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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BackgroundInfluential
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Mermin, S. A., Steigerwald, G., & Choi-Kain, L. W. (2024) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000417 · Cited by 9
What predicts psychosocial functioning in borderline personality disorder? Investigating the association with reflective functioning
Volkert, J., Ilagan, G. S., Iliakis, E. A., Ren, B., Schröder‐Pfeifer, P., & Choi-Kain, L. W. (2024) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12516 · Cited by 5
On the relationship between group analysis and mentalization-based group therapy
Karterud, S., Gunnarsen, G., Kongerslev, M., Staun, L., & Schultz-Venrath, U. (2024) · Group Analysis · doi:10.1177/05333164231218694 · Cited by 5
“The breeding grounds of mentalization-based group therapy (MBT-G) were psychotherapeutic day hospitals, strongly influenced by therapeutic community ideology and group analysis (Bateman and Fonagy, 1999; Karterud et al., 1992).”
Case report: Brief, intensive EMDR therapy for borderline personality disorder: results of two case studies with one year follow-up
Hafkemeijer, L., Slotema, K., de Haard, N., & de Jongh, A. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1283145 · Cited by 5
Metacognition and insight dynamics exploration in borderline personality disorder: Exploring the underlying dynamics
Martin, S. S., & Del-Monte, J. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.02.023 · Cited by 7
“…Personality Disorder (BPD) psychotherapy field regarding consciousness of internal states and self-reflectiveness is Mentalization, one of the most renowned BPD treatments being Mentalization Based Therapy (MBT), a psychodynamic-inspired therapy program developed by Bateman and Fonagy (1999, 2004).”
Background
Meta-Analysis of the Effect of Psychotherapy in an Inpatient Setting: Examining the Moderating Role of Diagnosis and Therapeutic Approach
Cohen-Chazani, Y., Lavidor, M., Gilboa-Schechtman, E., Roe, D., & Hasson-Ohayon, I. (2022) · Psychiatry · doi:10.1080/00332747.2022.2062660 · Cited by 5
“In contrast, psychotherapy as a treatment for people with personality disorders has been found to have a large and stable effect in various studies that tested its effectiveness (e.g., Bateman & Fonagy, 1999; Dixon-Gordon et al., 2011).”
Psychodynamic day treatment program for borderline personality disorder: factors that predict outcome and dropout
Pec, O., Bob, P., Pec, J., & Ludvikova, I. (2021) · Medicine · doi:10.1097/md.0000000000025186 · Cited by 5
Effects of interventions promoting mentalization and interventions disconfirming pathogenic beliefs: A comparative single case study of three patients
Brockmann, J., Kirsch, H., Dembler, K., König, D., de Vries, I., Zabolitzki, M., & Silberschatz, G. (2018) · Cogent Psychology · doi:10.1080/23311908.2018.1470482 · Cited by 5
“Mentalization-based treatment (MBT) was specifically developed to treat borderline personality disorder, and its efficacy has been demonstrated in a number of studies (Bateman & Fonagy, 1999, 2001, 2008, 2009).”
Method
The Place for Psychodynamic Therapy and Obstacles to Its Provision
Lazar, S. G. (2018) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2018.01.004 · Cited by 9
Understanding Anxiety in Borderline Personality Disorder
Bulbena‐Cabré, A., Pérez-Rodríguez, M. M., Porges, S. W., Bulbena, A., & Goodman, M. S. (2017) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-017-0122-0 · Cited by 5
A Common Factors Approach to Psychotherapy With Chronically Suicidal Patients: Wrestling With the Angel of Death.
Yager, J., & Feinstein, R. E. (2017) · PubMed · doi:10.1080/00332747.2017.1304079 · Cited by 6
“…CBT (Slee, Garnefsk, van der Leeden, Arensman, & Spinhoven, 2008), DBT (Linehan et al., 2015), problem-solving therapy (PST; Hatcher, Sharon, Parag, & Collins, 2011), mentalization-based therapy (MBT; Bateman & Fonagy, 1999), and psychodynamic interpersonal therapy (PIT; Guthrie et al., 2001).”
