data only}
    1. Rathus JH, Miller AL. Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life-Threatening Behavior 2002;32:146-57. - PubMed
Sachsse 2006 {published data only}
    1. Sachsse U, Vogel C, Leichsenring F. Results of psychodynamically oriented trauma-focused inpatient treatment for women with complex posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). Bulletin of the Menninger Clinic 2006;70:125-44. - PubMed
Schuppert 2009 {published data only}
    1. Schuppert HM, Giesen-Bloo J, Van Gemert TG, Wiersema HM, Minderaa RB, Emmelkamp PM, et al. Effectiveness of an emotion regulation group training for adolescents - a randomized controlled pilot study. Clinical Psychology & Psychotherapy 2009;16(6):467-78. - PubMed
Slee 2008 {published data only}
    1. Slee N, Garnefski N, Van der Leeden R, Arensman E, Spinhoven P. Cognitive-behavioural intervention for self-harm: randomised controlled trial. British Journal of Psychiatry 2008;192:202-11. - PubMed
Springer 1996 {published data only}
    1. Springer T, Lohr NE, Buchtel HA, Silk KR. A preliminary report of short-term cognitive-behavioral group therapy for inpatients with personality disorders. Journal of Psychotherapy Practice and Research 1996;5(1):57-71. - PMC - PubMed
Stanley 2007 {published data only}
    1. Stanley B, Brodsky B, Nelson JD, Dulit R. Brief dialectial behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Archives of Suicide Research 2007;11:337-41. - PubMed
Stevenson 1992 {published data only}
    1. Stevenson J, Meares R. An outcome study of psychotehrapy for patients with borderline personality disorder. American Journal of Psychiatry 1992;149:358-62. - PubMed
Stiles 2006 {published data only}
    1. Stiles WB, Barkham M, Twigg E, Mellor-Clark J, Cooper M. Effectiveness of cognitive-behavioural, person-centered and psychodynamic therapies as practised in UK National Health Service settings. Psychological Medicine 2006;36:555-66. - PubMed
Trupin 2002 {published data only}
    1. Trupin EW, Stewart DG, Beach B, Boesky L. Effectiveness of a dialectical behaviour therapy program for incarcerated female juvenile offenders. Child and Adolescent Mental Health 2002;7:121-7.
Tyrer 2003 {published data only}
    1. Tyrer P, Thompson S, Schmidt U, Jones V, Knapp M, Davidson K, . Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study. Psychological Medicine 2003;33:969-76. - PubMed
Tyrer 2009 {published data only}
    1. Tyrer P, Cooper S, Rutter D, Seivewright H, Duggan C, Maden T, et al. The assessment of dangerous and severe personality disorder: lessons from a randomised controlled trial linked to qualitative analysis. The Journal of Forensic Psychiatry & Psychology 2009;20:132-46.
Vinnars 2009 {published data only}
    1. Vinnars B, Thormählen B, Gallop R, Norén K, Barber JP. Do personality problems improve during psychodynamic supportive-expressive psychotherapy? Secondary outcome results from a randomized controlled trial for psychiatric outpatients with personality disorders. Psychotherapy: Theory, Research, Practice, Training 2009;46:362-75. - PMC - PubMed
Waltz 2009 {published data only}
    1. Waltz J, Dimeff LA, Koerner K, Linehan MM, Taylor L, Miller C. Feasibility of using video to teach a dialectical behavior therapy skill to clients with borderline personality disorder. Cognitive and Behavioral Practice 2009;16:214-22.
Weertman 2007 {published data only}
    1. Weertman A, Arntz A. Effectiveness of treatment of childhood memories in cognitive therapy for personality disorders: a controlled study contrasting methods focusing on the present and methods focusing on childhood memories. Behaviour Research and Therapy 2007;45:2133-43. - PubMed
Wildgoose 2001 {published data only}
    1. Wildgoose A, Clarke S, Waller G. Treating personality fragmentation and dissociation in borderline personality disorder: a pilot study of the impact of cognitive analytic therapy. British Journal of Medical Psychology 2001;74:47-55. - PubMed
Yen 2009 {published data only}
    1. Yen S, Johnson J, Costello E, Simpson EB. A 5-day dialectical behavior therapy partial hospital program for women with borderline personality disorder: predictors of outcome from a 3-month follow-up study. Journal of Psychiatric Practice 2009;15:173-82. - PMC - PubMed
Zorn 2007 {published data only}
    1. Zorn P, Roder V, Müller DR, Tschacher W, Thommen M. Schema Focussed Emotive Behavioural Therapy (SET): a randomised controlled trial on patients with cluster B and C personality disorders [Schemazentrierte emotiv-behaviorale Therapie (SET): eine randomisierte evaluationsstudie an patienten mit persönlichkeitsstörungen aus den Clustern B und C]. Verhaltenstherapie 2007;17:233-41.

