CoChat
Sign Up
Cited by 450Personality Disorders and PsychopathologyPsychotherapy Techniques and ApplicationsBipolar Disorder and Treatment

The DOI matches its Crossref record; 495 of the 501 references it cites were found in a registry or an index.

Psychological therapies for people with borderline personality disorder

Open access
Storebø, Ole Jakob, Stoffers-Winterling, Jutta M, Völlm, Birgit A, Kongerslev, Mickey T, Mattivi, Jessica T, Jørgensen, Mie S, Faltinsen, Erlend, Todorovac, Adnan, Sales, Christian P, Callesen, Henriette E, Lieb, Klaus, Simonsen, Erik·2020·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd012955.pub2
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Over the decades, a variety of psychological interventions for borderline personality disorder (BPD) have been developed. This review updates and replaces an earlier review (Stoffers-Winterling 2012). OBJECTIVES: To assess the beneficial and harmful effects of psychological therapies for people with BPD. SEARCH METHODS: In March 2019, we searched CENTRAL, MEDLINE, Embase, 14 other databases and four trials registers. We contacted researchers working in the field to ask for additional data from published and unpublished trials, and handsearched relevant journals. We did not restrict the search by year of publication, language or type of publication. SELECTION CRITERIA: Randomised controlled trials comparing different psychotherapeutic interventions with treatment-as-usual (TAU; which included various kinds of psychotherapy), waiting list, no treatment or active treatments in samples of all ages, in any setting, with a formal diagnosis of BPD. The primary outcomes were BPD symptom severity, self-harm, suicide-related outcomes, and psychosocial functioning. There were 11 secondary outcomes, including individual BPD symptoms, as well as attrition and adverse effects. DATA COLLECTION AND ANALYSIS: At least two review authors independently selected trials, extracted data, assessed risk of bias using Cochrane's 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach. We performed data analysis using Review Manager 5 and quantified the statistical reliability of the data using Trial Sequential Analysis. MAIN RESULTS: We included 75 randomised controlled trials (4507 participants), predominantly involving females with mean ages ranging from 14.8 to 45.7 years. More than 16 different kinds of psychotherapy were included, mostly dialectical behaviour therapy (DBT) and mentalisation-based treatment (MBT). The comparator interventions included treatment-as-usual (TAU), waiting list, and other active treatments. Treatment duration ranged from one to 36 months. Psychotherapy versus TAU Psychotherapy reduced BPD symptom severity, compared to TAU; standardised mean difference (SMD) -0.52, 95% confidence interval (CI) -0.70 to -0.33; 22 trials, 1244 participants; moderate-quality evidence. This corresponds to a mean difference (MD) of -3.6 (95% CI -4.4 to -2.08) on the Zanarini Rating Scale for BPD (range 0 to 36), a clinically relevant reduction in BPD symptom severity (minimal clinical relevant difference (MIREDIF) on this scale is -3.0 points). Psychotherapy may be more effective at reducing self-harm compared to TAU (SMD -0.32, 95% CI -0.49 to -0.14; 13 trials, 616 participants; low-quality evidence), corresponding to a MD of -0.82 (95% CI -1.25 to 0.35) on the Deliberate Self-Harm Inventory Scale (range 0 to 34). The MIREDIF of -1.25 points was not reached. Suicide-related outcomes improved compared to TAU (SMD -0.34, 95% CI -0.57 to -0.11; 13 trials, 666 participants; low-quality evidence), corresponding to a MD of -0.11 (95% CI -0.19 to -0.034) on the Suicidal Attempt Self Injury Interview. The MIREDIF of -0.17 points was not reached. Compared to TAU, psychotherapy may result in an improvement in psychosocial functioning (SMD -0.45, 95% CI -0.68 to -0.22; 22 trials, 1314 participants; low-quality evidence), corresponding to a MD of -2.8 (95% CI -4.25 to -1.38), on the Global Assessment of Functioning Scale (range 0 to 100). The MIREDIF of -4.0 points was not reached. Our additional Trial Sequential Analysis on all primary outcomes reaching significance found that the required information size was reached in all cases. A subgroup analysis comparing the different types of psychotherapy compared to TAU showed no clear evidence of a difference for BPD severity and psychosocial functioning. Psychotherapy may reduce depressive symptoms compared to TAU but the evidence is very uncertain (SMD -0.39, 95% CI -0.61 to -0.17; 22 trials, 1568 participants; very low-quality evidence), corresponding to a MD of -2.45 points on the Hamilton Depression Scale (range 0 to 50). The MIREDIF of -3.0 points was not reached. BPD-specific psychotherapy did not reduce attrition compared with TAU. Adverse effects were unclear due to too few data. Psychotherapy versus waiting list or no treatment Greater improvements in BPD symptom severity (SMD -0.49, 95% CI -0.93 to -0.05; 3 trials, 161 participants), psychosocial functioning (SMD -0.56, 95% CI -1.01 to -0.11; 5 trials, 219 participants), and depression (SMD -1.28, 95% CI -2.21 to -0.34, 6 trials, 239 participants) were observed in participants receiving psychotherapy versus waiting list or no treatment (all low-quality evidence). No evidence of a difference was found for self-harm and suicide-related outcomes. Individual treatment approaches DBT and MBT have the highest numbers of primary trials, with DBT as subject of one-third of all included trials, followed by MBT with seven RCTs. Compared to TAU, DBT was more effective at reducing BPD severity (