Psychotherapie der Suizidalität
Lindner, R., & Schneider, B. (2016) · Der Nervenarzt · doi:10.1007/s00115-016-0096-y · Cited by 5
Nuevas definiciones de evidencia en la Medicina contemporánea: aportes desde la Antropología
Martos, J., Juárez, L. M., & Martínez, J. G. (2016) · Saúde e Sociedade · doi:10.1590/s0104-12902016144893 · Cited by 5
Prevalence and course of sexual relationship difficulties in recovered and non-recovered patients with borderline personality disorder over 16 years of prospective follow-up.
Karan, E., Niesten, I. J. M., Frankenburg, F., Fitzmaurice, G., & Zanarini, M. (2016) · Personality and Mental Health · doi:10.1002/pmh.1327 · Cited by 5
Studies of Personality Disorders: Past, Present, and Future in Recognition of ISSPD's 25th Anniversary
Ronningstam, E. F., Simonsen, E. H., Oldham, J. M., Maffei, C., Gunderson, J. G., Chanen, A. M., & Millon, T. (2014) · Journal of Personality Disorders · doi:10.1521/pedi.2014.28.5.611 · Cited by 9
Mentalization based treatment (MBT) in der Gruppe - neues Paradigma oder alter Wein in neuen Schläuchen?
Potthoff, P., & Moini-Afchari, U. (2012) · Gruppenpsychotherapie und Gruppendynamik · doi:10.13109/grup.2012.48.2.198 · Cited by 5
Differential Diagnosis of Borderline Personality Disorder from Bipolar Disorder
Hatchett, G. T. (2010) · Journal of Mental Health Counseling · doi:10.17744/mehc.32.3.n682682184554445 · Cited by 5
Psychological therapies provision: views from primary care
Ward, A., Polizzi, G., & Milovanović, M. (2008) · Psychiatric Bulletin · doi:10.1192/pb.bp.107.017533 · Cited by 5
“There is growing evidence for the efficacy of psychotherapy in this group (Bateman & Fonagy, 1999; Giesen-Bloo et al, 2006; Clerkin et al, 2007; Gabbard, 2007; Oldham, 2007).”
Background
Risk factors for suicidal behaviour: translating knowledge into practice
Goldney, R. D. (2005) · Oxford University Press eBooks · doi:10.1093/med/9780198529767.003.0010 · Cited by 6
Clinical Management for Hospital-Treated Deliberate Self-Poisoning: Comparisons between Patients with Major Depression and Borderline Personality Disorder
Carter, G. L., Lewin, T., Stoney, C., Whyte, I. M., & Bryant, J. L. (2005) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2005.01564.x · Cited by 5
“For example, dialectical behaviour therapy has been shown to be effective in reducing the number of parasuicide episodes in BPD in a randomized controlled trial [14] and so too has a psychoanalytically informed day hospital program [15].”
Background
Development of the American Psychiatric Association Practice Guideline for the Treatment of Borderline Personality Disorder.
Oldham, J. (2002) · Journal of Personality Disorders · doi:10.1521/pedi.16.2.109.22548 · Cited by 5
Suicide reduction: policy context
Higgitt, A. (2000) · International Review of Psychiatry · doi:10.1080/09540260074067 · Cited by 5
Mentalization-Based Treatment (MBT)
Fonagy, P. (2020) · Encyclopedia of Personality and Individual Differences · doi:10.1007/978-3-319-28099-8_912-1 · Cited by 5
Self-citation
Personality Disorders and ASD
Cagna, F. D., Squillari, E., Rocchetti, M., & Fusar‐Poli, L. (2019) · Springer eBooks · doi:10.1007/978-3-030-26276-1_10 · Cited by 8
Mentalizing, Loneliness and Pain-Related Depressive Symptoms Are Associated with Pain Severity in Patients with Rheumatic Diseases: Results of a Cross-Sectional Secondary Analysis
Riedl, D., Karnik, J., Lampe, A., Kirchhoff, C., Labek, K., & Schirmer, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14113624 · Cited by 3
“…treatment approaches, such as Mentalization-Based Treatment (MBT) [27], have been developed and proven to substantially enhance the mental health, overall functioning, and vocational status of patients with Borderline Personality Disorder (BPD), demonstrating long-term effectiveness [28,29].”
