Cited by 1,416Personality Disorders and PsychopathologyPsychoanalysis and Psychopathology ResearchPsychotherapy Techniques and Applications

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Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial

Bateman, Anthony, Fonagy, Peter·1999·American Journal of Psychiatry

DOI 10.1176/ajp.156.10.1563

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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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BackgroundMethod
Guidelines for Art Group Therapy as Part of a Day Treatment Program for Patients with Personality Disorders
Johns, S., & Karterud, S. (2004) · Group Analysis · doi:10.1177/533316404045532 · Cited by 31
“However, the most successful day treatment programs being reported contain one mode or another of expressive group therapies (e.g. Piper et al., 1996; Wilberg et al., 1998; Bateman and Fonagy, 1999).”
Background
Management of personality disorders in acute in-patient settings. Part 1: Borderline personality disorders
Fagin, L. (2004) · Advances in Psychiatric Treatment · doi:10.1192/apt.10.2.93 · Cited by 41
“Although some researchers have reported considerable improvements in specialised units run on psychodynamic (Bateman & Fonagy, 1999) or cognitive–behavioural or dialectical behavioural lines (Linehan et al , 1991; Gunderson, 2001), these interventions are not easily available in all districts.”
Efficacy of mentalization‐based therapy in treating self‐harm: A systematic review and meta‐analysis
Hajek Gross, C., Oehlke, S., Prillinger, K., Goreis, A., Plener, P. L., & Kothgassner, O. D. (2024) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.13044 · Cited by 31
Short-Term versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder: A Randomized Clinical Trial (MBT-RCT)
Juul, S., Jakobsen, J. C., Hestbaek, E., Jørgensen, C. K., Olsen, M. H., Rishede, M., Frandsen, F. W., Bo, S., Lunn, S., Poulsen, S., et al. (2023) · Psychotherapy and Psychosomatics · doi:10.1159/000534289 · Cited by 30
Self-citation
Substance misuse is associated with increased psychiatric severity among treatment-seeking individuals with borderline personality disorder
Heath, L. M., Laporte, L., Paris, J., Hamdullahpur, K., & Gill, K. J. (2018) · Journal of Personality Disorders · doi:10.1521/pedi_2017_31_307 · Cited by 30
Handbook of Mentalizing in Mental Health Practice, Second Edition
(2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379019 · Cited by 30
Posttraumatic Stress Disorder in Patients With Borderline Personality Disorder: Treatment Outcomes and Mediators.
Barnicot, K., & Crawford, M. J. (2018) · Journal of Traumatic Stress · doi:10.1002/jts.22340 · Cited by 30
Do people with borderline personality disorder complicated by antisocial personality disorder benefit from the STEPPS treatment program?
Black, D. W., Simsek‐Duran, F., Blum, N. S., McCormick, B. A., & Allen, J. (2015) · Personality and Mental Health · doi:10.1002/pmh.1326 · Cited by 32
“Whether these positive results would apply to other evidence-based programs is unknown since the issue has not been addressed (Bateman & Fonagy, 1999; Clarkin et al., 2007; Giesen-Bloo et al., 2006; Linehan et al., 2006).”
Background
Demonstrating Adherence to Guidelines for the Treatment of Patients with Borderline Personality Disorder
Kolla, N., Links, P., McMain, S. F., Streiner, D., Cardish, R., & Cook, M. R. (2009) · Canadian journal of psychiatry. Revue canadienne de psychiatrie · doi:10.1177/070674370905400306 · Cited by 30
Persönlichkeitsstörungen im Kindes- und Jugendalter?
Schmid, M., Schmeck, K., & Petermann, F. (2008) · Kindheit und Entwicklung · doi:10.1026/0942-5403.17.3.190 · Cited by 58
Prediction of Medium-Term Outcome in Cluster B Personality Disorder following Residential and Outpatient Psychosocial Treatment
Chiesa, M., & Fonagy, P. (2007) · Psychotherapy and Psychosomatics · doi:10.1159/000107562 · Cited by 30
Self-citation
From general day hospital treatment to specialized treatment programmes
Karterud, S., & Wilberg, T. (2007) · International Review of Psychiatry · doi:10.1080/09540260601080821 · Cited by 30
“Bateman and Fonagy (2001) reported the 36-month status of their borderline sample. Since discharge from the day treatment programme, the BPD patients receiving the experimental mentalization based treatment (MBT) had followed a post-treatment or continuation treatment for 18 months (twice weekly group analytic psychot…”
BackgroundMethodResultInfluential
Strategies for Securing Commitment to Treatment from Individuals Diagnosed with Borderline Personality Disorder
Ben‐Porath, D. D. (2004) · Journal of Contemporary Psychotherapy · doi:10.1023/b:jocp.0000036633.76742.0b · Cited by 35
“…to be efficacious in clinically controlled treatment trials for individuals with BPD—dialectical behavior therapy (Linehan, Armstrong, Suarez, Allmon, & Heard, 1991; Linehan, Heard, & Armstrong, 1993) and a psychoanalyticallyoriented partial hospitalization program (Bateman & Fonagy, 1999).”
