Early intervention for adolescents with borderline personality disorder: quasi-experimental comparison with treatment as usual.
OBJECTIVE
The aim of the present study was to compare the effectiveness of specialized team-based early intervention for borderline personality disorder (BPD) with treatment as usual.


METHODS
In a quasi-experimental design, 32 outpatients who received historical treatment as usual (H-TAU) were compared with 78 participants from a recently published randomized controlled trial of cognitive analytic therapy (CAT; n = 41) versus manualized good clinical care (GCC; n = 37), conducted in a specialized early intervention service for BPD (the Helping Young People Early (HYPE) programme). All participants were 15-18-year-old outpatients who fulfilled 2-9 DSM-IV BPD criteria. It was predicted that, compared with H-TAU, HYPE + GCC and HYPE + CAT would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24 months.


RESULTS
At 24 month follow up: (i) HYPE + CAT had lower standardized levels of, and a significantly faster standardized rate of improvement in, internalizing and externalizing psychopathology, compared with H-TAU; and (ii) HYPE + GCC had lower standardized levels of internalizing psychopathology and a faster rate of improvement in global functioning than H-TAU. HYPE + CAT yielded the greatest median improvement on the four continuous outcome measures over 24 months. No adverse effects were shown with any of the treatments.


CONCLUSIONS
Specialized early intervention for subsyndromal or full-syndrome BPD is more effective than TAU, with HYPE + CAT being the most effective intervention. Reform of existing services using the HYPE model might yield substantial improvements in patient outcomes.
ORYGEN Youth Health Research Centre, University of Melbourne, Locked Bag10, Parkville, Vic. 3052, Australia. achanen@unimelb.edu.au
Andrew M
AM
Chanen
Henry J
HJ
Jackson
Louise K
LK
McCutcheon
Martina
M
Jovev
Paul
P
Dudgeon
Hok Pan
HP
Yuen
Dominic
D
Germano
Helen
H
Nistico
Emma
E
McDougall
Caroline
C
Weinstein
Verity
V
Clarkson
Patrick D
PD
McGorry
D000293:Adolescent; D001883:Borderline Personality Disorder / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016728:Self-Injurious Behavior / Q000628:therapy