Borderline Aid: Psychotherapy soothes personality ailment

Borderline personality disorder, a psychiatric condition marked by volatile relationships and stormy emotions, has the reputation of being tough to treat. A new study, however, indicates that any of three types of psychotherapy stimulates substantial improvement in people with this disorder.

Psychotherapy that centers on emotional themes arising in the interaction between patient and therapist, known as transference-focused therapy, stimulates the most change in people with borderline personality disorder, according to a team led by psychologist John F. Clarkin of New York Hospital–Cornell Medical Center in White Plains, N.Y.

Dialectical behavior therapy, a currently popular brand of psychotherapy that teaches patients how to control and alter their emotional reactions, also produced good responses, as did supportive psychotherapy that provides basic advice on dealing with daily challenges.

“Contrary to earlier belief in [psychiatry], borderline patients respond to structured treatments of various orientations with symptom improvement,” Clarkin says. “We now must explore the mechanisms of treatment effects.” The new report is in the June American Journal of Psychiatry.

Borderline personality disorder afflicts an estimated 1.3 percent of U.S. adults. Symptoms include intense fear of abandonment, frequent displays of anger, unstable and intense personal relationships, impulsive acts, feelings of emptiness, suicidal threats or acts, and self-mutilation.

Clarkin’s group randomly assigned each of 90 outpatients diagnosed with borderline personality disorder, most of them women, to one of the three psychotherapies. For 1 year, each participant attended one or two weekly sessions with a seasoned therapist.

Overall, patients in each group displayed notable 1-year improvements on measures of depression, anxiety, social adjustment, and overall ability to function in daily life. No one fully recovered from borderline personality disorder, though.

Other measures of success varied across treatments. For example, only transference-focused and dialectical behavior therapy yielded declines in suicide threats and attempts, while only transference-focused and supportive therapy reduced anger and impulsiveness.

Moreover, only transference-focused therapy led to fewer instances of verbal and physical assaults on others and increased patients’ ability to reflect on their own motivations and those of others. Clarkin and his colleagues developed the transference-focused approach, which draws on psychoanalytic concepts (SN: 6/9/07, p. 363).

Psychiatrist Glen O. Gabbard of Baylor College of Medicine in Houston calls the work “a landmark study.” Research with larger groups of patients must confirm that transference-focused therapy sparks broader improvement than the other forms of psychotherapy do, Gabbard says.

Other recent findings question whether transference-focused therapy is the best available treatment for borderline personality disorder. An example is a study, published in the June 2006 Archives of General Psychiatry, directed by psychologist Arnoud Arntz of the University of Maastricht in the Netherlands.

Arntz and his coworkers studied 88 patients randomly assigned to transference-focused therapy or to schema-focused therapy, which addresses feelings related to past traumatic experiences as well as the patient’s current relationship with the therapist.

After 3 years of twice-weekly sessions, patients in both groups displayed fewer symptoms of borderline personality disorder and reported quality-of-life improvements. Schema-focused therapy yielded bigger changes than transference-focused therapy did, the researchers say.