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Randomized Controlled Trial
. 2022 Feb;36(2):159-169.
doi: 10.1177/02698811211069108. Epub 2022 Feb 1.

Clinical effects of glabellar botulinum toxin injections on borderline personality disorder: A randomized controlled trial

M Axel Wollmer  1 , Insa Neumann  1 , Stefanie Jung  2 , Agnès Bechinie  2 , Julian Herrmann  2 , Antje Müller  1 , Peter Wohlmuth  3 , Larissa Fournier-Kaiser  1 , Christian Sperling  2 , Liza Peters  1 , Jonas Kneer  2 , Jannis Engel  2 , Frank Jürgensen  1 , Jara Schulze  2 , Matthias Nagel  4   5 , Welf Prager  6 , Christopher Sinke  2 , Kai G Kahl  7 , Matthias Karst  8 , Birger Dulz  1 , Tillmann H C Kruger  2   9
Affiliations
Randomized Controlled Trial

Clinical effects of glabellar botulinum toxin injections on borderline personality disorder: A randomized controlled trial

M Axel Wollmer et al. J Psychopharmacol. 2022 Feb.

Abstract

Background: Inhibition of frowning via injections of botulinum toxin A (BTX) into the glabellar region has shown beneficial effects in the treatment of major depression. Preliminary research suggests that improvements in the affective domain are not depression-specific, but may also translate to other psychiatric disorders.

Aim: This 16-week, single-blind, two-center randomized controlled trial investigated the influence of BTX on clinical symptoms of borderline personality disorder (BPD).

Methods: Fifty-four patients with BPD were randomly assigned to treatment with BTX (n = 27) or a minimal acupuncture (ACU) control condition (n = 27). Clinical outcomes were followed at 2, 4, 6, 8, 12, and 16 weeks. Primary endpoint was the relative score change on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) 8 weeks after baseline relative to the control group and adjusted for treatment center. Secondary and additional outcome variables were self-rated borderline symptoms, comorbid symptoms of depression, psychological distress, and clinical global impression.

Results: Participants showed significant improvements at the primary efficacy endpoint in both treatment groups (BTX: M = -0.39, SD = 0.39; ACU: M = -0.35, SD = 0.42), but no superior effect of the BTX condition in comparison with the control intervention was found-F(1,5323) = 0.017, p = 0.68). None of the secondary or additional outcomes yielded significant group differences. Side effects were mild and included headache, transient skin or muscle irritations, and dizziness.

Conclusion: Evidence regarding the efficacy of BTX for BDP remains limited, and the design of adequate control conditions presents an opportunity for further research.ClinicalTrials.gov registry: Botulinum Toxin A for Emotional Stabilization in Borderline Personality Disorder (BPD), NCT02728778, https://clinicaltrials.gov/ct2/show/NCT02728778.

Keywords: Botulinum toxin; acupuncture; borderline personality disorder; mental disorder; proprioception; therapy.

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