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NEW YORK (Reuters Health) Jun 25 - Results of a study published in the June issue of the American Journal of Psychiatry suggest that patients with borderline personality disorder benefit from structured treatments in an outpatient setting, with different facets of the disorder responding more to different approaches.

"Impulsivity, diminished nonaffective constraint, negative affectivity, and emotional dysregulation are core characteristics of borderline personality disorder," Dr. John F. Clarkin, of New York Hospital-Cornell Medical Center, White Plains, and colleagues write. "This chronic and debilitating syndrome is associated with high rates of medical and psychiatric utilization of services."

The researchers evaluated three year-long outpatient treatments for borderline personality disorder. A total of 90 patients (mean age 30.9 years) diagnosed with borderline personality disorder were randomly assigned to transference-focused psychotherapy, dialectical behavior therapy, or supportive treatment. The patients received medication treatment when indicated.

Domains of outcome included suicidal behavior, aggression, impulsivity, anxiety, depression, and social adjustment, and were assessed prior to treatment and at 4-month intervals during the 1-year study.

Transference-focused psychotherapy included two individual weekly sessions and dialectical behavior therapy consisted of a weekly individual and group session and available telephone consultation. Supportive therapy included one weekly session. This could be supplemented with additional sessions as needed.

There were significant positive changes in depression, anxiety, global functioning, and social adjustment among patients in all three treatment groups. A significant association was observed between both transference-focused psychotherapy and dialectical behavior therapy and improvement in suicidality. Transference-focused psychotherapy and supportive treatment, but not dialectical behavior therapy, were significantly associated with improvement in anger.

"Only transference-focused psychotherapy was significantly predictive of symptom improvement in Barratt Factor 2 impulsivity, irritability, verbal assault, and direct assault," Dr. Clarkin's team report. "Supportive treatment alone was predictive of improvement in Barratt Factor 3 impulsivity."

The investigators conclude that, while there are some domain differences, "these structured treatments for borderline personality disorder are generally equivalent with respect to broad positive change."

 

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