Few Effective Treatments Exist for Borderline Personality Disorder

No single treatment stands out as especially effective for borderline personality disorder, a mental illness that can involve self-harm and suicide attempts, according to two new reviews of recent studies.

BPD does appear to respond more strongly to certain kinds of psychological "talk" therapies, British researchers found. However, the psychological treatments that showed the most promise were relatively new and supported by "too few data for confidence," the authors write.

Because both are complex, intensive therapies that require long-term staff training, "we believe that such treatments will only be available to a select few patients," said co-author Mark Fenton.

The team, led by Conor Duggan of the University of Nottingham and Clive Adams of the University of Leeds, conducted separate reviews on psychological and drug therapies for BPD.

The reviews appear in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The team analyzed findings from seven studies on structured talking therapies, comprising 262 adult outpatients with either a formal diagnosis of BPD or at least three criteria for the illness.

People undergoing a treatment called dialectical behavior therapy appeared to have fewer suicide attempts or thoughts of suicide at six months compared to those in usual care. Introduced in 1991, the treatment involves individual psychotherapy sessions, telephone coaching, lengthy group therapy sessions and cognitive modification.

Treating patients in a day hospital unit geared to psychoanalytic treatment also seemed to "decrease admission and use of prescribed medication and increase social improvement and social adjustment," the reviewers found.

Although both treatments are "difficult to apply to everyday care," the researchers say that results so far suggest that "the problems of people with borderline personality disorder may be amenable to treatment."

BPD is characterized by "an internal sense of emptiness and an inability to regulate emotion, going from high to low levels of emotion very quickly," according to Scott Haltzman, M.D, a professor at Brown University. "These people tend to respond to the world with swings from rage to glee."

Two percent of the general population and 20 percent of psychiatric inpatients have borderline personality disorder. Borderline patients are overwhelmingly female (75 percent).

"This group of people is often a challenge to health service providers," said Fenton, who is also editor of the U.K.-based "Database of Uncertainties About the Effects of Treatments. He said that people with BPD have difficulty engaging in relationships, including relationships with therapists.