Effectiveness of adolescent identity treatment (AIT) versus DBT-a for the treatment of adolescent borderline personality disorder.

Abstract

Borderline personality disorder (BPD) is among the most severe mental health problems with long-lasting deterioration of functioning. According to a Cochrane review, evidence for methods focused on treatment for adolescent BPD patients is very limited. Aims of the study were to demonstrate the noninferiority of adolescent identity treatment (AIT) compared with dialectical behavior therapy for adolescents (DBT-A), and that intensive early treatment of BPD leads to significant improvement of psychosocial and personality functioning in adolescent patients. In a nonrandomized controlled trial using a noninferiority approach, we compared 37 patients treated with DBT-A with 23 patients treated with AIT. Both treatments included 25 weekly individual psychotherapy sessions and five to eight family sessions. Patients were assessed at four timepoints: baseline, posttreatment, 1-and 2-year follow-up. Primary outcome was psychosocial functioning at 1-year follow-up. We performed both intention-to-treat analyses and per-protocol analyses (completers). Baseline characteristics of both groups were not significantly different except for age and self-injurious behavior. In all, six AIT patients (26%) and 10 DBT-A patients (27%) dropped out of treatment. Both DBT-A and AIT significantly improved adolescents' psychosocial functioning (AIT: d = 1.82; DBT-A: d = 1.73) and personality functioning. BPD criteria and depression were significantly reduced by both treatments. Overall, AIT was found to be not inferior to DBT-A and even more efficient in reducing BPD criteria. Both treatments are highly effective in improving psychosocial functioning and personality functioning in adolescent BPD patients. AIT is a promising approach and not inferior to DBT-A in respect to treatment efficiency.

A borderline personality assessment for adolescents: Validity and reliability of the Chinese languages borderline personality features scale (short form version) for adolescents/children

“…For example, Cohen et al reported that the onset of personality disorders emerges early in adolescence (13). The abovementioned results converged to indicated that some characteristics of adolescence might facilitate the onset of personality disorder (14, 15); specifically, these studies indicated that BPD may have predisposing features which facilitate the development of personality disorders (6, [10][11][12][13][14][15]. Some studies recommend that for adolescents with BPD, early diagnosis and intervention are ideal (3,(16)(17)(18) and provide optimal outcomes (19)(20)(21)(22).…”

“…Although debated, some studies suggest that the diagnosis of personality disorders in childhood or adolescence, should be avoided and personality disorders must not be diagnosed in adolescence owing to continued personality maturation and high developmental variability (3,4). More notably, many studies proposed that adolescence is a pivotal period in the development of personality disorder (5)(6)(7)(8)(9)(10)(11)(12). For example, Cohen et al reported that the onset of personality disorders emerges early in adolescence (13).…”

Commentary: Commentary on the Twitter comments evoked by the May 2022 debate on diagnosing personality disorders in adolescents

“…It is a sad fact that the accumulated evidence indicating that there are effective treatments for young people with PD (Chanen, Nicol, Betts, & Thompson, 2020) and that good outcomes are possible (Alvarez‐Tomás et al., 2017; Balaratnasingam & Janca, 2020; Buerger et al., 2019; Schmeck et al., 2022; Temes & Zanarini, 2018) has not changed routine clinical practice in many jurisdictions around the globe. This appears to be further evidence of the hostile clinical cultures, referred to above.…”

Withdrawal ruptures in adolescents with borderline personality disorder psychotherapy are marked by increased speech pauses–can minimal responses be automatically detected?

“…Our research group has studied the effectiveness of Adolescent Identity Treatment (AIT) and Dialectic Behaviour Therapy in adolescent patients with BPD. The result of this study showed that both these treatments are effective at improving psychosocial functioning and personality functioning in these patients [ 20 ]. In the same project [ 21 ], we have also studied ruptures and resolutions occurring in the psychotherapy with AIT.…”

“…Confrontation ruptures seemed to have a stronger impact than withdrawal ruptures [ 22 ]. A major limitation of the study by Schenk et al [ 22 ] was that it only contained 10 fully analysed psychotherapies while our total sample amounted to 23 cases [ 20 ]. This was due to a lack of 3RS trained personnel since the involved PhD and master students finished their projects.…”