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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Background
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BackgroundResult
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BackgroundSelf-citation
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Method
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BackgroundInfluential
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Background
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Background
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MethodInfluential
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BackgroundMethod
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Method
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“While outpatient offers comprise DBT, MBT, transference focused psychotherapy, and schema therapy, inpatient and day clinic treatments are mostly based on DBT (Bohus and Kröger 2011; Richter et al. 2013).”
Reputation and science: examining the effectiveness of DBT in the treatment of borderline personality disorder
Bendit, N. (2014) · Australasian Psychiatry · doi:10.1177/1039856213510959 · Cited by 10
“Australasian Psychiatry 2014, Vol 22(2) 144 –148 © The Royal Australian and New Zealand College of Psychiatrists 2013 Reprints and permissions: sagepub.”
Background
Assessment and Treatment of Patients with Borderline Personality Disorder in the College and University Population
Hersh, R. G. (2013) · Journal of College Student Psychotherapy · doi:10.1080/87568225.2013.824326 · Cited by 9
“In recent years a number of evidence-based interventions for BPD have been developed and tested (Bateman & Fonagy, 1999; Black, Blum, Pfohl, & St. John, 2004; Clarkin, Yeomans, & Kernberg, 2007; Linehan, 1993; McMain, Links, & Gnam, 2009; Young, 1999); at the same time, a consensus has emerged…”
BackgroundMethod
Models of Change in the Psychotherapy of Borderline Personality Disorders
Viviani, R., Kächele, H. U., & Buchheim, A. (2011) · Neuropsychoanalysis · doi:10.1080/15294145.2011.10773671 · Cited by 11
“Recently, several manualized approaches to the treatment of BPD have been developed, whose efficacy has been empirically validated (Bateman & Fonagy, 1999; Clarkin, Levy, Lenzenweger, & Kernberg, 2007; Cottraux et al., 2009; Giesen-Bloo et al., 2006; Doering et al., 2010; Linehan, 1993, 2000; for…”
Background
Self-harm: a strategy for survival and nodal point of change
Nathan, J. (2006) · Advances in Psychiatric Treatment · doi:10.1192/apt.12.5.329 · Cited by 10
A 44-year-old woman with borderline personality disorder.
Oldham, J. (2002) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.287.8.1029 · Cited by 10
“Although the APA does not specifically endorse a particular form of psychotherapy for borderline personality disorder, 2 types have been shown to be effective in randomized controlled trials: a particular type of cognitive behavioral therapy known as dialectical behavior therapy (DBT)(52-56) and psychodynamic psychoth…”
Background
Mentalization‐Based Therapy for Borderline Personality Disorder: State‐Of‐The‐Science and Future Directions
Jørgensen, M. S., Høgenhaug, S. S., Sharp, C., & Bo, S. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70120 · Cited by 15
Psychotherapy for Borderline Personality Disorder: Does the Type of Treatment Make a Difference?
Ellison, W. D. (2020) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-020-00224-w · Cited by 12
Experiential avoidance in adolescents with borderline personality disorder: comparison with a non-BPD psychiatric group and healthy controls
Jones, J. G., Penner, F., Schramm, A. T., & Sharp, C. (2019) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2019.1623303 · Cited by 11
“More specifically, treatments targeting reduction in EA levels in adolescents with borderline features may be beneficial in reducing negative features related to BPD. Theoretically, this may be one reason why treatment models that target concepts related to EA and other emotion dysregulation concepts (e.g. Dialectical…”
The Capacity to End: Termination of Mentalization-Based Therapy for Borderline Personality Disorder
Juul, S., Simonsen, S., & BATEMAN, A. W. (2020) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-020-09456-6 · Cited by 13
Self-citation
Eficacia de la psicoterapia para el tratamiento del trastorno límite de la personalidad: Una revisión
Juanmartí, F. B., & Lizeretti, N. P. (2017) · Papeles del Psicólogo - Psychologist Papers · doi:10.23923/pap.psicol2017.2832 · Cited by 9
The neglect of treatment-construct validity in psychotherapy research: a systematic review of comparative RCTs of psychotherapy for Borderline Personality Disorder
Lundh, L., Petersson, T., & Wolgast, M. (2016) · BMC Psychology · doi:10.1186/s40359-016-0151-2 · Cited by 11
“and Fonagy’s [8] first MBT study, still the positive results”
BackgroundMethod
Co-Occurring Disorders in the Treatment of Nonsuicidal Self-Injury: An Evidence-Informed Approach
Washburn, J. J., Gebhardt, M., Styer, D. M., Juzwin, K. R., & Gottlieb, L. (2012) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.26.4.348 · Cited by 6
“Psychodynamic approaches such as interpersonal psychodynamic psychotherapy (Guthrie et al., 2001), mentalization-based therapy (Bateman & Fonagy, 1999), object-relations psychodynamic psychotherapy (Monsen, Odland, Faugli, Daae, & Eilertsen, 1995), and transference-focused psychotherapy (Levy,…”
Background
Implementatie van een behandelmodel voor persoonlijkheidsgestoorde adolescenten
Hutsebaut, J., Bales, D., Kavelaars, M., van Gerwen, J., Busschbach, J., & Verheul, R. (2011) · Tijdschrift voor Psychotherapie · doi:10.1007/s12485-011-0030-5 · Cited by 9
“MBT heeft een breed indicatiegebied en heeft haar effectiviteit vooral bewezen voor de groep van ernstig gestoorde volwassenen (Bateman & Fonagy, 1999, 2001, 2008).”