BackgroundResultInfluential
A Series of Meta-Analytic Tests of the Efficacy of Long-Term Psychoanalytic Psychotherapy
Woll-Weber, C. F. J., & Schönbrodt, F. D. (2019) · European Psychologist · doi:10.1027/1016-9040/a000385 · Cited by 37
Symptom, alexithymia and self-image outcomes of Mentalisation-based treatment for borderline personality disorder: a naturalistic study
Löf, J., Clinton, D., Kaldo, V., & Rydén, G. (2018) · BMC Psychiatry · doi:10.1186/s12888-018-1699-6 · Cited by 29
“The efficacy of MBT in the treatment of borderline personality disorder (BPD) has been demonstrated in three randomised controlled trials (RCTs) [1, 2, 5].”
Background
Day hospital Mentalization-based treatment versus intensive outpatient Mentalization-based treatment for patients with severe borderline personality disorder: protocol of a multicentre randomized clinical trial
Laurenssen, E. M. P., Smits, M. L., Bales, D. L., Feenstra, D. J., Eeren, H. V., Noom, M. J., Köster, M. A., Lucas, Z., Timman, R., Dekker, J., et al. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0301-0 · Cited by 27
“In a first trial [26-28], 38 BPD patients were randomized to either MBT-DH or treatment as usual (TAU).”
MethodInfluential
Patterns of inner change and their relation with patient characteristics and outcome in a psychoanalytic hospitalization-based treatment for personality disordered patients.
Vermote, R., Lowyck, B., Luyten, P., Verhaest, Y., Vertommen, H., Vandeneede, B., Corveleyn, J., & Peuskens, J. (2011) · Clinical Psychology and Psychotherapy · doi:10.1002/cpp.713 · Cited by 29
Emotion-Focused Principles for Working with Borderline Personality Disorder
Warwar, S. H., Links, P. S., Greenberg, L. S., & Bergmans, Y. (2008) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000314316.02416.3e · Cited by 29
Short-Term Cognitive Behavioral Partial Hospital Treatment: A Pilot Study
Neuhaus, E. C., Christopher, M. S., Jacob, K. L., Guillaumot, J., & Burns, J. (2007) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000290668.10107.f3 · Cited by 29
The Experience of Trauma Recovery: A Qualitative Study of Participants in the Women Recovering from Abuse Program (WRAP)
Parker, A., Fourt, A., Langmuir, J. I., Dalton, E. J., & Classen, C. C. (2007) · Journal of Child Sexual Abuse · doi:10.1300/j070v16n02_04 · Cited by 31
“The six-month time interval was chosen based on studies by Stalker and Fry (1999) and Bateman and Fonagy (1999) that reported significant improvement of both symptoms and psychosocial functioning after an average of six months post-individual or group treatment.”
Method
EMDR in the Treatment of Borderline Personality Disorder
Brown, S., & Shapiro, F. (2006) · Clinical Case Studies · doi:10.1177/1534650104271773 · Cited by 29
“Sanderson and colleagues (2002) stated that the evidence for psychodynamic/psychoanalytic psychotherapy was based on one controlled study (Bateman & Fonagy, 1999) and that the evidence for CBT/DBT was based on four randomized studies (Evans et al., 1999; Linehan, Heard, & Armstrong, 1993; Linehan…”
Background
CHANGE NORMS: A COMPLEMENTARY APPROACH TO THE ISSUE OF CONTROL GROUPS IN PSYCHOTHERAPY OUTCOME RESEARCH
Leichsenring, F., & Rabung, S. (2006) · Psychotherapy Research · doi:10.1080/10503300600805217 · Cited by 29
“The greatest deteriorations were found in patients with borderline personality disorder in the study by Bateman and Fonagy ( 1999 ), also treated by TAU.”
