Psychotherapies Effective for BPD, But Effects are Small, Study Says

Some psychotherapies are effective for alleviating some symptoms of borderline personality disorder (BPD) and related problems, but effects are small, and studies are plagued by methodological problems, according to a meta-analysis published yesterday in JAMA Psychiatry.

The study found that dialectical behavior therapy (DBT) and psychodynamic approaches to treating people with BPD demonstrated efficacy for borderline-relevant symptoms such as self-harm, suicide, health service use, and general psychopathology.

Researchers from several international institutions searched PubMed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials using the terms “borderline personality” and "randomized trial.” Thirty-three trials with 2,256 participants were included.


Standardized mean differences in efficacy were calculated using all outcomes reported in the trials for borderline symptoms including self-harm, suicide, health service use, and general psychopathology.

The results showed significant but small, posttest between-group effect sizes in all outcome categories. For borderline-relevant outcomes and psychopathology, effects were small to medium. There were no differences between types of psychotherapies; most trials focused on DBT followed by psychodynamic approaches, and both types generated significant but still small effects compared with comparison interventions.

Statistical analysis suggested that the results may be inflated by risk of bias (greater attention paid to patients in experimental arms) and publication bias (the likelihood that trials would be published when results were favorable to the experimental arm).

The researchers noted that further research is needed and that prospective registration in clinical trial registries is necessary to address methodological problems in research on psychotherapy for BPD. 

Peter Fonagy, Ph.D., and colleagues concurred in an accompanying editorial. “While these findings provide further support for cautious optimism in relation to the role of specialized psychotherapy (and psychotherapy more generally) in treating BPD, the meta-analysis by Cristea, et al., also highlights important limitations and concerns that the field needs to urgently address.”

For related information, see the Psychiatric News article "Recovered BPD Patients More Likely to Marry, Have Children."

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