Borderline personality disorder (BPD) is a major public health problem. This study aims to delay the onset of or reduce the severity of subsequent BPD in a sample of adolescents at risk of BPD.
Eighty-six 15- to 18-year-old participants were drawn from an adolescent psychiatric service. They had one or more childhood risk factors for BPD and met criteria for two or more current DSM-IV BPD features, using rigorous diagnosis. Participants were randomly allocated to 24 sessions of either cognitive analytic therapy [CAT; Ryle 1997] or manualized ‘good clinical care’ (GCC). A third, nonrandomized comparison group (n = 30), which received ‘treatment as usual’ (TAU), was collected prior to implementation of the study. Outcome measures completed at baseline, 6, 12 and 24 months included BPD score, internalizing and externalizing psychopathology and social and occupational functioning.
At 24 months, patients receiving CAT had statistically significant lower levels of externalizing pathology compared with those receiving GCC. Patients receiving CAT had statistically significant lower scores on internalizing and externalizing psychopa-thology compared with those receiving TAU, and patients receiving GCC had statistically significant lower scores on internalizing psychopathology compared with TAU. BPD scores improved from baseline levels in all three conditions and no significant differences were found between the groups.
CAT is an effective early intervention for BPD and is superior to both manual-based ‘GCC’ and TAU.