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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Schwarzer, N.-H., Heim, N., Gingelmaier, S., Fonagy, P., & Nolte, T. (2024) · Psychological Reports · doi:10.1177/00332941241261902 · Cited by 21
“…2023; Levy et al., 2006), and these improvements were associated with a decrease in psychological symptoms in adults (e.g., Bateman et al., 2016; Bateman & Fonagy, 1999, 2008, 2009; De Meulemeester et al., 2018; Jørgensen et al., 2013), adolescents (Johnstone et al., 2021; Rossouw & Fonagy,…”
Self-citation
Narrative Exposure Therapy in Patients With Posttraumatic Stress Disorder and Borderline Personality Disorder in a Naturalistic Residential Setting: A Randomized Controlled Trial
Steuwe, C., Berg, M., Beblo, T., & Driessen, M. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.765348 · Cited by 18
Telehealth Treatment of Patients With Borderline Personality Disorder in a Partial Hospital Setting During the COVID-19 Pandemic: Comparative Safety, Patient Satisfaction, and Effectiveness of In-Person Treatment.
Zimmerman, M., Ward, M., D’Avanzato, C., & Tirpak, J. W. (2021) · Journal of Personality Disorders · doi:10.1521/pedi_2021_35_539 · Cited by 18
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Oliveira, C. D., Rahioui, H., Smadja, M., Gorsane, M.-A., & Louppe, F. (2016) · L Encéphale · doi:10.1016/j.encep.2016.02.020 · Cited by 19
Exploring narratives of psychological input in the acute inpatient setting
Donaghay‐Spire, E. G., McGowan, J. F., Griffiths, K., & Barazzone, N. (2015) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12081 · Cited by 17
Impact of Interpersonal Problems in Borderline Personality Disorder Inpatients on Treatment Outcome and Psychopathology
Dammann, G., Riemenschneider, A., Walter, M., Sollberger, D., Küchenhoff, J., Gündel, H., Clarkin, J., & Gremaud-Heitz, D. J. (2016) · Psychopathology · doi:10.1159/000446661 · Cited by 18
Change in interpersonal functioning during psychological interventions for borderline personality disorder—a systematic review of measures and efficacy
Sinnaeve, R., van den Bosch, L. M. C., & van Steenbergen-Weijenburg, K. M. (2015) · Personality and Mental Health · doi:10.1002/pmh.1296 · Cited by 21
The use of mentalization-based treatment for adolescents (MBT-A) with a young woman with mixed personality disorder and tendencies to self-harm.
Rossouw, T. (2015) · Journal of Clinical Psychology · doi:10.1002/jclp.22153 · Cited by 18
The Evidence Base for Psychodynamic Psychotherapy
Drisko, J. W., & Simmons, B. (2012) · Smith College Studies in Social Work · doi:10.1080/00377317.2012.717014 · Cited by 18
Clinical Associations of Deliberate Self-Injury and Its Impact on the Outcome of Community-Based and Long-Term Inpatient Treatment for Personality Disorder
Chiesa, M., Sharp, R., & Fonagy, P. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000320975 · Cited by 18
“consists of forty-five 5-point scales that measures patients’ subjective experience of symptoms and yields a highly reliable indicator of overall symptom severity, the General Severity Index (GSI). The BSI was completed at baseline, and at 6, 12 and 24 months after intake.A modification of the Suicide and Self-Harm In…”
MethodSelf-citation
Psychosocial treatment refusal in personality disorder: a comparative study
Chiesa, M., Martino, F., & Pozzi, E. (2010) · Personality and Mental Health · doi:10.1002/pmh.121 · Cited by 18
Controversies Surrounding Classification of Personality Disorder
Kim, Y., & Tyrer, P. J. (2010) · Psychiatry Investigation · doi:10.4306/pi.2010.7.1.1 · Cited by 20
Identifying clinical cases among patients assigned to psychoanalytic treatment.
Berghout, C., & Zevalkink, J. (2008) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2008.72.3.163 · Cited by 18
How do intake clinicians use patient characteristics to select treatment for patients with personality disorders?
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“5 for various outcome parameters (Bateman & Fonagy, 1999 ; Leichsenring & Leibing, 2003 ; Perry, Banon, & Ianni, 1999 ).”
Reasons for Change in Borderline Personality Disorder (and Other Axis II Disorders)
Zanarini, M. (2008) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2008.03.006 · Cited by 18
The Social Adjustment Scale-Self-Report: Psychometric Properties for Older Adults
Zweig, R., & Turkel, E. (2007) · Psychological Reports · doi:10.2466/pr0.101.3.920-926 · Cited by 18
Special Section: Contemporary Challenges for Research in Group Analysis
Lorentzen, S. (2006) · Group Analysis · doi:10.1177/0533316406066591 · Cited by 18
“It is a commonly held view that the group treatment contributes to this improvement, but construction of control conditions is difficult (Bateman and Fonagy, 1999, 2001; Linehan et al., 2001).”
Background
Changes in Personality Functioning After Inpatient Psychodynamic Therapy: A Dimensional Approach to Personality Disorders.
Leichsenring, F., Jaeger, U., Masuhr, O., Dally, A., Dümpelmann, M., Fricke-Neef, C., Steinert, C., & Spitzer, C. (2019) · Psychodynamic Psychiatry · doi:10.1521/pdps.2019.47.2.183 · Cited by 18
Current state of the evidence on community treatments for people with complex emotional needs: a scoping review
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Kernmodell der Mentalisierungsbasierten Therapie
Taubner, S., & Sevecke, K. (2015) · Psychotherapeut · doi:10.1007/s00278-015-0012-0 · Cited by 36
“Zunächst wurde MBT als ein stationäres Programm für BPS entwickelt [30], findet inzwischen aber größtenteils in ambulanten Settings Anwendung.”
