A Meta-Analysis of Treatment as Usual for Borderline Personality Disorder

• Published in: Personality disorders 2019-11, Vol.10 (6), p.491-499
• Main Authors: Finch, Ellen F., Iliakis, Evan A., Masland, Sara R., Choi-Kain, Lois W.
• Format: Article
• Language: English
• Subjects: Borderline Personality Disorder; Evidence Based Practice; Female; Human; Male; Psychopathology; Psychotherapy; Randomized Controlled Trials
• ISSN: 1949-2715; 1949-2723
• DOI: 10.1037/per0000353

In the era of evidence-based medicine, "treatment as usual" (TAU) for borderline personality disorder (BPD) is often considered ineffective or even iatrogenic. To evaluate the effects of TAU, this meta-analysis examined published data from the TAU arms of randomized controlled trials of manualized psychotherapies for BPD. Studies were selected through a comprehensive bibliographic search. A total of 16 studies met inclusion criteria. Comprehensive Meta-analysis V3 software was used for computing and pooling effect sizes. For the primary outcome category of BPD symptoms, Hedges' g showed a small-to-moderate improvement for patients in TAU conditions (11 studies; g = 0.371; 95% confidence intervals [CI: 0.246, 0.495]). Secondary outcomes included general psychopathology, global functioning, and self-harm/suicidality. Hedges' g indicated small improvements in general psychopathology (14 studies; g = 0.119; 95% CI [0.025, 0.214]) and global functioning (10 studies; g = 0.254; 95% CI [0.123, 0.384]). No significant effect was found for changes in self-harm/suicidality (four studies; g = 0.003; 95% CI [−0.193, 0.199]). These findings question the notion that TAU for BPD is inherently iatrogenic. Thus, in the absence of specialized treatment for BPD, standard available care may be a practical option.