Borderline Personality Disorder

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Borderline Personality Disorder

• Recent Psychodynamic therapy Trials

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BATEMAN AND FONAGYPARTIAL HOSPITILISATION
STUDIES 1999, 2001, 2003, 2008

• (1)
• 38 BPD patients
• Random Allocation
• 18/12 partial Hospitalisation General
  Psychiatric Care
• Individual and group Psychotherapy (Rx
  as Usual)
• PH Stat sign - suicide attempts
• - self harming
• - number and duration I/P stays
• - self reports depression, anxiety general
  symptom distress, interpersonal functioning
  and social adjustment
• Began after 6/12 Continued to end.
• TAU group limited change or deterioration

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BATEMAN AND FONAGY PH STUDIES

• (2)
• Follow up of original group. 3/12ly for 18/12 of
  44 patients
• Maintained gains and continued to improve (stat.
  sign.) on most measures for PH group.
• Limited change in TAU group
• Rehabilitative change

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BATEMAN AND FONAGY PH STUDIES

• COSTS Psychiatric, Pharmacological, AE
• Pre Rx and during Rx No differences in service
  utilisation
• cost of day care in PH group balanced by less
  I/P care and less AE
• Trend for costs in PH group during F/U no trend
  for costs in TAU group

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8 yr follow up-5yrs after Rx 2008

• Rxed group-13 vs 87 TAU group still meet
  criteria for BPD
• Stat sig decrease in suicidality, service and
  medication use in Rx Gp
• Stat sig increase in global and vocational
  functioning in Rx Gp
• But still appreciable social and functional
  impairment- quality of life.
• Bateman and Fonagy Am J Psych 165 631-638

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Transference Focused Therapy(TFP)

• Clarkin et al 2007-Am J Psych 1646 922-928- RCT
• Levy et al 2006-J Cons and Clin Psychol 74(6)
  1027-1040.RCT
• Structured Outpatient treatment-twice weekly,
  modified psychodynamic Rx based on Kernbergs
  theoretical model

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TFP /DBT/SPT Clarkin et al-1yr figs

• All broadly equivalent overall but individual
  domains differ-?different routes to symptom
  change
• TFP and DBT reduce suicidality
• TFT and SPT reduce anger and impulsivity
• All reduce depression, anxiety
• All improve global functioning
• All improve social adjustment
• Only TFT sign predictive of changes in
  irritability, verbal and physical assault

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TFP /DBT/SPT Clarkin et al-1yr figs

• All broadly equivalent overall but individual
  domains differ-?different routes to symptom
  change
• TFP and DBT reduce suicidality
• TFT and SPT reduce anger and impulsivity
• All reduce depression, anxiety
• All improve global functioning
• All improve social adjustment
• Only TFT sign predictive of changes in
  irritability, verbal and physical assault

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Attachment changes in Levy 2006

• Same trial as Clarkin
• Sign inc in attachment security on AAI in TFP not
  others
• Sign inc in reflective functioning, and
  attachment coherence in TFT not others

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Borderline Personality Disorders

• Are Common
• Frequently exist as co-morbid disorders
• Arouse powerful feelings in staff and teams
• Can test professional boundaries
• Can be understood
• Can be treated-often need combined psychotherapy
  and pharmacotherapy
• MBT,DBT TFP all effective
• Treatment teams need to communicate