Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial
Abstract
OBJECTIVE: This study compared the effectiveness of psychoanalytically oriented partial hospitalization with standard psychiatric care for patients with borderline personality disorder. METHOD: Thirty-eight patients with borderline personality disorder, diagnosed according to standardized criteria, were allocated either to a partially hospitalized group or to a standard psychiatric care (control) group in a randomized controlled design. Treatment, which included individual and group psychoanalytic psychotherapy, was for a maximum of 18 months. Outcome measures included the frequency of suicide attempts and acts of self-harm, the number and duration of inpatient admissions, the use of psychotropic medication, and self-report measures of depression, anxiety, general symptom distress, interpersonal function, and social adjustment. Data analysis used repeated measures analysis of covariance and nonparametric tests of trend. RESULTS: Patients who were partially hospitalized showed a statistically significant decrease on all measures in contrast to the control group, which showed limited change or deterioration over the same period. An improvement in depressive symptoms, a decrease in suicidal and self-mutilatory acts, reduced inpatient days, and better social and interpersonal function began at 6 months and continued until the end of treatment at 18 months. CONCLUSIONS: Psychoanalytically oriented partial hospitalization is superior to standard psychiatric care for patients with borderline personality disorder. Replication is needed with larger groups, but these results suggest that partial hospitalization may offer an alternative to inpatient treatment.
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Bateman 1999 found a very large, statistically significant difference in favour of MBT-PH for depression (SMD -1.98; N = 38, 95% CI -2.78 to -1.19; Analysis 1.14).
“Bateman 1999 report data indicating a very large, statistically significant difference in favour of MBT-PH (SMD -1.98; N = 38, 95% CI -2.78 to -1.19; Analysis 1.14).”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 1999
Two trials (Bateman 1999; Zanarini 2008) did not mention blinding of outcome assessors, and their risk of bias was judged unclear.
“Two trials did not mention blinding of outcome assessors (Bateman 1999;Zanarini 2008), and the risk of bias was judged 'unclear'.”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 1999
MBT has been compared with control groups in two trials, one testing MBT in a partial hospitalisation (MBT-PH; Bateman 1999) and one testing MBT in an outpatient setting (MBT-out; Bateman 2009).
“It has been compared with control groups in two trials, one testing MBT in a partial hospitalisation (MBT-PH; Bateman 1999) and one testing MBT in an outpatient setting (MBT-out; Bateman 2009).”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 1999
Bateman 1999 reported a very large, significant effect of less interpersonal pathology in partially-hospitalised MBT patients (SMD -2.22; N = 38, 95% CI -3.04 to -1.39; Analysis 1.10).
“Bateman 1999 report data indicating a very large, significant effect of less interpersonal pathology in partially-hospitalised MBT patients (SMD -2.22; N = 38, 95% CI -3.04 to -1.39; Analysis 1.10).”
From Psychological therapies for people with borderline personality disorder. (2012) · cites this paper as Bateman 1999
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“Bateman and Fonagy (35) showed that a psychoanalytically oriented day treatment program for patients with borderline personality disorder was superior to standard psychiatric care.”
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“This dropout rate compares well with previous studies (Bateman & Fonagy, 1999; Linehan, Armstrong, Suarez, Allmon, & Heard, 1991; Linehan, Schmidt, Dimeff, & Craft et al., 1999; Stevenson & Meares, 1992), which reported a range between 16.7% to 21.0%.”
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“In most European countries, residential treatment programs are routinely offered to patients who lack adequate local treatment opportunities or have not adequately responded to outpatient treatment (e.g., Bateman & Fonagy, 1999).”
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“However, Bateman and Fonagy (2004a) themselves acknowledge that they were unable to show that the target of their interventions, mentalization, had been enhanced in patients treated within the program compared with control patients because of the complexity of measuring the construct.”
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“…(65) Brown et al, 2005 (41) Slee et al, 2008 (64) Fitzpatrick et al, 2005 (51) Hatcher et al, 2011 (54) Bannan, 2010 (37) Linehan et al, 2006 (59) Bateman and Fonagy, 1999 (38) Guthrie et al, 2001 (52) Kovac and Range, 2002 (56) Subtotal (I2 = 60.5%, P = 0.003) with estimated predictive…”
BackgroundInfluentialIs Hospitalization Useful for Suicidal Patients with Borderline Personality Disorder?
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“In such cases, day treatment has empirically demonstrated effectiveness (Bateman & Fonagy, 1999; Piper, Rosen, & Joyce, 1996), and should be considered the main alternative to admission.”