Overview

Integrity signals

Registry

Crossref · 10.1002/14651858.cd012955.pub2

Cites

495 of 495 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

Flagged first, then by citations

Show all 501 references

6 of the 501 references couldn’t be matched to a known paper.

Research works printed but not linked: 68

  1. Andreoli A Re: your study in BPD - Cochrane Collaboration review [personal communication] Email to: J Stoffers-Winterling
  2. Bateman A Important: question regarding your BPD trial for systematic review in Cochrane Collaboration [personal communication] Email to: K Lieb, J Stoffers
  3. Bateman A Fonagy P Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Supplementary data ajp.psychiatryonline.org/doi/suppl/10.1176/appi.ajp.2009.09040539/suppl_file/ajp_166_12_1355_01.pdf · DOI
  4. Bateman A Important question regarding your BPD trial for systematic review in Cochrane Collaboration [personal communication] Email to: K Lieb
  5. Bellino, 2005, Combined therapy with interpersonal psychotherapy of major depressed patients with borderline personality disorder: a comparison with pharmacotherapy, Journal of Psychopathology, 11, 34
  6. Bellino S Question regarding your BPD trials for inclusion in Cochrane Collaboration review [personal communication] Email to: J Stoffers-Winterling
  7. Zizza, 2009, Combined treatment of borderline personality disorder: a trial of modified interpersonal therapy, World Psychiatry, 8, 234
  8. Blum, 2008, Erratum, American Journal of Psychiatry, 165, 777. Erratum fo
  9. Borschmann R Joint crisis plans for BPD - question on publication in British Journal of Psychiatry [pers communication] Email to: J Stoffers-Winterling
  10. Borschmann R RE: joint crisis plans for BPD - question on publication in British Journal of Psychiatry [personal communication] Email to: J Stoffers-Winterling
  11. Doering S Question regarding your BPD trial for systematic review in Cochrane Collaboration [personal communication] Email to: K Lieb, J Stoffers
  12. Important: question regarding your BPD trial for systematic review in Cochrane Collaboration [personal communication] Email to: J Stoffers-Winterling
  13. Haeyen, 2018, Efficacy of art therapy in individuals with personality disorders cluster B/C: a randomised controlled trial, Journal of Personality Disorders, 32, 527, 10.1521/pedi_2017_31_312 · DOI
  14. Haeyen S Re: Cochrane Collaboration review of psychotherapies for BPD - your RCT of art therapy [personal communication] Email to: J Stoffers-Winterling
  15. Jochems EC Cochrane Collaboration review on psychotherapies for borderline PD [personal communication] Email to: EG Faltinsen
  16. Jochems EC Re: Cochrane Collaboration review on psychotherapies for borderline PD [personal communication] Email to: J Stoffers-Winterling
  17. Kredlow, 2017, Cognitive behavioral therapy for posttraumatic stress disorder in individuals with severe mental illness and borderline personality disorder, Psychiatry Research, 249, 86, 10.1016/j.psychres.2016.12.045 · DOI · Paper page
  18. Lindenboim, 2009, To Know Me is to Keep Me: Self-Verification, Validation, and Therapy Dropout in the Treatment of Borderline Personality Disorder [PhD thesis]
  19. Heard, 2000, Cost-Effectiveness of Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder [PhD thesis]
  20. Lindenboim, 2009, To Know Me is to Keep Me: Self-Verification, Validation, and Therapy Dropout in the Treatment of Borderline Personality Disorder [PhD thesis]
  21. Secrist, 2014, The Role of Executive Functioning in the Treatment of Borderline Personality Disorder [PhD thesis]
  22. Hope for chronically suicidal patient: evaluating the clinical and health services impact of dialectical behaviour therapy (DBT) in individuals with borderline personality disorder www.isrctn.com/ISRCTN02634417 10.1186/ISRCTN02634417 · DOI
  23. McMain, 2010, Dr McMain replies to letter to the editor on 'McMain SF, Links PS, Gnam WH, Guimond T, Cardish RJ, Korman L, et al. A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry 2009;166(12):1365-74. DOI: 10.1176/appi.ajp.2009.09010039', American Journal of Psychiatry, 167, 475, 10.1176/appi.ajp.2009.09101532r) · DOI
  24. McMurran M RE: Cochrane Collaboration review - PEPS study [personal communication] Email to: J Stoffers-Winterling
  25. McMurran M Request for data on BPD subjects in the PEPS rcp-study for use a new Cochrane review [personal communication] Email to: M Kongerslev
  26. Mohamadizadeh, 2017, Comparing of the effect of dialectical behavior therapy (DBT) and schema therapy (ST) on reducing mood activity and suicidal thoughts in patients with borderline personality disorder, Acta Medica Mediterranea, 33, 1025, 10.19193/0393-6384_2017_6_162 · DOI
  27. Rossouw, 2015, Mentalisation based treatment for adolescents with self harm: an RCT, European Child & Adolescent Psychiatry, 24, S113
  28. Salzer S AW: Re: Cochrane Review on psychotherapies for BPD - RCT testing PiM vs WL [personal communication] Email to: J Stoffers-Winterling
  29. Schilling L Re Schilling 2015/2018 - Cochrane Review of psychotherapies for BPD [personal communication] Email to: J Stoffers-Winterling
  30. Sinnaeve R Cochrane Collaboration review [personal communication] Email to: J Stoffers-Winterling
  31. Van Roijen, 2015, Cost-effectiveness and cost-utility of shortterm inpatient dialectical behavior therapy for chronically parasuicidal BPD (young) adults, Journal of Mental Health Policy and Economics, 18, S19
  32. Smith PN Re: Cochrane Collaboration review of psychotherapies for BPD [personal communication] Email to: J Stoffers-Winterling
