Background People with Borderline Personality Disorder (BPD) have limited access to long term psychological therapies. Briefer interventions have been developed but trial evidence to support their use has not been reviewed.
Aims To examine whether psychological interventions for adults with BPD of six months duration or less improve symptoms, mood, self-harm, suicidal behaviour, and service use.
Methods The protocol was prospectively registered (PROSPERO CRD42017063777). Database searches were conducted up to April 2020. Inclusion, data extraction and risk of bias were assessed in duplicate. We identified 27 randomised controlled trials. We conducted random-effects meta-analyses sub-grouping data into delivery method, additional support, and comparison type.
Results High levels of bias were found for attrition and reporting. Heterogeneity was high in some pooled data. Borderline symptom reductions were greatest for interventions including additional support (SMD. -1.23, 95% C.I. -2.13, −0.33). Planned generic support may be as effective as specialist interventions for borderline symptoms (SMD = −0.11, 95% C.I. -0.51, 0.29) and social functioning (SMD = −0.16., 95% C.I. -0.65, 0.33). Follow-up was limited and direct comparison with post-intervention results was unreliable.
Conclusions Short-term interventions may be effective. Access to additional support has an impact on outcomes. It is unclear if symptomatic change is sustained.
Borderline personality disorder (BPD) is a severe mental health condition that affects 1-2% of the population (Coid, Yang, & Tyrer, 2006) and is characterised by significant difficulties in emotion regulation, the ability to develop and sustain relationships, and the ability to regulate impulsive behaviour, including self-harm and suicidal behaviour (American Psychological Association, 2013). A range of long-term psychological therapies have been developed that have been shown to improve the mental health of people with borderline personality disorder (Omar, Tejerina-Arreal, & Crawford, 2014; Stoffers-Winterling, Völlm, Rücker, Timmer, & Lieb, 2012), and are included in recommendations and guidelines for the treatment of people with BPD (American Psychiatric Association, 2001; National Institute for Health and Care Excellence, 2009; National Health and Medical Research Council, 2012; Simonsen et al., 2019). Long term psychological therapies have limited availability (Paris, 2013) and many people with severe borderline personality disorder are unable to engage or drop out of treatment before it is completed (Crawford et al., 2009; McMurran, Huband, & Overton, 2010). There has been a reluctance to deliver brief psychological therapies due to concerns that they may be unhelpful or even harmful for people who can find it difficult to form trusting relationships and cope when relationships end (National Institute for Health and Care Excellence, 2009). However, in response to increased recognition of the needs of people with BPD and increased demand for treatment, efforts have been made to develop and test the effectiveness of shorter-term interventions. Stoffers et al. (2012) identified 12 studies of interventions of 6 months duration or less. Subsequent reviews have mainly identified small-scale feasibility studies of shorter-term interventions with inconclusive results (Cristea et al., 2017).