Effect of 3 Forms of Early Intervention for Young People With Borderline Personality Disorder

Abstract

IMPORTANCE Clinical trials have neither focused on early intervention for psychosocial impairment nor on the contribution of components of borderline personality disorder (BPD) treatment beyond individual psychotherapy. OBJECTIVE To evaluate the effectiveness of 3 early interventions for BPD of differing complexity. DESIGN, SETTINGS, AND PARTICIPANTS This single-blinded randomized clinical trial recruited young people between March 17, 2011, and September 30, 2015, into parallel groups. The study took place at 2 government-funded mental health services for young people in Melbourne, Australia. Inclusion criteria were age 15 to 25 years (inclusive), recent DSM-IV-TR BPD diagnosis, and never receiving evidence-based BPD treatment. A total of 139 participants were randomized (pool of 876; 70 declined, 667 excluded), balanced for sex, age, and depressive symptomatology. Data analysis completed May 2020. INTERVENTIONS (1)The Helping Young People Early (HYPE) dedicated BPD service model for young people, combined with weekly cognitive analytic therapy (CAT); (2) HYPE combined with a weekly befriending psychotherapy control condition; and (3) a general youth mental health service (YMHS) model, combined with befriending. Therefore, the 3 treatment arms were HYPE + CAT, HYPE + befriending, and YMHS + befriending. Participants were randomly assigned both to 1 treatment arm (in a 1:1:1 ratio) and to a clinician. MAIN OUTCOMES AND MEASURESPsychosocial functioning, measured with the Inventory of Interpersonal Problems Circumplex Version and the Social Adjustment Scale Self-report. RESULTS One hundred twenty-eight participants (104 [81.3%] were female; mean [SD] age, 19.1 [2.8] years; HYPE + CAT: 40 [31.3%]; HYPE + befriending: 45 [35.2%]; YMHS + befriending: 43 [33.6%]) who provided postbaseline data were included in the intent-to-treat analysis. Regardless of group, from baseline to 12 months, there was a mean of 19.3% to 23.8% improvement in the primary outcomes and 40.7% to 52.7% for all secondary outcomes, except severity of substance use and client satisfaction. The latter remained high across all time points. Planned comparisons (YMHS + befriending vs HYPE; HYPE + CAT vs befriending) showed that neither the service model nor the psychotherapy intervention was associated with a superior rate of change in psychosocial functioning by the 12-month primary end point. The HYPE service model was superior to YMHS + befriending for treatment attendance (median [IQR], 22 [19] vs 3 [16] contacts; median duration, 200 [139.5] vs 94 [125] days) and treatment completion (44 of 92 [47.8%] vs 9 of 47 [19.2%]). HYPE + CAT was superior to befriending for treatment attendance (median [IQR], 12 [16.5] vs 3 [9.8] sessions) and treatment completion (24 of 46 [52.2%] vs 29 of 93 [31.2%]). CONCLUSIONS AND RELEVANCEIn this randomized clinical trial of 3 interventions for young people with BPD, effective early intervention was not reliant on availability of specialist psychotherapy but did require youth-oriented clinical case management and psyc...

Dropout from psychological treatment for borderline personality disorder: a multilevel survival meta-analysis

“…There were 23 residuals lying outside the 95% CI, which is 4.96% of the 463 residuals – thus less than the 5% that can be expected given the 95% CI. Nine of the outliers (to the left) were related to more actual dropouts than predicted by the GLMM survival model: three DBT (Barnicot & Crawford, 2019 , Quarter 4; Fitzpatrick, Bailey, & Rizvi, 2020 , Quarter 2; Sinnaeve, van den Bosch, Hakkaart-van Roijen, & Vansteelandt, 2018 , Quarter 1); two TAU (Soler et al, 2009 , Quarter 1; Verheul et al, 2003 , Quarter 1); one psychodynamic (Löffler-Stastka, Ponocny-Seliger, Meißel, & Springer-Kremser, 2006 , Quarter 1); one CTBE (Doering et al, 2010 , Quarter 1); one specified other (Chanen et al, 2022 , Quarter 1), and one CBT (Morey, Lowmaster, & Hopwood, 2010 , Quarter 1). Seven of 9 were from Quarter 1.…”

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Improving Treatment Outcomes for Adolescents with Borderline Personality Disorder Through a Socioecological Approach

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Debate: It is time to stop turning a blind eye to personality disorder in young people

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