BackgroundThe borderline personality disorder (BPD) population is notably heterogeneous, and this has potentially important implications for intervention. Identifying distinct subtypes of patients may represent a first step in identifying which treatments work best for which individuals.MethodsA cluster-analysis on dimensional personality disorder (PD) features, as assessed with the SCID-II, was performed on a sample of carefully screened BPD patients (N = 187) referred for mentalization-based treatment. The optimal cluster solution was determined using multiple indices of fit. The validity of the clusters was explored by investigating their relationship with borderline pathology, symptom severity, interpersonal problems, quality of life, personality functioning, attachment, and trauma history, in addition to demographic and clinical features.ResultsA three-cluster solution was retained, which identified three clusters of BPD patients with distinct profiles. The largest cluster (n = 145) consisted of patients characterized by “core BPD” features, without marked elevations on other PD dimensions. A second “Extravert/externalizing” cluster of patients (n = 27) was characterized by high levels of histrionic, narcissistic, and antisocial features. A third, smaller “Schizotypal/paranoid” cluster (n = 15) consisted of patients with marked schizotypal and paranoid features. Patients in these clusters showed theoretically meaningful differences in terms of demographic and clinical features.ConclusionsThree meaningful subtypes of BPD patients were identified with distinct profiles. Differences were small, even when controlling for severity of PD pathology, suggesting a strong common factor underlying BPD. These results may represent a stepping stone toward research with larger samples aimed at replicating the findings and investigating differential trajectories of change, treatment outcomes, and treatment approaches for these subtypes.Trial registrationThe study was retrospectively registered 16 April 2010 in the Nederlands Trial Register, no. NTR2292.

Objective This meta‐analysis examines the efficacy of recently developed psychological treatments for anorexia nervosa, compared with control condition. Outcome criteria are weight gain, eating disorder pathology, and quality of life. Method Twelve thousand nine hundred ninety‐seven abstracts, published between 1980 and 2017, were retrieved. End‐of‐treatment data from 1,279 participants, from 15 of 17 eligible studies, were used to calculate pooled‐effect sizes (Hedges' g) for outcome using random‐effects model. Subgroup analyses were used to explore the influence of various patient and study characteristics. Results No significant differences between psychological treatment and controls were found on weight gain, g = 0.07, 95% CI [−0.09, 0.23], eating disorder pathology, g = 0.06, 95% CI [−0.10, 0.21], and quality of life, g = −0.11, 95% CI [−0.36, 0.15]. Studies including only patients over 18 years of age were more effective on weight gain than studies including adolescents as well. High‐quality studies and studies with reported therapist training had larger effects on weight gain and quality of life compared with low‐quality studies and studies without reported training. Conclusions Despite progress in the development of specialized treatments, the efficacy of psychological treatment over an active control condition could not be established. Outcomes, however, are obscured by low‐quality and heterogeneous studies.

BackgroundAnorexia Nervosa (AN) has a devastating impact on the psychological and physical well being of affected individuals. There is an extensive body of literature on interventions in AN, however more studies are needed to establish which form of pharmacotherapy is effective. The few meta-analyses that have been done are based on one type of medication only. This article is the first to present data on three different, most commonly used, forms of pharmacotherapy. The primary objective of this meta-analysis was to create an overview and to determine the efficacy of three forms of pharmacotherapy (antidepressants, antipsychotics, hormonal therapy) compared to treatment with placebo in patients with AN.MethodA systematic literature search was performed to identify all randomized controlled intervention trials investigating the effectiveness of pharmacotherapy for AN within the following databases: PubMed, PsycINFO, Embase and Cochrane Library. In addition, 32 relevant reviews and meta-analyses were screened for additional intervention studies. A meta-analysis was performed on a total of 18 included studies (N = 869). Efficacy was measured in terms of weight gain or weight restoration.ResultsThe pooled effect sizes indicating the difference between antidepressants and placebo, and between antipsychotics and placebo on weight were not significant. Because of the small sample size no meta regression and subgroup analyses could be conducted. The pooled effect size indicating the difference between hormonal therapy and the placebo condition on weight (all weight measures) at post-treatment was 0.42 (95% CI: 0.11 ~ 0.73), which was significant. For hormonal therapy heterogeneity was high (I2 = 64.70). No evidence for publication bias was found. Meta-regression analyses of the weeks of medication treatment (slope = −0.008) yielded a significant effect (p = 0.04).ConclusionsIn this study we found that hormonal therapy has a significantly larger effect on weight compared to placebo in the treatment of AN. However for these analyses heterogeneity was high, which means that these results have to be regarded with caution. We found that anti-depressants and antipsychotics had no significant effect on weight compared to placebo in the treatment of AN, although the power to detect significant effects was too low.Electronic supplementary materialThe online version of this article (doi:10.1186/s40337-014-0027-x) contains supplementary material, which is available to authorized users.

Background: Anorexia Nervosa (AN) has a devastating impact on the psychological and physical well being of affected individuals. There is an extensive body of literature on interventions in AN, however more studies are needed to establish which form of pharmacotherapy is effective. The few meta-analyses that have been done are based on one type of medication only. This article is the first to present data on three different, most commonly used, forms of pharmacotherapy. The primary objective of this meta-analysis was to create an overview and to determine the efficacy of three forms of pharmacotherapy (antidepressants, antipsychotics, hormonal therapy) compared to treatment with placebo in patients with AN. Method: A systematic literature search was performed to identify all randomized controlled intervention trials investigating the effectiveness of pharmacotherapy for AN within the following databases: PubMed, PsycINFO, Embase and Cochrane Library. In addition, 32 relevant reviews and meta-analyses were screened for additional intervention studies. A meta-analysis was performed on a total of 18 included studies (N = 869). Efficacy was measured in terms of weight gain or weight restoration. Results: The pooled effect sizes indicating the difference between antidepressants and placebo, and between antipsychotics and placebo on weight were not significant. Because of the small sample size no meta regression and subgroup analyses could be conducted. The pooled effect size indicating the difference between hormonal therapy and the placebo condition on weight (all weight measures) at post-treatment was 0.42 (95% CI: 0.11~0.73), which was significant. For hormonal therapy heterogeneity was high (I 2 = 64.70). No evidence for publication bias was found. Meta-regression analyses of the weeks of medication treatment (slope = −0.008) yielded a significant effect (p = 0.04). Conclusions:In this study we found that hormonal therapy has a significantly larger effect on weight compared to placebo in the treatment of AN. However for these analyses heterogeneity was high, which means that these results have to be regarded with caution. We found that anti-depressants and antipsychotics had no significant effect on weight compared to placebo in the treatment of AN, although the power to detect significant effects was too low.