Background
Longitudinal comparison of depressive personality disorder and dysthymic disorder.
Markowitz, J., Skodol, A., Petkova, E., Xie, H., Cheng, J., Hellerstein, D., Gunderson, J., Sanislow, C., Grilo, C., & McGlashan, T. (2005) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2004.09.003 · Cited by 29
“—Heraclitus”
Short-term versus long-term mentalization-based therapy for outpatients with subthreshold or diagnosed borderline personality disorder: a protocol for a randomized clinical trial
Juul, S., Lunn, S., Poulsen, S., Sørensen, P. S., Salimi, M. L., Jakobsen, J. C., BATEMAN, A. W., & Simonsen, S. (2019) · Trials · doi:10.1186/s13063-019-3306-7 · Cited by 54
“been tested in randomized controlled trials: day hospital MBT [21, 22] and intensive outpatient MBT [13], each”
MethodSelf-citation
Therapist interventions using the Psychodynamic Interventions Rating Scale (PIRS) in dynamic therapy, psychoanalysis and CBT
Banon, E., Perry, J. C., Semeniuk, T., Bond, M., de Roten, Y., Hersoug, A. G., & Despland, J.-N. (2013) · Psychotherapy Research · doi:10.1080/10503307.2012.745955 · Cited by 27
“These were followed by four more recent clinical trials that reported more positive findings (Bateman & Fonagy, 1999; Clarkin, Levy, Lenzenweger, & Kernberg, 2007, Levy et al., 2006; Svartberg, Stiles, & Seltzer, 2004).”
Background
Disappointed Love and Suicide: A Randomized Controlled Trial of "Abandonment Psychotherapy" Among Borderline Patients.
Andreoli, A., Burnand, Y., Cochennec, M., Ohlendorf, P., Frambati, L., Gaudry-Maire, D., Clemente, T. D., Hourton, G., Lorillard, S., Canuto, A., et al. (2016) · Journal of Personality Disorders · doi:10.1521/pedi_2015_29_196 · Cited by 27
Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project
Antonsen, B., Klungsøyr, O., Kamps, A., Hummelen, B., Johansen, M., Pedersen, G., Urnes, Ø., Kvarstein, E., Karterud, S., & Wilberg, T. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-119 · Cited by 27
“Bateman A, Fonagy P: Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial.”
BackgroundInfluential
A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 1. Quantitative outcome and process studies
Winter, D. A., Bradshaw, S. A., Bunn, F., & Wellsted, D. (2013) · Counselling and Psychotherapy Research · doi:10.1080/14733145.2012.761717 · Cited by 27
The changing shape of clinical practice: Driven by science or by pragmatics?
Fonagy, P. (2010) · Psychoanalytic Psychotherapy · doi:10.1080/02668731003590139 · Cited by 30
“…ten controlled studies of long-term psychoanalytic psychotherapy versus other types of treatment (Bachar, Latzer, Kreitler, & Berry, 1999; Bateman & Fonagy, 1999; Bateman & Fonagy, in press; Clarkin, Levy, Lenzenweger, & Kernberg, 2007; Dare, Eisler, Russell, Treasure, & Dodge, 2001;…”
Self-citation
Community-Based Psychodynamic Treatment Program for Severe Personality Disorders: Clinical Description and Naturalistic Evaluation
Chiesa, M., Fonagy, P., & Gordon, J. (2009) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000344915.61706.d4 · Cited by 27
Self-citation
INTEGRATION IN PSYCHOTHERAPY: AN EVOLVING REALITY IN PERSONALITY DISORDER
Bateman, A. (2000) · British Journal of Psychotherapy · doi:10.1111/j.1752-0118.2000.tb00571.x · Cited by 27
Self-citation
Self-Rated Mentalizing Mediates the Relationship Between Stress and Coping in a Non-Clinical Sample
Schwarzer, N.-H., Nolte, T., Fonagy, P., & Gingelmaier, S. (2021) · Psychological Reports · doi:10.1177/0033294121994846 · Cited by 34
“…& Fonagy, 2004) and other approaches (e.g. Fischer-Kern et al., 2015; Levy et al., 2006) also leading to a decrease in psychological symptoms (e.g. Bateman et al., 2016; Bateman & Fonagy, 1999, 2001, 2008, 2009, 2013; De Meulemeester et al., 2018; Jørgensen et al., 2013; Rossouw & Fonagy, 2012).”
BackgroundSelf-citation
Treatment of Borderline Personality Disorder.