Short-Term versus Long-Term Mentalization-Based Therapy for Borderline Personality Disorder: 24 Months Follow-Up of a Randomized Clinical Trial
Juul, S., Jakobsen, J., Hestbaek, E., Kamp, C., Olsen, M. H., Rishede, M., Frandsen, F., Bo, S., Poulsen, S., Sørensen, P., et al. (2025) · Psychotherapy and Psychosomatics · doi:10.1159/000544934 · Cited by 4
Self-citation
Socio-demographic predictors of the time interval between successive hospitalizations among patients with borderline personality disorder
Yaniv-Rosenfeld, A., Savchenko, E., Elalouf, A., & Nitzan, U. (2024) · Journal of Mental Health · doi:10.1080/09638237.2024.2408236 · Cited by 4
“Inpatient treatment of BPD patients in general, and its duration in particular, are major areas of contention among mental health clinicians (Bateman & Fonagy, 1999, 2001).”
The Interpersonal Hypersensitivity Formulation of Good Psychiatric Management as a Psychoeducational Intervention for Borderline Personality Disorder
Greiner, C., Charbon, P., Néris, M. D., Rassi, L. E., Prada, P., & Choi-Kain, L. W. (2024) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000778 · Cited by 6
“” That also provides a fairly elegant de ﬁ nition of patients with BPD, who are regarded as “ people with special needs who are dif ﬁ cult to meet intuitively.”
MethodInfluential
A Cross-Sectional Study on Outcomes of Hospitalization in Patients with Borderline Personality Disorder After Six Months
Sharifi, A., Mohammadsadeghi, H., Ardebili, M. E., & Saeidi, M. (2023) · Journal of Iranian medical council · doi:10.18502/jimc.v6i4.13450 · Cited by 4
“For instance, a 3-month follow-up study of patients with BPD, for whom Dialectical Behavior Therapy (DBT) was performed, indicated that symptoms of depression and hopelessness, anger expression, dissociation, and general psychopathology scores were significantly improved (11).”
Background
Dispelling myths and challenging neglect in ‘borderline personality disorder’ healthcare: a lived-experience perspective
Aves, W. (2023) · Journal of Psychosocial Studies · doi:10.1332/147867323x16881441383633 · Cited by 6
The effects of developmental trauma on theory of mind and its relationship to psychotic experiences: A behavioural study
Turner, R. J., Louie, K., Parvez, A., Modaffar, M., Rezaie, R., Greene, T., Bisby, J. A., Fonagy, P., & Bloomfield, M. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114544 · Cited by 9
Self-citation
The Cost-Effectiveness of Psychodynamic Therapy: The Obstacles, the Law, and a Landmark Lawsuit
Lazar, S. G. (2021) · Psychoanalytic Inquiry · doi:10.1080/07351690.2021.1983404 · Cited by 4
“…for those patients who need it often includes a cost offset from decreased sick leave, decreased medical costs and decreased hospital costs (Bateman & Fonagy, 1999, 2003, 2008; J Clarkin et al., 2007; Dossmann et al., 1997; Duehrssen, 1962; J. F. Clarkin et al., 2001; Hall et al., 2001;…”
Background
Psicoterapias intensivas prolongadas ambulatorias para niños y adolescentes con trastorno mental grave
Torres, D., Gutiérrez, E., & Maresca, I. P. (2021) · Clínica Contemporánea · doi:10.5093/cc2021a11 · Cited by 4
The psychodynamics of self-harm
Gibbons, R. (2021) · BJ Psych Advances · doi:10.1192/bja.2024.68 · Cited by 5
Mentalisieren und selbstregulative Fähigkeiten bei nichtklinischen Probanden
Schwarzer, N.-H., Nolte, T., Kirsch, H., & Gingelmaier, S. (2021) · Prävention und Gesundheitsförderung · doi:10.1007/s11553-021-00856-7 · Cited by 4
Trastorno Límite de la Personalidad: Revisión Sistemática de las Intervenciones
Domènech, E. F. (2019) · Revista de Psicoterapia · doi:10.33898/rdp.v30i113.274 · Cited by 4

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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