Borderline personality disorder (BPD) affects up to 2 percent of the population, according to a team of researchers in Spain who investigated which therapies offer the greatest benefit to patients with the condition. The team systematically reviewed published studies on the most popular therapies used in treating BPD. The outcomes associated with BPD are often disheartening. At best, patients exhibit heavy use of medical services; at worst, they experience early death or suicide. This has led to widespread acknowledgement in the mental health community of the importance of properly diagnosing the condition and developing more effective treatment for it. Of late, there have been a number of randomized and controlled trials investigating the efficacy of various forms of psychotherapy used to treat BPD. The Spanish review does a careful job of sifting through the related data within its own narrow confines of evaluation.
The Review
Reviewers gathered 211 published papers on BPD and specialized psychotherapy treatments. The team looked particularly at how study participants were chosen, how well the participants adhered to the prescribed therapy and how efficacious the strategy proved. Efficacy was narrowly defined in three distinct measures. The team accessed multiple databases and made use of previous review material. Only studies that met predetermined inclusion/exclusion criteria were reviewed. The researchers compared descriptive data along with primary outcome variables. Each therapy was evaluated in the basis of how many participants experienced an adverse event. Adverse events were defined as: self-harm, hospital admission or suicide. The intervention was also evaluated by the degree to which it lowered one or more of those adverse events at the same time. Given the parameters set by the review team, just 11 of the original 211 papers qualified for examination and review. Of the 11 studies that were selected for review: 1. Six were evaluations of dialectical behavior therapy (DBT). DBT was developed to specifically address the needs of BPD patients. 2. Three were evaluations of transference focused psychotherapy (TFP). 3. Two were evaluations of mentalization based therapy (MBT). 4. One evaluated the benefit of cognitive behavioral therapy (CBT). 5. One was an evaluation of schema focused therapy (SFT). 6. There were studies that attempted to evaluate multiple therapies. 7. Reviewers used standard assessment tools for gauging study quality. All 11 studies were found to be at least adequate in terms of quality.
Results
The two psychotherapies that provided the greatest benefit to BPD patients according to review standards were DBT and MBT. DBT effectively lowered suicide rates while MBT proved most beneficial in reducing the number of hospital admissions. In their conclusion, the reviewers suggest that as many as 40 percent of BPD patients who ask for a specific form of therapy may not actually receive benefit from that treatment. Only 20 percent of patients with BPD will likely ever initiate treatment, and as many as one quarter of those who do begin any form of treatment will not respond.