Background
A Person-Centered Approach to the Treatment of Borderline Personality Disorder
Quinn, A. E. (2011) · Journal of Humanistic Psychology · doi:10.1177/0022167811399764 · Cited by 9
“In contrast to mainstream psychodynamic thinking regarding the primacy of the therapeutic frame in BPD treatment (McWilliams, 1994), Bateman and Fonagy (2004) argue that “the potential effectiveness of all treatments depends not so much on their frame but on their ability to increase a patient’s capacity to mentalize”…”
BackgroundInfluential
Patients with Borderline Personality Disorder Not Participating in an RCT: Are They Different?
Rentrop, M., Martius, P., Bäuml, J., Buchheim, P., Döring, S., & Hörz, S. (2010) · Psychopathology · doi:10.1159/000320351 · Cited by 9
“In the last 15 years major randomized controlled trials (RCTs) on treatments for borderline personality disorder (BPD) have been published [e.g. [”
Background
Acceptabilité et faisabilité de la psychothérapie par les patients avec trouble de personnalité limite
Cailhol, L., Bouchard, S., Belkadi, A., Benkirane, G., Corduan, G., Dupouy, S., Villeneuve, É., & Guelfi, J. (2010) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2009.06.020 · Cited by 9
Mentalization-Based Treatment (MBT) in der stationären und ambulanten Gruppenpsychotherapie
Bolm, T. (2010) · Vandenhoeck & Ruprecht eBooks · doi:10.13109/9783666491320.144 · Cited by 9
Attachment and psychopathy in forensic patients
van den Berg, A., & Oei, K. (2009) · Mental Health Review Journal · doi:10.1108/13619322200900020 · Cited by 7
Evidence and Narrative in Contemporary Psychiatry
Gray, S. H. (2009) · Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry · doi:10.1521/jaap.2009.37.3.415 · Cited by 8
PREVALENCE AND NATURAL HISTORY OF SELF-HARM
Ougrin, D., & Kyriakopoulos, M. (2009) · CRC Press eBooks · doi:10.1201/b13320-7 · Cited by 1
Aggressive Behaviour in High-Risk Personality Disordered Inpatients During Prison and Following Admission to Hospital
Daffern, M., & Howells, K. (2007) · Psychiatry Psychology and Law · doi:10.1375/pplt.14.1.26 · Cited by 9
“…between therapist and patient; the tailoring of the treatment to the patient and the targeting of therapy interfering behaviours — contribute considerably to treatment effectiveness (Bateman & Fonagy, 1999; Bateman & Tyrer, 2004; Blennerhassett & Wilson O’Raghallaigh, 2005; Livesley, 2003).”
Background
Pharmakologische und psycho- therapeutische Behandlung der Borderline-Störung
Remmel, A., & Bohus, M. (2006) · Zeitschrift für Psychiatrie Psychologie und Psychotherapie · doi:10.1024/1661-4747.54.3.185 · Cited by 9
The stability of personality disorders
Tyrer, P., & Seivewright, H. (2005) · Psychiatry · doi:10.1383/psyt.4.3.29.62440 · Cited by 9
THE EDINBURGH PROJECT:A PILOT STUDY FOR THE PSYCHOTHERAPEUTIC TREATMENT OF BORDERLINE AND OTHER SEVERE PERSONALITY DISORDERS
Cookson, A., Espie, J., & Yates, K. (2001) · British Journal of Psychotherapy · doi:10.1111/j.1752-0118.2001.tb00007.x · Cited by 9
Die Behandlung von Borderline-Persönlichkeitsstörungen
Eckert, J., Dulz, B., & Makowski, C. (2000) · Psychotherapeut · doi:10.1007/s002780000107 · Cited by 9
Mentalizing as Mechanism: An Interpretive Phenomenological Analysis of Workplace Social Support in Intimate Partner Violence Practice
Brend, D., & MacIntosh, H. (2020) · Smith College Studies in Social Work · doi:10.1080/00377317.2020.1859432 · Cited by 8
Clinical Characteristics of Suicidal Youths and Adults: A One-Year Retrospective Study
Besch, V., Greiner, C., Magnin, C., Néris, M. D., Ambrosetti, J., Perroud, N. A., Poulet, E., Debbané, M., & Prada, P. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17238733 · Cited by 11
“After controlling data, we have grouped related diagnoses into 9 mental disorders: anxiety, depressive disorder, bipolar disorder, borderline personality disorder (BPD), personality disorder other than borderline (OPD), psychotic spectrum disorder (PSD), post-traumatic stress disorder (PTSD), eating disorder, substanc…”
BackgroundInfluential
Running a mentalization-based treatment (MBT) programme within a public community adult mental health service setting: a feasibility study
Beattie, D., Murphy, S., Jamieson, S., & Lee, A. (2019) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2019.7 · Cited by 10
“Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland ORIGINAL RESEARCH doi:10.1017/ipm.2019.7 18-month follow-up and 8-year follow-up (Bateman & Fonagy, 1999, 2001, 2008).”