  33. Van den Bosch, 2005, Efficacy of dialectical behaviour therapy in the treatment of female borderline patients with and without substance abuse problems: results of a Dutch study, Tijdschrift voor Psychiatrie, 47, 127
  34. Bira, 2014, Brief Psychological Intervention for Acute Posttraumatic stress: Individual and Trauma Factors Affecting Recovery in Low-SES Minorities [PhD thesis]
  35. Ha, 2016, The Effects of Intranasal Oxytocin on Social Cognitive Functioning in Adolescents with Borderline Personality Disorder Compared to a Sample of Non-Clinical Adolescents [PhD thesis]
  36. Merolla, 2017, A Study of the Relationship between Borderline-Dysregulated Personality and Treatment-Resistant Depression in the Course of the TADS Randomised Controlled Trial [D Clin Psy thesis]
  37. Ower, 2014, Effects of Oxytocin on Social Cognition and Empathy in Women with Borderline Personality Disorder/Effekte von Oxytocin auf die Soziale Kognition und Empathie bei Frauen mit Borderline-Persönlichkeitsstörung [PhD thesis]
  38. Roussignol, 2010, Étude de L'effet de la Stimulation Magnétique Transcrânienne Répétitive Chez des Patients Présentant un Trouble de la Personnalité borderline [Thèse d'exercice] / [Effect of Repetitive Transcranial Magnetic Stimulation in Patients with Borderline P
  39. TufekciogIu, 2015, Pre-Treatment Axis II Diagnosis and Psychotherapy Process in Two Time-Limited Therapies [PhD thesis]
  40. Akbari, 2009, Effectiveness of CBT, pharmacotherapy and combined approach in improvement of symptoms depression anger in borderline personality disorder, Journal of Psychology, 13, 342
  41. Cowperthwait, 2016, Outpatient Dialectical Behavior Therapy for Adolescents: Treatment Outcomes and Comparison of Treatment Effects in Two Skills Training Group Formats [PhD thesis]
  42. Johnson, 2017, Cognitive Analytic Therapy (CAT) for Borderline Personality Disorder : Is CAT effective, and what influences the delivery of this therapy? [DClinPsy thesis]
  43. Ostermeier, 2014, Adapting Dialectic Behavioral Therapy Skills Group Based on the Severity Level of Borderline Personality Disorder [PsyD thesis)
  44. 1980, Diagnostic and Statistical Manual of Mental Disorders (DSM-III)
  45. Bateman, 2003, Health care utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care, American Journal of Psychiatry, 160, 169, 10.1176/appi.ajp.160.1.169 · DOI
  46. Bateman, 2019, A randomized controlled trial of a mentalization-based intervention (MBT-FACTS) for families of people with borderline personality disorder, Personality Disorders, 10, 70, 10.1037/per0000298 · DOI
  47. Black, 2009, STEPPS: a practical, evidence-based way to treat borderline personality disorder, Current Psychiatry, 8, 31
  48. Davidson, 2010, Cognitive therapy v usual treatment for borderline personality disorder: prospective 6-year follow-up, British Journal of Psychiatry, 197, 456, 10.1192/bjp.bp.109.074286 · DOI
  49. Gratz, 2001, Measurement of deliberate self-harm: preliminary data on the Deliberate Self-Harm Inventory, Journal of Psychopathology and Behavioral Assessment, 23, 253, 10.1023/A:1012779403943.pdf · DOI
  50. Gregory, 2010, Dynamic deconstructive psychotherapy versus optimized community care for borderline personality disorder co-occurring with alcohol use disorders: a 30-month follow-up., Journal of Nervous and Mental Disease, 198, 292, 10.1097/NMD.0b013e3181d6172d · DOI · Paper page
  51. Higgins JPT Deeks JJ Altman DG Cochrane Statistical Methods Group Chapter 16: Special topics in statistics. In: Higgins JPT, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011 Available from handbook.cochrane.org
  52. Higgins, 2019, Cochrane Handbook for Systematic Reviews of Interventions, 10.1002/9781119536604 · DOI · Paper page
  53. International Council for Harmonisation Expert Working Group International conference on harmonisation of technical requirements for registration of pharmaceuticals for human use. ICH harmonised tripartite guideline. Guideline for good clinical practice E6(R1) www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/Efficacy/E6/E6_R1_Guideline.pdf
  54. Karterud S Kongerslev MT Psychotherapy of personality disorders needs an integrative theory of personality Journal of Psychotherapy Integration 10.1037/int0000196 · DOI
  55. Livesley, 2016, Integrated Treatment for Personality Disorder: A Modular Approach
  56. Loranger, 1988, Personality Disorder Examination (PDE) Manual
  57. Morey, 2007, Personality Assessment Inventory (PAI): Professional Manual
  58. Pfohl, 1997, Structured Interview for DSM-IV Personality (SIPD-IV)
  59. Review Manager 5 (RevMan 5) Nordic Cochrane Centre, The Cochrane Collaboration 2014
  60. Ryle, 1997, Cognitive Analytic Therapy and Borderline Personality Disorder: The Model and the Method
  61. Spielberger, 1988, Manual for the State-Trait Anger Expression Inventory
  62. Spitzer, 1989, Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II)
  63. Sterne JAC Egger M Moher D Boutron I Chapter 10: Addressing reporting biases. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017). Cochrane, 2017 Available from www.training.cochrane.org/handbook
  64. Streeck, 2009, Handbuch Psychoanalytisch-Interaktionelle Therapie. Zur Behandlung von Patienten mit Strukturellen Störungen und Schweren Persönlichkeitsstörungen
  65. Verheul, 2003, Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands, British Journal of Psychiatry, 182, 135, 10.1192/bjp.182.2.135 · DOI
  66. World Health Organization, 1993, The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research
  67. Zanarini, 1996, Diagnostic interview for DSM-IV personality disorders (unpublished measure)
  68. Zanarini, 2003, The Childhood Interview for DSM-IV Borderline Personality Disorder (CI-BPD)