References to ongoing studies

ACTRN12605000594628 {published data only}
    1. ACTRN12605000594628. A pilot study to evaluate the feasibility, safety and efficacy of psychotherapeutic intervention for comorbid BPD and first-episode psychosis. www.anzctr.org.au/ACTRN12605000594628.aspx (accessed 8 August 2011).
ACTRN12606000206527 {published data only}
    1. ACTRN12606000206527. Process and outcome of acceptance based outpatient skills training groups for people with four or more criteria of borderline personality disorder. http://www.anzctr.org.au/trial_view.aspx?ACTRN=12606000206527 (accessed 8 August 2011).
ACTRN12610000100099 {published data only}
    1. ACTRN12610000100099. A randomised controlled trial (RCT) of specialised early intervention, with and without psychotherapy, versus a standard youth mental health intervention, for youth presenting with first presentation borderline personality disorder (BPD). www.anzctr.org.au/ACTRN12610000100099.aspx (accessed 9 August 2011).
DRKS00000068 {published data only}
    1. DRKS00000068. Psychoanalytical interactional psychotherapy in cluster B personality disorders [Psychoanalytisch-Interaktionelle Therapie bei Cluster B-Persönlichkeitsstörungen]. https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId... (accessed 08 August 2010).
ISRCTN12440268 {published data only}
    1. ISRCTN12440268. JOSHUA: a pilot randomised controlled trial of joint crisis plans for people who self harm. www.controlled-trials.com/ISRCTN12440268/12440268 (accessed 31 July 2011).
    1. Moran P, Borschman R, Flach C, Barrett B, Byford S, Hogg J, et al. The effectiveness of joint crisis plans for people with borderline personality disorder: protocol for an exploratory randomised controlled trial. Trials 2010;11:18. - PMC - PubMed
ISRCTN51304415 {published data only}
    1. ISRCTN51304415. Nice OUtcomes for Referrals with Impulsivity, Self-Harm and Eating Disorders: the NOURISHED study. http://www.controlled-trials.com/ISRCTN51304415 (accessed 08 August 2011).
ISRCTN54233644 {published data only}
    1. ISRCTN54233644. Dialectical behaviour therapy in patients with borderline personality disorder who self-harm: a pragmatic exploratory trial. www.controlled-trials.com/ISRCTN54233644/54233644 (accessed 31 July 2011).
ISRCTN72677277 {published data only}
    1. ISRCTN72677277. Psychological treatments for severe and complex mental health problems/personality disorder. A phase II randomised controlled trial (SPeDi). http://www.controlled-trials.com/ISRCTN72677277 (accessed 08 August 2011).
ISRCTN79187618 {published data only}
    1. ISRCTN79187618. Psychoanalytically oriented brief group treatment for borderline personality disorder: a randomised controlled trial. http://www.controlled-trials.com/ISRCTN79187618 (accessed 08 August 2011).
ISRCTN98982683 {published data only}
    1. ISRCTN98982683. Mentalisation-based treatment for dual diagnoses. www.controlled-trials.com/ISRCTN98982683 (accessed 02 November 2010).
Jørgensen 2009 {published data only}
    1. Jørgensen CR, Kjølbye M, Freund C, Bøye R, Jordet H, Andersen D. Level of functioning in patients with borderline personality disorder. The Risskov-I study. Nordic Psychology 2009;61(1):42-60.
NCT00117741 {published data only}
    1. NCT00117741. Evaluation of DBT compared to drug counseling for opiate addicts. www.clinicaltrials.gov/ct2/show/NCT00117741?term=00117741&rank=1 (accessed 9 August 2011).
NCT00183651 {published data only}
    1. NCT00183651. Treatment of suicidal women with borderline personality disorders. www.clinicaltrials.gov/ct2/show/NCT00183651?term=00183651&rank=1 (accessed 9 December 2010).
NCT00218595 {published data only}
    1. NCT00218595. DBT compared to I/GDC for the treatment of opiate addiction in emotionally dysregulated patients. www.clinicaltrials.gov/show/NCT00218595 (accessed 3 January 2011).
