Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Jan;65(1):5-15.
doi: 10.1177/0706743719878975. Epub 2019 Sep 26.

Psychotherapies for Adolescents with Subclinical and Borderline Personality Disorder: A Systematic Review and Meta-Analysis

Jennifer Wong  1 , Anees Bahji  1   2 , Sarosh Khalid-Khan  1   3
Affiliations
Meta-Analysis

Psychotherapies for Adolescents with Subclinical and Borderline Personality Disorder: A Systematic Review and Meta-Analysis

Jennifer Wong et al. Can J Psychiatry. 2020 Jan.

Abstract
in English, French

Background: Evidence regarding the efficacy of psychotherapy in adolescents with borderline personality disorder (BPD) symptomatology has not been previously synthesized.

Objective: To conduct a systematic review and meta-analysis of the randomized controlled trials (RCTs) in order to assess the efficacy of psychotherapies in adolescents with BPD symptomatology.

Methods: Seven electronic databases were systematically searched using the search terms BPD, adolescent, and psychotherapy from database inception to July 2019. Titles/abstracts and full-texts were screened by one reviewer; discrepancies were resolved via consensus. We extracted data on BPD symptomatology, including BPD symptoms, suicide attempts, nonsuicidal self-injury, general psychopathology, functional recovery, and treatment retention. Data were pooled using random-effects models.

Results: Of 536 papers, seven trials (643 participants) were eligible. Psychotherapy led to significant short-term improvements in BPD symptomatology posttreatment (g = -0.89 [-1.75, -0.02]) but not in follow-up (g = 0.06 [-0.26, 0.39]). There was no significant difference in treatment retention between the experimental and control groups overall (odds ratio [OR] 1.02, 95% confidence interval [CI], 0.92 to 1.12, I2 = 52%). Psychotherapy reduced the frequency of nonsuicidal self-injury (OR = 0.34, 95% CI, 0.16 to 0.74) but not suicide attempts (OR = 1.03, 95% CI, 0.46 to 2.30).

Conclusions: There is a growing variety of psychotherapeutic interventions for adolescents with BPD symptomatology that appears feasible and effective in the short term, but efficacy is not retained in follow-up-particularly for frequency of suicide attempts.

Contexte :: Les données probantes sur l’efficacité de la psychothérapie chez les adolescents présentant la symptomatologie du trouble de la personnalité limite (TPL) n’ont pas été précédemment synthétisées.

Objectif :: Mener une revue systématique et une méta-analyse des essais cliniques randomisés (ECR) afin d’évaluer l’efficacité des psychothérapies chez les adolescents présentant une symptomatologie du TPL.

Méthodes :: Une recherche systématique a été menée dans 7 bases de données électroniques à l’aide des termes de recherche TPL, adolescent et psychothérapie depuis la date de création de la base de données jusqu’en juillet 2019. Les titres/résumés et les textes complets ont été examinés par un réviseur; les disparités ont été résolues par consensus. Nous avons extrait des données sur la symptomatologie du TPL, notamment les symptômes du TPL, les tentatives de suicide, l’automutilation non suicidaire, la psychopathologie générale, le rétablissement fonctionnel, et la rétention en traitement. Les données ont été regroupées à l’aide des modèles à effets aléatoires.

Résultats :: Sur 536 articles, 7 essais (643 participants) étaient admissibles. La psychothérapie entraînait des améliorations significatives à court terme de la symptomatologie du TPL post-traitement (g = −0.89 [−1.75, −0.02]), mais pas au suivi (g = 0.06 [−0.26, 0.39]). Il n’y avait pas de différence significative de rétention en traitement entre le groupe expérimental et le groupe témoin en général (Rapports de cotes [RC] 1.02; IC à 95% 0.92 à 1.12; I 2 = 52%). La psychothérapie réduisait la fréquence de l’automutilation non suicidaire (RC = 0.34; IC à 95% 0.16 à 0.74), mais pas celle des tentatives de suicide (RC = 1.03; IC à 95% 0.46 à 2.30).

Conclusions :: Il existe une variété croissante d’interventions psychothérapeutiques pour les adolescents présentant une symptomatologie du TPL qui semblent faisables et efficaces à court terme, mais l’efficacité ne persiste pas au suivi, en particulier en ce qui concerne la fréquence des tentatives de suicide.

Keywords: child and adolescent psychiatry; personality disorder; psychotherapy.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preferred reporting items for systematic review and meta-analyses flow diagram of systematic review process.
Figure 2.
Figure 2.
Risk of bias graph: Authors’ judgments about each risk of bias represented as percentage across all included studies.
Figure 3.
Figure 3.
Forest plot of borderline personality disorder symptom outcomes. Shown are standardized posttest follow-up and overall effect sizes of comparisons between investigated psychotherapies and control conditions for BPD symptoms for included trials.
See this image and copyright information in PMC

Comment in

References

    1. Bernstein DP, Cohen P, Velez CN, Schwab-Stone M, Siever LJ, Shinsato L. Prevalence and stability of the DSM-III-R personality disorders in a community-based survey of adolescents. Am J Psychiatry. 1993;150(8):1237–1243. - PubMed
    1. Biskin RS, Paris J, Renaud J, Raz A, Zelkowitz P. Outcomes in women diagnosed with borderline personality disorder in adolescence. J Can Acad Child Adolesc Psychiatry. 2011;20(3):168–174. - PMC - PubMed
    1. Newton-Howes G, Clark LA, Chanen A. Personality disorder across the life course. Lancet Lond Engl. 2015;385(9969):727–734. - PubMed
    1. Zanarini MC, Horwood J, Wolke D, Waylen A, Fitzmaurice G, Grant BF. Prevalence of DSM-IV borderline personality disorder in two community samples: 6,330 English 11-year olds and 34,653 American Adults. J Personal Disord. 2011;25(5):607–619. - PMC - PubMed
    1. Chanen AM, McCutcheon LK. Personality disorder in adolescence: the diagnosis that dare not speak its name. Personal Ment Health. 2008;2(1):35–41.

Substances