Psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features—A systematic review of randomized clinical trials with meta-analysis and Trial Sequential Analysis
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Objectives: To review the effectiveness of psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features. Methods: We included randomized clinical trials on psychological therapies for adolescents with BPD and BPD features. Data were extracted and assessed for quality according to Cochrane guidelines, and summarized as mean difference (MD) with 95% confidence intervals (CI) for continuous data and as Odds ratios (OR) with 95% CI for dichotomous data. Risk of bias was assessed using Cochrane’s risk of bias tool for each domain. When possible, we pooled trials into meta-analyses, and used Trial Sequential Analysis (TSA) to control for random errors. Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: 10 trials on adolescents with BPD or BPD features were included. All trials were considered at high risk of bias, and the quality of the evidence was rated as “very low”. We did TSA on the primary outcome and found that the required information size was reached. The risk of random error was thus discarded. Conclusion: Only 10 trials have been conducted on adolescents with BPD or BPD features. Of these only few showed superior outcomes of the experimental intervention compared to the control intervention. No adverse effects of the interventions were mentioned. Attrition rates varied from 15–75% in experimental interventions. The overall quality was very low due to high risk of bias, imprecision and inconsistency, which limits the confidence in effect estimates. Due to the high risk of bias, high attrition rates and underpowered studies in this area, it is difficult to derive any conclusions on the efficacy of psychological therapies for BPD in adolescence. There is a need for more high quality trials with larger samples to identify effective psychological therapies for this specific age group with BPD or BPD features.
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The limited effects of brief treatments for these young people seem to be in large part due to the considerable dropout rate from these treatments.
“The limited effects of brief treatments for these young people seem to be in large part due to the considerable dropout rate from these treatments.”
From The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial (2024) · cites this paper as [17]
The Conclusions and future directions section reports that most trials found no superiority over control treatments, and the Results (Secondary outcomes, Table 4; page not provided) document substantial attrition in some trials. The paper treats attrition as a reason for uncertainty and risk of bias, however; it does not establish that dropout largely caused the limited effects or make that finding specifically about brief treatments. (LLM, conf=0.85)
Experimental — accuracy not yet measuredApproximately 40-50% of young people with BPD drop out from treatment prematurely, even though they experience high levels of distress and suffering.
“Approximately 40–50% of young people with BPD drop out from treatment prematurely, even though they experience high levels of distress and suffering [17].”
From The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial (2024) · cites this paper as [17]
Results, Table 4 reports substantial attrition in some adolescent BPD trials, including 50% in one treatment arm, but rates vary widely; it does not establish that approximately 40–50% of young people with BPD generally leave treatment prematurely. The Discussion describes BPD as a severe disorder with enduring difficulties, broadly supporting the reference to suffering, but does not link distress to those who dropped out. Page numbers are unavailable in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe heterogeneity of the samples involved in these studies is typically large.
“Moreover, the heterogeneity of the samples involved in these studies is typically large [17, 22].”
Young people with BPD are up to four times more likely to have recurrent depressive episodes than those without BPD, and about 40-50% disengage from treatment prematurely.
“These young people are up to four times more likely to have recurrent depressive episodes than those without BPD (62). One important reason for this non-response might be the high dropout rate from these treatments, with about 40–50% of young people with BPD disengaging from treatment prematurely, despite their high levels of distress and suffering (63).”
From The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence (2023) · cites this paper as [63]
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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
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“Moreover, the heterogeneity of the samples involved in these studies is typically large [17, 22].”
Background
- Authors
- Jørgensen, M. S., Storebø, O. J., Stoffers-Winterling, J. M., Faltinsen, E., Todorovac, A., & Simonsen, E.
- Affiliations
- University of Copenhagen (DK)
- University of Southern Denmark (DK)
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- Region Zealand (DK)
- Corresponding author
- Jørgensen, Mie Sedoc
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-01-14
- Volume
- 16
- Issue
- 1
- Pages
- e0245331
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7808579
- OpenAlex
- W3120967814
- Cited by
- 78
- References
- 64
- Citations by year
- 2026: 16 · 2025: 16 · 2024: 16 · 2023: 14 · 2022: 7 · 2021: 9
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- University of Southern Denmark Research Portal (University of Southern Denmark) (acceptedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Trygfonden (115638)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- borderline personality disorder, adolescents, psychotherapy, psychotherapy efficacy, treatment effectiveness, attrition rates, risk of bias, trial sequential analysis
- MeSH terms
- Adolescent, Borderline Personality Disorder, Humans, Psychotherapy, Randomized Controlled Trials as Topic, Treatment Outcome
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