Levy, K. N., McMain, S. F., Bateman, A., & Clouthier, T. L. (2018) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2018.07.011 · Cited by 26
Self-citation
Associations of borderline personality with pain, problems with medications and suicidality in a community sample of chronic non-cancer pain patients prescribed opioids for pain
Campbell, G., Bruno, R., Darke, S. G., & Degenhardt, L. J. (2015) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2015.05.004 · Cited by 27
Ethical considerations in treatment of personality dysfunction: Using evidence, principles, and clinical judgment.
Magnavita, J., Levy, K. N., Critchfield, K., & Lebow, J. (2010) · Professional Psychology: Research and Practice · doi:10.1037/a0017733 · Cited by 26
Modifiable risk factors for attempted suicide in Australian clinical and community samples.
Carter, G. L., Child, C., Page, A., Clover, K., & Taylor, R. J. K. (2007) · Suicide and Life-Threatening Behaviour · doi:10.1521/suli.2007.37.6.671 · Cited by 26
“Aearlier intervention studies (Bateman & Fonagy, 1999; Linehan et al., 1991).”
Background
A randomised trial of dialectical behaviour therapy and the conversational model for the treatment of borderline personality disorder with recent suicidal and/or non-suicidal self-injury: An effectiveness study in an Australian public mental health service
Walton, C. J., Bendit, N., Baker, A., Carter, G. L., & Lewin, T. J. (2020) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867420931164 · Cited by 30
“Beyond cognitive behavioural therapies, there is evidence from randomised trials for numerous psychodynamic therapies developed specifically for the treatment of BPD (Bateman and Fonagy, 1999, 2009; Clarkin et al., 2007; Gunderson and Links, 2014).”
BackgroundResult
The burden of disease in patients eligible for mentalization-based treatment (MBT): quality of life and costs
Laurenssen, E. M. P., Eeren, H. V., Kikkert, M., Peen, J., Westra, D., Dekker, J., & Busschbach, J. J. V. (2016) · Health and Quality of Life Outcomes · doi:10.1186/s12955-016-0538-z · Cited by 24
“At the same time, two intensities of MBT, day-hospital MBT [56] and intensive outpatient MBT [57], are compared on effectiveness and costs [26].”
Background
Psychopathologie und Psychotherapie der Borderline-Persönlichkeitsstörung
Bohus, M., & Kröger, C. (2011) · Der Nervenarzt · doi:10.1007/s00115-010-3126-1 · Cited by 25
Distinguishing Suicidal from Non-Suicidal Deliberate Self-Harm Events in Women with Borderline Personality Disorder
Maddock, G. R., Carter, G. L., Murrell, E., Lewin, T., & Conrad, A. (2010) · Australian and New Zealand journal of psychiatry (Print) · doi:10.1080/00048671003610104 · Cited by 25
Long-term continuation treatment after short-term day treatment of female patients with severe personality disorders: Body awareness group therapy versus psychodynamic group therapy
Leirvåg, H., Pedersen, G., & Karterud, S. (2010) · Nordic Journal of Psychiatry · doi:10.3109/08039480903487525 · Cited by 25
Psychotherapy in psychiatry
Gabbard, G. O. (2007) · International Review of Psychiatry · doi:10.1080/09540260601080813 · Cited by 40
“…a partial hospitalization study involving the use of both individual psychoanalytic psychotherapy, once weekly and thrice-weekly group psychoanalytic psychotherapy, Bateman and Fonagy (1999) compared 38 borderline patients to a control group of borderline patients who did not receive psychotherapy.”
Background
Transference focused psychotherapy: Development of a psychodynamic treatment for severe personality disorders
Clarkin, J., Levy, K. N., & Schiavi, J. M. (2005) · Clinical Neuroscience Research · doi:10.1016/j.cnr.2005.03.003 · Cited by 25
“7% drop out, and one suicide (4%); Stevenson and Meares’ study [23] had a 16% drop out rate; and Bateman and Fonagy’s study [4] had 21% drop out.”
Influential

Authors: Bateman, A., & Fonagy, P.
Affiliations: St Ann's Hospital (GB)
ORCID: Bateman, Anthony
Fonagy, Peter
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 1999-10-01
Volume: 156
Issue: 10
Pages: 1563-1569
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/ajp.156.10.1563
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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Effectiveness of Partial Hospitalization in the Treatment of Borderline Personality Disorder: A Randomized Controlled Trial

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