Background
Day Hospital Mentalization-Based Treatment (MBT-DH) versus treatment as usual in the treatment of severe borderline personality disorder: protocol of a randomized controlled trial
Laurenssen, E. M. P., Westra, D., Kikkert, M., Noom, M. J., Eeren, H. V., van Broekhuyzen, A. J., Peen, J., Luyten, P., Busschbach, J. J. V., & Dekker, J. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-149 · Cited by 16
“First, one of the two RCTs was conducted by the developers of MBT [31], and thus researcher allegiance may have influenced this study.”
BackgroundMethodInfluential
Predicting domains and rates of change in borderline personality disorder.
Lenzenweger, M. F., Clarkin, J. F., Levy, K. N., Yeomans, F. E., & Kernberg, O. F. (2012) · Personality Disorders Theory Research and Treatment · doi:10.1037/a0025872 · Cited by 15
Konzept der Mentalisierung
Brockmann, J., & Kirsch, H. (2010) · Psychotherapeut · doi:10.1007/s00278-010-0751-x · Cited by 61
Principles and Clinical Application of Schema Therapy for Patients with Borderline Personality Disorder
Nysæter, T., & Nordahl, H. (2008) · Nordic Psychology · doi:10.1027/1901-2276.60.3.249 · Cited by 17
“…therapy (Roller & Nelson, 1999), psychopharmacological treatments (Markowitz, Calabrese, Schulz, & Meltzer, 1991; Siever & Davis, 1991), clinical management of inpatient (Bateman & Fonagy, 1999; Stone et al., 1987) or outpatient settings (Linehan et al., 1991; Linehan, Heard, & Armstrong, 1993).”
Background
Treatment concepts of day hospitals for general psychiatric patients. Findings from a national survey in Germany
Seidler, K.-P., Garlipp, P., Machleidt, W., & Haltenhof, H. (2006) · European psychiatry · doi:10.1016/j.eurpsy.2005.04.001 · Cited by 17
“In parallel with this development, patients with severe personality disorders have increasingly found their way into day hospitals, especially those patients who are not sufficiently or adequately treated as in- or outpatients [3,17,20,33].”
Background
PSYCHOTHERAPY RESEARCH AND NEUROBIOLOGY: CHALLENGE, CHANCE, OR ENRICHMENT?
Caspar, F. (2003) · Psychotherapy Research · doi:10.1093/ptr/kpg013 · Cited by 17
A description of an audit cycle of early dropouts from an inpatient psychotherapy unit
Chiesa, M., Wright, M., & Neeld, R. (2003) · Psychoanalytic Psychotherapy · doi:10.1080/1474973031000105294 · Cited by 17
“…et al. 1989), although considerably lower dropout rates were reported in specialist psychotherapy day hospital programmes (Karterud et al. 1992, Bateman and Fonagy 1999) and in two outpatient programmes based on dialectic behaviour therapy and expressive psychotherapy (Linehan et al. 1991,…”
BackgroundResult
An intensive outpatient program for patients with borderline personality disorder.
Smith, G. W., Ruíz-Sancho, A., & Gunderson, J. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.4.532 · Cited by 17
The impact of mindfulness therapy combined with mentalization-based family therapy on suicidal ideation in adolescents with depressive disorder: randomized intervention study
Fan, X., Peng, J.-Y., Zhang, L., Hu, Y.-L., Li, Y., Shi, Y., & Zhang, T.-M. (2024) · Annals of General Psychiatry · doi:10.1186/s12991-024-00503-3 · Cited by 16
“In the adult BPD population, MBT reduces self harm, emotional distress, and hospital stay compared to normal treatment, and improves social function, with continuous improvement at 18 months [17, 18].”
Background
A meta-analysis of treatment as usual for borderline personality disorder.
Finch, E. F., Iliakis, E. A., Masland, S. R., & Choi-Kain, L. W. (2019) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000353 · Cited by 27
To Integrate or Not to Integrate Dialectical Behaviour Therapy with Other Therapy Approaches?
Chapman, A., Turner, B. J., & Dixon-Gordon, K. (2011) · Clinical Social Work Journal · doi:10.1007/s10615-010-0283-4 · Cited by 16
“As a result, a therapist blending the biosocial theory with an alternative understanding of BPD (e.g., psychodynamic or even cognitive, which do not emphasize skill deficits; see Bateman and Fonagy 1999, 2004; Kellogg and Young 2006; Clarkin et al. 2005) may essentially steer therapy off course by de-emphasizing the i…”
Background
Clinical challenges in the assessment and management of suicidal behaviour in patients with bordeline personality disorder
Mehlum, L. (2009) · Epidemiologia e Psichiatria Sociale · doi:10.1017/s1121189x00000440 · Cited by 16
“In a RCT Bateman & Fonagy (1999; 2001) compared the effectiveness of MBT with standard psychiatric care for patients with BPD through the course of 18 months of treatment.”
BackgroundInfluential
In Their Own Words
Buteau, E., Dawkins, K., & Hoffman, P. (2008) · Social Work in Mental Health · doi:10.1300/j200v06n01_16 · Cited by 16
Effectiveness of Psychosocial Treatments on Suicidality in Personality Disorders
McMain, S. F. (2007) · Canadian journal of psychiatry. Revue canadienne de psychiatrie · doi:10.1177/07067437070526s109 · Cited by 16
“Eight trials have reported on the efficacy of psychodynamic treatments of PDs on suicide outcomes, 35–38, 43 , 45 Stevenson and Meares evaluated the effectiveness of 1 year of psychoanalytic outpatient therapy for patients with BPD. 38 Thirty participants received twice-weekly psychotherapy…”

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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