Psychotherapy for borderline personality disorder: a review of literature on the efficacy of four manualized treatments

Objectives This work compares the efficacy of four treatment models for Borderline Personality Disorder (BPD) that have been tested in empirical research. The models considered are Mentalization-Based treatment (MBT) by Bateman and Fonagy(1), Transference-Focused Psychotherapy (TFP) by Clarkin, Yeomans and Kernberg(2), Dialectical Behaviour Therapy (DBT) by Linehan(3), and Schema-Focused Therapy (SFT) by Young(4). For all four models, a specific treatment manual is available that allows reliable trials on efficacy to be carried out. Methods A critical review of literature from 1991 to date has been conducted, reviewing all published empirical studies on the efficacy of the four models. Pubmed and Psychinfo databases were searched using as keywords the terms "Mentalization-Based Treatment", "Transference-Focused Psychotherapy", "Dialectical Behaviour Therapy" and "Schema-Focused Therapy". The efficacy of treatments was compared considering three different parameters: dysregulation, mentalization, and duration/stability of changes. Results The review of literature identified 5 studies on MBT, 7 on TFP, 20 on DBT and its modified forms, and 7 on SFT. The four models showed efficacy in reducing self-mutilating, suicidal, and parasuicidal behaviours. TFP is the most effective treatment in reducing anger and impulsivity, while DBT was effective in treating eating behaviour disorders, one of the symptoms of severe dysregulation. Considering substance abuse, data are unclear. As for mentalization, only TFP demonstrated efficacy in increasing the level of reflective functioning. The changes obtained with treatments showed long-term stability for MBT, TFP, and DBT, while further follow-up studies are required for SFT. Conclusions All four models can be considered effective in treating BPD (or, at least, some aspects) with a level of efficacy that varies depending on the parameter considered. According to criteria of the American Psychiatric Association 5 for empirically-validated treatments, TFP, DBT and SFT can be considered well-established treatments for BPD, while MBT meets the criteria for probably-efficacious treatment.