BackgroundThe Effectiveness of Long-Term Psychoanalytic Therapy: A Systematic Review of Empirical Studies
de Maat, S., de Jonghe, F., Schoevers, R., & Dekker, J. (2009) · Harvard Review of Psychiatry · doi:10.1080/10673220902742476 · Cited by 190 · see citing works
TYRER, P., THOMPSON, S., SCHMIDT, U., JONES, V., KNAPP, M., DAVIDSON, K., CATALAN, J., AIRLIE, J., BAXTER, S., BYFORD, S., et al. (2003) · Psychological Medicine · doi:10.1017/s0033291703008171 · Cited by 190 · see citing works
“…(Charing Cross Campus), St Dunstan’s Road, London W6 8RP. 969 although smaller ones, involving selected populations, have suggested that repetition of selfharm can be reduced by both psychological and pharmacological interventions (Linehan et al. 1991; Verkes et al. 1998; Bateman & Fonagy, 1999).”
BackgroundSuijkerbuijk, Y. B., Schaafsma, F. G., van Mechelen, J., Ojajärvi, A., Corbière, M., & Anema, J. R. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011867.pub2 · Cited by 215 · see citing works
Borderline personality disorder
Gunderson, J. G., Herpertz, S. C., Skodol, A. E., Torgersen, S. O., & Zanarini, M. C. (2018) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2018.29 · Cited by 480 · see citing works
Blum, N., Pfohl, B., John, D. S. S., Monahan, P., & Black, D. (2002) · Comprehensive Psychiatry · doi:10.1053/comp.2002.33497 · Cited by 183 · see citing works
Borderline personality disorder in male and female offenders newly committed to prison.
Black, D., Gunter, T., Allen, J., Blum, N., Arndt, S., Wenman, G., & Sieleni, B. (2007) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2007.04.006 · Cited by 182 · see citing works
“Early identification and treatment of BPD including medication [31] and psychotherapy [32-35] may help to minimize its impact.”
BackgroundSchema Therapy for Personality Disorders—A Review
Jacob, G. A., & Arntz, A. (2013) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2013.6.2.171 · Cited by 181 · see citing works
Carter, G. L., Willcox, C. H., Lewin, T. J., Conrad, A. M., & Bendit, N. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048670903393621 · Cited by 180 · see citing works
Karterud, S., Pedersen, G., Bjordal, E., Brabrand, J., Friis, S., Haaseth, Ø., Haavaldsen, G., Irion, T., Leirvåg, H., Tørum, E., et al. (2003) · Journal of Personality Disorders · doi:10.1521/pedi.17.3.243.22151 · Cited by 178 · see citing works
Kerr, P. L., Muehlenkamp, J., & Turner, J. M. (2010) · Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2010.02.090110 · Cited by 176 · see citing works
“106 This therapy was originally developed by Bateman and Fonagy 106 as part of a day treatment program for severely and chronically dysfunctional patients with BPD.”
BackgroundMethodBarnicot, K., Katsakou, C., Marougka, S., & Priebe, S. (2011) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2010.01652.x · Cited by 173 · see citing works
Choi-Kain, L. W., Albert, E. B., & Gunderson, J. G. (2016) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000113 · Cited by 171 · see citing works
Pfohl, B., Blum, N., St. John, D., McCormick, B., Allen, J., & Black, D. W. (2009) · Journal of Personality Disorders · doi:10.1521/pedi.2009.23.3.281 · Cited by 169 · see citing works
Zanarini, M., Horwood, J., Wolke, D., Waylen, A., Fitzmaurice, G., & Grant, B. (2011) · Journal of Personality Disorders · doi:10.1521/pedi.2011.25.5.607 · Cited by 168 · see citing works
“However given the availability of five empirically validated psychosocial treatments for BPD in adults (Bateman & Fonagy, 1999; Blum et al., 2008; Clarkin, Levy, & Lenzenweger, 2007; Giesen-Bloo et al., 2006; Linehan, Armstrong, Heard, & Suarez, 1991), it might help to alleviate suffering and the…”
Carter, G., Page, A., Large, M., Hetrick, S., Milner, A. J., Bendit, N., Walton, C., Draper, B., Hazell, P., Fortune, S., et al. (2016) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867416661039 · Cited by 167 · see citing works
“We identified three RCTs published since the review (Bateman and Fonagy, 1999, 2009; Guthrie et al., 2001).”
BackgroundMethodResultInfluentialSempértegui, G. A., Karreman, A., Arntz, A., & Bekker, M. H. J. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.11.006 · Cited by 122 · see citing works
“This issue is important, as consumers tend to complain about the limited focus of treatments like DBT and MBT, reporting that the treatment does not address all range of problems characteristic of BPD (Katsakou et al., 2012).”
ResultInfluentialCalati, R., & Courtet, P. (2016) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2016.04.003 · Cited by 165 · see citing works
“were outliers (Bateman and Fonagy, 1999; 2009).”
BackgroundMethodResultInfluentialThe fate of integrated treatment: whatever happened to the biopsychosocial psychiatrist?
Gabbard, G., & Kay, J. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.12.1956 · Cited by 165 · see citing works
Clarkin, J., Levy, K. N., Lenzenweger, M., & Kernberg, O. (2004) · Journal of Personality Disorders · doi:10.1521/pedi.18.1.52.32769 · Cited by 163 · see citing works
“In a controlled randomized trial, Bateman and Fonagy (1999) compared the effectiveness of 18 months of a psychoanalytically-oriented day hospitalization program with routine general psychiatric care for patients with BPD.”
BackgroundTreatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs?
Iliakis, E. A., Sonley, A. K. I., Ilagan, G. S., & Choi-Kain, L. W. (2019) · Psychiatric Services · doi:10.1176/appi.ps.201900073 · Cited by 161 · see citing works
Suicidality in Borderline Personality Disorder
Paris, J. (2019) · Medicina · doi:10.3390/medicina55060223 · Cited by 160 · see citing works
“To avoid the harm of repetitive admissions, one might prefer day treatment, which offers the advantages of admission (intensive treatment by an experienced team) without its disadvantages, and has some supporting evidence for its efficacy [31].”
BackgroundMethodBarnicot, K., Katsakou, C., Bhatti, N., Savill, M., Fearns, N., & Priebe, S. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.04.004 · Cited by 159 · see citing works
Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis
Stoffers-Winterling, J. M., Storebø, O. J., Kongerslev, M. T., Faltinsen, E., Todorovac, A., Sedoc Jørgensen, M., Sales, C. P., Edemann Callesen, H., Pereira Ribeiro, J., Völlm, B. A., et al. (2022) · The British Journal of Psychiatry · doi:10.1192/bjp.2021.204 · Cited by 156 · see citing works
Cleary, M., Siegfried, N., & Walter, G. (2002) · International Journal of Mental Health Nursing · doi:10.1046/j.1440-0979.2002.00246.x · Cited by 154 · see citing works
What Works in the Treatment of Borderline Personality Disorder
Choi-Kain, L., Finch, E. F., Masland, S., Jenkins, J., & Unruh, B. (2017) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-017-0103-z · Cited by 148 · see citing works
Barone, L. (2003) · Attachment & Human Development · doi:10.1080/1461673031000078634 · Cited by 148 · see citing works
“…most compelling questions, which still remains outstanding, concerns the role of deficits in emotional regulation (Barone, 2000; Wagner & Linehan, 1999) and its implications for mentalizing abilities in structuring the treatment setting for these patients (Bateman & Fonagy, 1999; Linehan, 1993).”
BackgroundChiesa, M., Fonagy, P., Holmes, J., & Drahorad, C. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.8.1463 · Cited by 145 · see citing works
“A structured interview, modeled on the Suicide and Self-Harm Inventory (15), was applied at intake, 12 months, and 24 months to obtain details of self-harm episodes, number and length of psychiatric inpatient episodes, and psychiatric outpatient attendance over the year before the assessment.”
MethodSelf-citationHerpertz, S., Zanarini, M., Schulz, C., Siever, L., Lieb, K., & Möller, H. (2007) · World Journal of Biological Psychiatry · doi:10.1080/15622970701685224 · Cited by 143 · see citing works
“An RCT of a further psychodynamic therapy was conducted compared to treatment-as-usual in general psychiatric services by Bateman and Fonagy (1999, 2001).”
MethodFonagy, P., Speranza, M., Luyten, P., Kaess, M., Hessels, C. J., & Bohus, M. (2015) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-015-0751-z · Cited by 149 · see citing works
“Mentalization-Based Treatment (MBT) [131, 132] is based on psychodynamic psychotherapy and attachment theory.”
InfluentialSelf-citationDay hospital versus admission for acute psychiatric disorders
Marshall, M., Crowther, R., Sledge, W. H., Rathbone, J., & Soares-Weiser, K. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004026.pub2 · Cited by 137 · see citing works
- Authors
- Bateman, A., & Fonagy, P.
- Affiliations
- St Ann's Hospital (GB)
- Venue
- American Journal of Psychiatry
- Published
- 1999-10-01
- Volume
- 156
- Issue
- 10
- Pages
- 1563-1569
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2119720111
- Cited by
- 1,416
- References
- 0
- Citations by year
- 2026: 17 · 2025: 17 · 2024: 36 · 2023: 24 · 2022: 42 · 2021: 75 · 2020: 43 · 2019: 84 · 2018: 60 · 2017: 58 · 2016: 57 · 2015: 61 · 2014: 67 · 2013: 67 · 2012: 74
- FWCI
- 38.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- borderline personality disorder, partial hospitalization, psychoanalytic psychotherapy, group therapy, suicide attempts, self-harm, hospitalization, psychotropic drug use, depressive symptoms, social adaptation, interpersonal functioning
- MeSH terms
- Adult, Anxiety Disorders, Borderline Personality Disorder, Day Care, Medical, Depressive Disorder, Female, Health Status, Hospitalization, Humans, Interpersonal Relations, Length of Stay, London, Male, Personality Inventory, Psychiatric Status Rating Scales, Psychoanalytic Therapy, Psychotherapy, Group, Psychotropic Drugs, Self Mutilation, Social Adjustment, Suicide, Attempted, Treatment Outcome
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