Research Update - Borderline Personality Disorder

NAMI Montana is committed to raising awareness and providing valuable information on mental health topics to support individuals and their loved ones. In this week's research update, we are featuring three articles that shed light on various aspects of Borderline Personality Disorder. It is important to note that these articles are for informational purposes only and should not replace professional advice or guidance.

We encourage everyone to work closely with their own clinicians and healthcare providers to determine the most appropriate care and treatment options for their specific needs. These articles aim to enhance understanding and facilitate meaningful conversations between individuals and their healthcare teams.

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., Lieb, K., & Simonsen, E. (2022). Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis. The British journal of psychiatry : the journal of mental science, 221(3), 538–552. https://doi.org/10.1192/bjp.2021.204

Aims: To evaluate the effects of standalone and add-on psychotherapeutic treatments more concisely.

Results: Thirty-one randomised controlled trials totalling 1870 participants were identified. Among standalone treatments, statistically significant effects of low overall certainty were observed for dialectical behaviour therapy (self-harm: standardised mean difference (SMD) -0.54, P = 0.006; psychosocial functioning: SMD -0.51, P = 0.01) and mentalisation-based treatment (self-harm: risk ratio 0.51, P < 0.0007; suicide-related outcomes: risk ratio 0.10, P < 0.0001). For adjunctive interventions, moderate-quality evidence of beneficial effects was observed for DBT skills training (BPD severity: SMD -0.66, P = 0.002; psychosocial functioning: SMD -0.45, P = 0.002), and statistically significant low-certainty evidence was observed for the emotion regulation group (BPD severity: mean difference -8.49, P < 0.00001), manual-assisted cognitive therapy (self-harm: mean difference -3.03, P = 0.03; suicide-related outcomes: SMD -0.96, P = 0.005) and the systems training for emotional predictability and problem-solving (BPD severity: SMD -0.48, P = 0.002).

Conclusions: There is reasonable evidence to conclude that psychotherapeutic interventions are helpful for individuals with BPD. Replication studies are needed to enhance the certainty of findings.

Pharmacological Treatments for Borderline Personality Disorder: A Systematic Review and Meta-Analysis

Gartlehner, G., Crotty, K., Kennedy, S., Edlund, M. J., Ali, R., Siddiqui, M., Fortman, R., Wines, R., Persad, E., & Viswanathan, M. (2021). Pharmacological Treatments for Borderline Personality Disorder: A Systematic Review and Meta-Analysis. CNS drugs, 35(10), 1053–1067. https://doi.org/10.1007/s40263-021-00855-4

Background: Borderline personality disorder (BPD) is a debilitating psychiatric disorder that affects 0.4-3.9% of the population in Western countries. Currently, no medications have been approved by regulatory agencies for the treatment of BPD. Nevertheless, up to 96% of patients with BPD receive at least one psychotropic medication.

Objectives: The objective of this systematic review was to assess the general efficacy and the comparative effectiveness of different pharmacological treatments for BPD patients.

Results: Of 12,062 unique records, we included 21 randomized controlled trials (RCTs) with data on 1768 participants. Nineteen RCTs compared pharmacotherapies with placebo; two RCTs assessed active treatments head-to-head. Out of 87 medications in use in clinical practice, we found studies on just nine. Overall, the evidence indicates that the efficacy of pharmacotherapies for the treatment of BPD is limited. Second-generation antipsychotics, anticonvulsants, and antidepressants were not able to consistently reduce the severity of BPD. Low-certainty evidence indicates that anticonvulsants can improve specific symptoms associated with BPD such as anger, aggression, and affective lability but the evidence is mostly limited to single studies. Second-generation antipsychotics had little effect on the severity of specific BPD symptoms, but they improved general psychiatric symptoms in patients with BPD.

Conclusions: Despite the common use of pharmacotherapies for patients with BPD, the available evidence does not support the efficacy of pharmacotherapies alone to reduce the severity of BPD.

Borderline personality disorder and sexual abuse: A systematic review

de Aquino Ferreira, L. F., Queiroz Pereira, F. H., Neri Benevides, A. M. L., & Aguiar Melo, M. C. (2018). Borderline personality disorder and sexual abuse: A systematic review. Psychiatry research, 262, 70–77. https://doi.org/10.1016/j.psychres.2018.01.043

Abstract

Although sexual abuse (SA) is known to be frequent among borderline personality disorder (BPD) patients, few reviews evaluating that relationship have been published. This systematic review aimed to investigate SA (including adulthood) as a predictor of BPD diagnosis, clinical presentation and prognosis. Studies written in English or Portuguese from January 1997 until January 2017 were identified by searching the following keywords in three international databases: "borderline personality disorder" OR "borderline disorder" AND "sexual abuse" OR "sexual violence" OR "sexual victimization" OR "sexual assault" OR "rape". Forty articles met the eligibility criteria. Overall, SA was found to play a major role in BPD, particularly in women. Childhood sexual abuse (CSA) is an important risk factor for BPD. Adult sexual abuse (ASA) rates are significantly higher in BPD patients compared with other personality disorders (PDs). SA history predicts more severe clinical presentation and poorer prognosis. Suicidality has the strongest evidence, followed by self-mutilation, post-traumatic stress disorder (PTSD), dissociation and chronicity of BPD. Future research should study more ASA and include more males, milder BPD patients and documented or corroborated SA cases. The impact of other traumatic experiences (e.g., emotional abuse) on BPD must also be systematically reviewed.

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