Cited by

Sorted by citations

Items 401–447 of 447

Related

See all

Metadata

Authors
Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., Lieb, K., & Simonsen, E.
Affiliations
  • University of Southern Denmark (DK)
  • University Medical Center of the Johannes Gutenberg University Mainz (DE)
  • Department of Forensic Psychiatry, Center for Neurology; University Rostock; Rostock Germany
  • Region Zealand (DK)
  • University of Nottingham (GB)
  • Psychiatric Research Unit; Psychiatry of Region Zealand; Slagelse Denmark
  • Leibniz Institute for Resilience Research (DE)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2020-05-04
Volume
2020
Issue
11
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd012955.pub2
OpenAlex
W4253966971
Semantic Scholar
1f2b096423317b332672582b4f3034f2e2a8f9c7
Cited by
450
References
501
Citations by year
2026: 56 · 2025: 75 · 2024: 100 · 2023: 81 · 2022: 73 · 2021: 49 · 2020: 13
FWCI
4.22
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, other-oa)
Funders
  • Bundesministerium für Bildung und Forschung
  • Queen's University
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
borderline personality disorder, psychotherapy, dialectical behavior therapy, mentalization-based treatment, self-harm, suicide attempts, psychosocial functioning, treatment discontinuation, adverse effects, usual care, waitlist control, adolescents, adults, children

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review