Cognitive therapy v. usual treatment for borderline personality disorder: prospective 6-year follow-up.
BACKGROUND
Longer-term follow-up of patients with borderline personality disorder have found favourable clinical outcomes, with long-term reduction in symptoms and diagnosis.


OBJECTIVE
We examined the 6-year outcome of patients with borderline personality disorder who were randomised to 1 year of cognitive-behavioural therapy for personality disorders (CBT-PD) or treatment as usual (TAU) in the BOSCOT trial, in three centres across the UK (trial registration: ISRCTN86177428).


METHODS
In total, 106 participants met criteria for borderline personality disorder in the original trial. Patients were interviewed at follow-up by research assistants masked to the patient's original treatment group, CBT-PD or TAU, using the same measures as in the original randomised trial. Statistical analyses of data for the group as a whole are based on generalised linear models with repeated measures analysis of variance type models to examine group differences.


RESULTS
Follow-up data were obtained for 82% of patients at 6 years. Over half the patients meeting criteria for borderline personality disorder at entry into the study no longer did so 6 years later. The gains of CBT-PD over TAU in reduction of suicidal behaviour seen after 1-year follow-up were maintained. Length of hospitalisation and cost of services were lower in the CBT-PD group compared with the TAU group.


CONCLUSIONS
Although the use of CBT-PD did not demonstrate a statistically significant cost-effective advantage, the findings indicate the potential for continued long-term cost-offsets that accrue following the initial provision of 1 year of CBT-PD. However, the quality of life and affective disturbance remained poor.
Centre for Population and HealthSciences, University of Glasgow, UK. kate.davidson@glasgow.ac.uk
Kate M
KM
Davidson
Peter
P
Tyrer
John
J
Norrie
Stephen J
SJ
Palmer
Helen
H
Tyrer
D000328:Adult; D001883:Borderline Personality Disorder / Q000191:economics / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D016728:Self-Injurious Behavior / Q000453:epidemiology*; D013222:State Medicine; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D006113:United Kingdom