More Evidence on Effective Treatment for Borderline Personality Disorder

Time to breakout the champagne? A recent paper (no free access) in the Archives of General Psychiatry provides clear evidence of the effectiveness of long term treatment, both cognitive and dynamically based, for Borderline Personality Disorder.

As a clinician actively involved in a borderline treatment program using an integration of both these models this research is incredibly exciting news.

It is a significant piece of research conducted over three years showing clear efficacy for both treatment modalities but with Schema Focused Therapy (SFP) showing superior results to Transference Focused Therapy (TFP). The importance of this research is underlined by its publication in psychiatry’s highest impact journal the Archives of General Psychiatry.

To me it is not the evidence that one therapy is better than the other that is most important but the publication of long term research showing that borderline personality disorder is eminently treatable and that people with abusive histories and seriously dysfunctional behaviour can find ways to live normal and fulfilling lives. The clinical evidence that the interns report in the day to day work with borderline personality disorder is now supported by high quality research.

Hopefully this is the first in a series of evidence based research showing that intensive long term therapy using both cognitive and dynamic techniques.

Three years of SFT or TFP proved to bring about a significant change in patients’ personality, shown by reductions in all BPD symptoms and general psychopathologic dysfunction, increases in quality of life, and changes in associated personality features. Using intention-to-treat analysis with adjustments for baseline assessments, SFT and TFP effectiveness became apparent at 12 months of treatment and was further extended at 3 years of treatment. Schema-focused therapy was superior to TFP with respect to reduction in BPD manifestations, general psychopathologic dysfunction, and change in SFT/TFP personality concepts. All in all, it seems that changes in manifest (BPD) psychopathologic dysfunction go hand in hand with changes in pathologic personality features. An explanation may be that both treatments address the level of personality, not merely the “surface” symptom level. Schema-focused therapy was not consistently dominant over TFP with respect to patients’ improved quality of life, as trend and end point analyses yielded different results.

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