Borderline Personality Disorder Shows Improvements With Intensive Psychotherapy

BPD, a chronic and disabling condition affecting about 1% of the United States population, has long defied psychologists and psychiatrists seeking to treat the illness. Affecting day-to-day functions, symptoms of the illness include unstable relations with others, pervasive mood instability, chaotic variation in self-image, self-destructive behavior, impulsive behaviors (such as sexual promiscuity, substance abuse, or gambling), and intense, uncontrolled rages.

In the new study, Mark F. Lenzenweger, distinguished professor of psychology at Binghamton University, State University of New York, and colleagues at the Weill College of Medicine, Cornell University, examined three treatments applied to carefully diagnosed BPD patients for a period of one year.

The treatments included dialectical behavior therapy, supportive psychotherapy, and TFP, a specialized psychodynamic form of talk therapy, pioneered by Otto F. Kernberg, a study co-author and professor of psychiatry at Weill-Cornell, that focuses on dominant emotionally charged themes that emerge in the relationship between patient and therapist.

As the patients moved through the yearlong treatments, they were carefully assessed on a wide range of psychiatric symptom and functioning domains, such as depression, anger, social functioning, suicidal behaviors, impulsivity, social adjustment, and various forms of irritability and aggression.

At the end of the year of treatment, a detailed examination of the change revealed that the BPD patients in the TFP treatment showed improvement in ten out of the twelve domains studied.

“The improvements for the TFP patients were not merely statistically reliable, but they represented fairly impressive scientific effects, not just trivial changes,” said Lenzenweger. “TFP not only helped reduced suicidal behaviors, but also seemed particularly helpful in reducing irritability and angry behaviors.”

Kernberg noted, “We are pleased about the progress in the empirical development of a psychoanalytic treatment for borderline patients that focuses on the personality, rather than simply on symptoms, yet also shows improvements in symptoms.”

The study also included dialectical behavior therapy (or DBT), which is a cognitively based therapy. Supportive therapy also has its roots in psychoanalytic methods, but differs substantially from TFP.     

“This is the first study to compare DBT, considered by many to be the standard, with two psychodynamic treatments,” said John F. Clarkin, the lead author on the study and professor of clinical psychology at Weill-Cornell.

A major implication of the study is that all three treatments show some effect in alleviating the impact of BPD. The weight of the evidence in the study importantly suggests that TFP and supportive psychotherapy are both viable alternatives to DBT for the treatment of BPD.

“We hope to explore the results of the study further to determine what factors predicted the best outcomes,” said Lenzenweger. “And of course, we hope to use these results to further guide our development of basic studies in the neuroscience and genomics of BPD.”

The study was supported, in part, by the Borderline Personality Disorder Research Foundation and the Personality Disorders Institute at the Department of Psychiatry, Weill College of Medicine, Cornell University.