Effectiveness of dialectical behavioral therapy for borderline personality disorder under inpatient conditions: A controlled trial and follow-up data

Non-response to psychotherapy for borderline personality disorder: A systematic review

HIGHLIGHT

This is the first systematic review to investigate non-response to psychotherapy for borderline personality disorder.

BACKGROUND

Psychotherapy is the recommended treatment for borderline personality disorder. While systematic reviews have demonstrated the effectiveness of psychotherapy for borderline personality disorder, effect sizes remain small and influenced by bias. Furthermore, the proportion of people who do not respond to treatment is seldom reported or analysed.

OBJECTIVE

To obtain an informed estimate of the proportion of people who do not respond to psychotherapy for borderline personality disorder.

METHODS

Systematic searches of five databases, PubMed, Web of Science, Scopus, PsycINFO and the Cochrane Library, occurred in November 2020. Inclusion criteria: participants diagnosed with borderline personality disorder, treated with psychotherapy and data reporting either (a) the proportion of the sample that experienced 'reliable change' or (b) the percentage of sample that no longer met criteria for borderline personality disorder at conclusion of therapy. Exclusion criteria: studies published prior to 1980 or not in English. Of the 19,517 studies identified, 28 met inclusion criteria.

RESULTS

Twenty-eight studies were included in the review comprising a total of 2436 participants. Average treatment duration was 11 months using well-known evidence-based approaches. Approximately half did not respond to treatment; M = 48.80% (SD = 22.77).

LIMITATIONS

Data regarding within sample variability and non-response are seldom reported. Methods of reporting data on dosage and comorbidities were highly divergent which precluded the ability to conduct predictive analyses. Other limitations include lack of sensitivity analysis, and studies published in English only.

CONCLUSION

Results of this review suggest that a large proportion of people are not responding to psychotherapy for borderline personality disorder and that factors relating to non-response are both elusive and inconsistently reported. Novel, tailored or enhanced interventions are needed to improve outcomes for individuals not responding to current established treatments.

Personality disorders and body weight

We examine the impact of Axis II personality disorders (PDs) on body weight. PDs are psychiatric conditions that develop early in life from a mixture of genetics and environment, are persistent, and lead to substantial dysfunction for the affected individual. The defining characteristics of PDs conceptually link them with body weight, but the direction of the relationship likely varies across PD type. To investigate these links, we analyze data from Wave II of the National Epidemiological Survey of Alcohol and Related Conditions. We measure body weight with the body mass index (BMI) and a dichotomous indicator for obesity (BMI≥30). We find that women with PDs have significantly higher BMI and are more likely to be obese than otherwise similar women. We find few statistically significant or economically meaningful effects for men. Paranoid, schizotypal, and avoidant PDs demonstrate the strongest adverse impacts on women's body weight while dependent PD may be protective against elevated body weight among men. Findings from unconditional quantile regressions demonstrate a positive gradient between PDs and BMI in that the effects are greater for higher BMI respondents.