Early Intervention for Adolescents with Borderline Personality Disorder: Quasi-Experimental Comparison with Treatment as Usual

• Published in: Australian and New Zealand journal of psychiatry 2009-05, Vol.43 (5), p.397-408
• Main Authors: Chanen, Andrew M., Jackson, Henry J., McCutcheon, Louise K., Jovev, Martina, Dudgeon, Paul, Yuen, Hok Pan, Germano, Dominic, Nistico, Helen, McDougall, Emma, Weinstein, Caroline, Clarkson, Verity, McGorry, Patrick D.
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Borderline personality disorder; Borderline Personality Disorder - therapy; Borderline personality disorder in adolescence; Cognitive Therapy - methods; Female; Humans; Male; Medical sciences; Mental health; Miscellaneous; Patient Care Team; Prevention. Health policy. Planification; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapies. Psychological and clinical counseling; Psychotherapy - methods; Randomized Controlled Trials as Topic; Self-Injurious Behavior - therapy; Social psychiatry. Ethnopsychiatry; Treatment; Treatments
• ISSN: 0004-8674; 1440-1614
• DOI: 10.1080/00048670902817711

Objective: The aim of the present study was to compare the effectiveness of specialized team-based early intervention for borderline personality disorder (BPD) with treatment as usual. Method: In a quasi-experimental design, 32 outpatients who received historical treatment as usual (H-TAU) were compared with 78 participants from a recently published randomized controlled trial of cognitive analytic therapy (CAT; n = 41) versus manualized good clinical care (GCC; n = 37), conducted in a specialized early intervention service for BPD (the Helping Young People Early (HYPE) programme). All participants were 15–18-year-old outpatients who fulfilled 2–9 DSM-IV BPD criteria. It was predicted that, compared with H-TAU, HYPE + GCC and HYPE + CAT would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24months. Results: At 24month follow up: (i) HYPE + CAT had lower standardized levels of, and a significantly faster standardized rate of improvement in, internalizing and externalizing psychopathology, compared with H-TAU; and (ii) HYPE + GCC had lower standardized levels of internalizing psychopathology and a faster rate of improvement in global functioning than H-TAU. HYPE + CAT yielded the greatest median improvement on the four continuous outcome measures over 24months. No adverse effects were shown with any of the treatments. Conclusions: Specialized early intervention for subsyndromal or full-syndrome BPD is more effective than TAU, with HYPE + CAT being the most effective intervention. Reform of existing services using the HYPE model might yield substantial improvements in patient outcomes.