NCT00247234 {published data only}
    1. NCT00247234. Effectiveness of group based schema therapy in the treatment of personality disorders. www.clinicaltrials.gov/show/NCT00247234 (accessed 9 August 2011).
NCT00378248 {published data only}
    1. NCT00378248. Ullevål personality project. http://clinicaltrials.gov/show/NCT00378248 (accessed 09 August 2011).
NCT00533117 {published data only}
    1. NCT00533117. Treating suicidal behavior and self-mutilation in people with borderline personality disorder. www.clinicaltrials.gov/ct2/show/NCT00533117?term=00533117&rank=1 (accessed 3 January 2011).
NCT00603421 {published data only}
    1. NCT00603421. Effectiveness of a 24 hour phone line on the rate of suicide attempts in borderline patients. http://clinicaltrials.gov/show/NCT00603421 (accessed 09 August 2011).
    1. Pham-Scottez A. Impact of a 24/24 phone permanency on suicide attempts of borderline patients. Annales Medico-Psychologiques 2010;168(2):141-3.
NCT00834834 {published data only}
    1. NCT00834834. Comparing treatments for self-injury and suicidal behavior in people with borderline personality disorder. www.clinicaltrials.gov/ct2/show/NCT00834834?term=00834834&rank=1 (accessed 3 January 2011).
NCT00980824 {published data only}
    1. NCT00980824. ENGAGE - Meeting mental health needs of complex comorbid patients attending A&E following a suicide attempt. A pilot study. www.clinicaltrials.gov/ct2/show/NCT00980824?term=00980824&rank=1 (accessed 8 December 2010).
NCT01033708 {published data only}
    1. NCT01033708. A randomized control trial of narrative exposure therapy versus treatment as usual in the therapy of borderline personality disorder (NET). www.clinicaltrials.gov/show/NCT01033708 (accessed 9 August 2011).
NCT01081314 {published data only}
    1. NCT01081314. Treating PTSD in patients with borderline personality disorder. www.clinicaltrials.gov/ct2/show/NCT01081314?term=01081314&rank=1 (accessed 9 December 2010).
NCT01132976 {published data only}
    1. NCT01132976. The personal concerns inventory study (PCI). http://clinicaltrials.gov/show/NCT01132976 (accessed 9 August 2011).
NCT01193205 {published data only}
    1. NCT01193205. Evaluating the effectiveness of dialectical behaviour skills training for suicidality in borderline personality disorder. www.clinicaltrials.gov/ct2/show/NCT01193205?term=01193205&rank=1 (accessed 9 December 2010).
NTR1186 {published data only}
    1. Bernstein D, Arntz A. Schema focused therapy for forensic patients with personality disorders: new research findings. In: New Diagnostic Approaches in psychiatry: Relevance for Research and Practice in Europe. Proceedings of the 17th European Congress of Psychiatry of the European Psychiatric Association; January 2009. Lisbon, Portugal: European Psychiatric Association, 2009:38.
    1. NTR1186. Efficacy of schema-focused therapy versus usual treatment in forensic patients with personality disorder: a three-year randomized clinical trial. www.trialregister.nl/trialreg/admin/rctview.asp?TC=1186 (accessed 3 January 2011).
NTR2175 {published data only}
    1. NTR2175. Mentalisation-based treatment versus care-as-usual in the treatment of severe borderline personality disorders. www.trialregister.nl/trialreg/admin/rctview.asp?TC=2175 (accessed 9 December 2010).
NTR2292 {published data only}
    1. NTR2292. Intensive outpatient mentalisation-based treatment versus day hospital mentalisation-based treatment: a randomised controlled trial. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2292 (accessed 9 August 2011).
NTR2392 {published data only}
    1. ACTRN1261100015965. Group Schema Therapy for Borderline Personality Disorder. International multi-site RCT of two versions of Group Schema Therapy compared to treatment as usual for Borderline Personality Disorder in reducing symptom severity and improving quality of life. http://www.anzctr.org.au/ACTRN12611000158965.aspx (accessed 9 August 2011).
    1. NTR2392. Group schema therapy for borderline personality disorder. www.trialregister.nl/trialreg/admin/rctview.asp?TC=2392 (accessed 9 December 2010).

Additional references

Ansell 2007
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APA 1980
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APA 2000
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APA 2001
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