Evaluating three treatments for borderline personality disorder: a multiwave study.
OBJECTIVE
The authors examined three yearlong outpatient treatments for borderline personality disorder: dialectical behavior therapy, transference-focused psychotherapy, and a dynamic supportive treatment.


METHODS
Ninety patients who were diagnosed with borderline personality disorder were randomly assigned to transference-focused psychotherapy, dialectical behavior therapy, or supportive treatment and received medication when indicated. Prior to treatment and at 4-month intervals during a 1-year period, blind raters assessed the domains of suicidal behavior, aggression, impulsivity, anxiety, depression, and social adjustment in a multiwave study design.


RESULTS
Individual growth curve analysis revealed that patients in all three treatment groups showed significant positive change in depression, anxiety, global functioning, and social adjustment across 1 year of treatment. Both transference-focused psychotherapy and dialectical behavior therapy were significantly associated with improvement in suicidality. Only transference-focused psychotherapy and supportive treatment were associated with improvement in anger. Transference-focused psychotherapy and supportive treatment were each associated with improvement in facets of impulsivity. Only transference-focused psychotherapy was significantly predictive of change in irritability and verbal and direct assault.


CONCLUSIONS
Patients with borderline personality disorder respond to structured treatments in an outpatient setting with change in multiple domains of outcome. A structured dynamic treatment, transference-focused psychotherapy was associated with change in multiple constructs across six domains; dialectical behavior therapy and supportive treatment were associated with fewer changes. Future research is needed to examine the specific mechanisms of change in these treatments beyond common structures.
Clarkin
John F
JF
Weill Medical College of Cornell University, New York Hospital-Cornell Medical Center, Westchester Division, 21 Bloomingdale Rd., White Plains, NY 10605, USA. jclarkin@med.cornell.edu
Levy
Kenneth N
KN
Lenzenweger
Mark F
MF
Kernberg
Otto F
OF
D000293:Adolescent; D000328:Adult; D000374:Aggression / Q000523:psychology; D000553:Ambulatory Care; D000786:Anger; D001008:Anxiety Disorders / Q000523:psychology; D001521:Behavior Therapy; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011575:Psychoanalytic Therapy; D011613:Psychotherapy / Q000379:methods*; D012107:Research Design; D012917:Social Adjustment; D013405:Suicide / Q000523:psychology; D014167:Transference, Psychology; D016896:Treatment Outcome; D014754:Violence / Q000523:psychology