The Impact of Psychological Interventions on Functioning in the Context of Borderline Personality Disorder Features for Adolescents and Young Adults; a Systematic Review and Meta Analysis

Abstract

Background Adolescents recruited from clinical samples with borderline personality disorder (BPD) experience high levels of functional impairment in numerous domains. Evidence suggests that the presence of borderline personality features before adulthood predict long term functional impairment and can worsen into adulthood. However, the method of assessment and the impact of intervention on functioning remains unclear. Methods This study conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the impact of psychological intervention on functioning in adolescents and young adults with BPD features. Four databases were reviewed (PsycINFO, Medline, Embase, and CINAHL). Results Out of 1859 papers, seven trials (657 participants) met eligibility criteria. Overall, psychological intervention significantly improved functioning at post-treatment and final follow-up. However, when comparing "BPD-specific" interventions with generalist treatment as usual (TAU) at post-treatment, effect sizes were small (overall ES g = 0.08, 95% CI = -0.10–0.25), and marginally improved at final follow-up (overall ES g = 0.16, 95% CI = -0.13–0.46). However, the trials raised some concerns about the risk of bias, with one showing a high risk. Conclusions Based on the synthesis of findings, both interventions showed similar effects on functional impairment. The findings have implications for service design and addressing the needs of an often-underrepresented patient population. This study emphasizes a need for more high-quality trials with larger sample sizes to strengthen the evidence base further.