MethodInfluential
A preliminary service evaluation of a personality disorder case management service.
Graham, S., Sullivan, K., Briggs, L., Goodall, M., & Capucinello, R. I. (2019) · Personality and Mental Health · doi:10.1002/pmh.1439 · Cited by 8
Changes in Neurocognitive Functioning After 6 Months of Mentalization-Based Treatment for Borderline Personality Disorder.
Thomsen, M., Ruocco, A., Uliaszek, A. A., Mathiesen, B. B., & Simonsen, E. (2017) · Journal of Personality Disorders · doi:10.1521/pedi_2016_30_250 · Cited by 8
“According to Bateman and Fonagy (2004a), mentalizing in psychological therapies has been described as a process of shared attention where the patient and therapist jointly focus on a shared aspect of subjective experience.”
Background
Comparison of treatment outcomes in severe personality disorder patients with or without substance use disorders: a 36-month prospective pragmatic follow-up study
Lana, F., Sánchez-Gil, C., Adroher, N. D., Pérez, V., Feixas, G., Martí-Bonany, J., & Torrens, M. (2016) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s106270 · Cited by 8
“…follow-up conducted at a day hospital in a PD sample whose severity and psychosocial functioning (mean GAF # 40) was similar to that of our study 23,24,45 found that the need for psychiatric hospitalization in patients who followed treatment as usual did not improve gradually over time, rather…”
A psychoanalytically informed hospitalization‐based treatment of personality disorders
Vermote, R., Luyten, P., Verhaest, Y., Vandeneede, B., Vertommen, H., & Lowyck, B. (2015) · The International journal of psycho-analysis · doi:10.1111/1745-8315.12394 · Cited by 8
Mentalization-based Treatment in Groups — a Paradigm Shift or old Wine in New Skin?
Potthoff, P., & Moini-Afchari, U. (2014) · Group Analysis · doi:10.1177/0533316413518488 · Cited by 8
“Several randomized studies indicate that ‘Mentalization-based treatment’ (MBT) is very effective for patients with borderline personality disorder (Bateman and Fonagy, 1999; 2001; 2008), whereas its effectiveness with other disorders has yet to be proved.”
Background
Evaluating treatments of borderline personality disorder
Biskin, R. S., & Paris, J. (2012) · Clinical Practice · doi:10.2217/cpr.12.35 · Cited by 9
Comment traiter la tentative de suicide ? Seconde partie : une revue des traitements et de leur efficacité chez des patients borderline
Lorillard, S., Schmitt, L., & Andreoli, A. (2011) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2010.08.008 · Cited by 8
Évaluation de l’efficacité d’une permanence téléphonique sur l’incidence des tentatives de suicide des patients borderline
Pham-Scottez, A. (2010) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2009.12.011 · Cited by 8
When costs count: the impact of staff size, skill mix and treatment intensity on patient outcome for psychotherapeutic day treatment programmes.
Halsteinli, V., Karterud, S., & Pedersen, G. (2008) · Health Policy · doi:10.1016/j.healthpol.2007.10.013 · Cited by 8
“Results from randomized controlled trials indicate positive effects from day treatment programmes [ 6 ,7] ,b ut at the same time policy makers have been advised to consider how far the costs of providing day treatment programmes can be justified, given that outpatient treatment appears to be an alternative [8].”
Background
New frontiers in the role of hospitalization for patients with personality disorders
Vijay, N. R., & Links, P. (2007) · Current Psychiatry Reports · doi:10.1007/s11920-007-0011-0 · Cited by 8

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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