Specialist Psychotherapy Not Required for Effective Early Intervention for BPD

Early intervention for young people with borderline personality disorder (BPD) can be effective without BPD-specific psychotherapy, according to new research from JAMA Psychiatry.

The Monitoring Outcomes of a Borderline Personality Disorder Australian single-blinded randomized clinical trial included 139 individuals (80.6% females aged 19.1±2.8 years) diagnosed with BPD who had not received previous evidence-based treatment for BPD or had not been diagnosed with schizophrenia spectrum, bipolar I or II, or past-year psychotic disorder. The intent-to-treat analysis included 128 individuals.

Each individual was assigned to a clinician and a treatment arm. The treatment options were Helping Young People Early (HYPE), a dedicated BPD service model for young people and weekly cognitive analytic therapy (CAT) (n=40), HYPE with weekly befriending psychotherapy control condition (n=45), or a general youth mental health service (YMHS) and befriending (n=43).

From baseline to 1 year, individuals across groups experienced a mean improvement with a 28.91-point decrease (23.8%) in the Inventory of Interpersonal Problems Circumplex Version scores and a mean 0.55-point (19.3%) reduction in Social Adjustment Scale self-report scores. Mean change over a year was 40.7% (17.64 points) for the Center for Epidemiological Studies Depression Scale-Revised and 52.7% (6.22 points) for the Beck Scale for Suicide Ideation.

Individuals who participated in the HYPE service model were more likely to have higher treatment attendance (median 22 vs 3 sessions) and treatment completion (47.8% vs 19.2%) compared with YMHS and befriending. Treatment attendance (median 12 vs 3 sessions) and treatment completion (52.2% vs 31.2%) tended to be higher among the HYPE and CAT group individuals compared with those in the befriending group.

Service model and psychotherapy intervention were not associated with an increased rate of change in psychosocial function by one year.

Limitations included uneven randomization for antisocial personality disorder, inability to say whether treatments were equally effective, the possibility that the distance between HYPE and YMHS sites presented access challenges, and a lack of control in posttreatment phase.

“Early intervention is likely to be effective if it includes a service culture that is nonstigmatizing toward BPD, youth-friendly, and oriented to early detection and treatment for BPD,” the researchers said.

“Essential elements of care appear to include a model for understanding BPD, clinical case management, and treatment of co-occurring functional, physical, and psychopathological difficulties. How these elements might work remains an open question for further investigation. Early intervention for BPD does not appear to be reliant on availability of specialist psychotherapy and the role and timing of such treatments needs further study. With appropriate funding, services could be scaled up immediately, via existing national mental health platforms for young people or similar services globally.”

Disclosure: Some study authors declared affiliations with the Helping Young People Early programs. Please see the original reference for a full list of authors’ disclosures. 

Reference

Chanen AM, Betts JK, Jackson H, et al. Effect of 3 forms of early intervention for young people with borderline personality disorder: the MOBY randomized clinical trial. JAMA Psychiatry. Published online December 15, 2021. doi:10.1001/jamapsychiatry.2021.3637