Common and distinct treatment elements in psychotherapies for borderline personality disorder

Abstract

Introduction: Borderline personality disorder (BPD) is defined as "a pervasive pattern of instability of interpersonal relationships, self-image, affects, and marked impulsivity" (DSM-IV-TR; APA, 2000). These very characteristics make it difficult to establish firm therapeutic relationships and keep patients in treatment. In recent decades, a number of new psychotherapeutic approaches have been developed in order to meet these specific challenges and demands. To date, there is evidence of efficacy for various treatments, as data of a recent systematic review and meta-analysis of our working group indicate. Objectives: To give an overview of all psychotherapeutic treatments investigated in randomised controlled trials so far and included in the above mentioned systematic review. To establish common and distinct treatment features of successful psychotherapeutic approaches for BPD treatment and investigate possible relations to treatment outcomes. Methods: Essential treatment characteristics were extracted from primary studies and surveyed. Subgroup analyses were done where possible with regard to presence/absence of these characteristics in order to investigate possible impacts on treatment outcome. Results: BPD specific therapies share many similarities like use of explicit treatment frameworks, e.g., as delineated in explicit treatment contracts, and special attention to the therapeutic relationship. However, they differ with regard to treatment intensity and length, provision of complementary group sessions, availability of the therapist in case of crisis or importance of psychodynamic and experiential techniques. Conclusions: Though stemming from different theoretical backgrounds or schools, various treatments seem both feasible as well as beneficial if applying BPD specific adaptations.