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Evidence Tables for Individual Studies Supporting Guideline Statements

Appendix D

Psychoeducation

Psychoeducation vs. Wait-list

Study characteristics and main results of psychoeducation compared with WL control
AE = adverse event; BPD = borderline personality disorder; DIB-R = Diagnostic Interview for Borderlines–Revised; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; MS = multiple sclerosis; N = sample size; NIMH = National Institute of Mental Health; NR = not reported; RCT = randomized controlled trial; SAS = Social Adjustment Scale; SD = standard deviation; SUD = substance use disorder; WL = wait-list; ZAN-BPD = Zanarini Rating Scale for Borderline Personality Disorder.
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Psychosocial Interventions

Interpersonal Psychotherapy vs. Wait-List Plus Clinical Management

Study characteristics and main results of IPT compared with WL plus clinical management
AE = adverse event; BIS-11 = Barratt Impulsiveness Scale–version 11; BPD = borderline personality disorder; BPDSI = Borderline Personality Disorder Severity Index; CGI-S = Clinical Global Impression-Severity; DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; G1 = Group 1; G2 = Group 2; IPT = interpersonal psychotherapy; MDE = major depressive episode; N = sample size; NR = not reported; RCT = randomized controlled trial; SHI = Self-Harm Inventory; SOFAS = Social Occupational Functioning Assessment Scale; WL = wait-list.
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Interpersonal Psychotherapy Plus Fluoxetine vs. Clinical Management Plus Fluoxetine

Study characteristics and main results of IPT plus fluoxetine compared with clinical management plus fluoxetine
BPD = borderline personality disorder; BPDSI = Borderline Personality Disorder Severity Index; CGI-S = Clinical Global Impression-Severity; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision; G1 = Group 1; G2 = Group 2; Ham-A = Hamilton Rating Scale for Anxiety; Ham-D = Hamilton Rating Scale for Depression; IPT = interpersonal psychotherapy; MDE = major depressive episode; N = sample size; NR = not reported; RCT = randomized controlled trial; SD = standard deviation; SOFAS = Social Occupational Functioning Assessment Scale; SUD = substance use disorder.
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Acceptance and Commitment Therapy vs. Treatment as Usual

Study characteristics and main results of ACT compared with TAU
ACT = acceptance and commitment therapy; AE = adverse event; BEST = Borderline Evaluation of Severity Over Time; BHS = Beck Hopelessness Scale; BPD = borderline personality disorder; DERS = Difficulty in Emotion Regulation Scale; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; MHS = mental health service; N = sample size; NR = not reported; RCT = randomized controlled trial; SCID-I = Structured Clinical Interview for DSM-IV Axis I Disorders; SCID-II = Structured Clinical Interview for DSM-IV Axis II Disorders; SD = standard deviation; TAU = treatment as usual.
aControl group worsened over time, hence the positive change on the scale.
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Manual-Assisted Cognitive Therapy vs. Treatment as Usual

Study characteristics and main results of MACT compared with TAU
BHS = Beck Hopelessness Scale; BPD = borderline personality disorder; DIB-R = Diagnostic Interview for Borderlines-Revised; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; MACT = manual-assisted cognitive therapy; N = sample size; NR = not reported; RCT = randomized controlled trial; SD = standard deviation; SUD = substance use disorder; TAU = treatment as usual.
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Cognitive-Behavioral Therapy vs. Treatment as Usual

Study characteristics and main results of CBT compared with TAU
AE = adverse event; BDI-II = Beck Depression Inventory; BOSCOT = Borderline Personality Disorder Study of Cognitive Therapy; BPD = borderline personality disorder; CBT = cognitive-behavioral therapy; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; EQ-5D = European Quality of Life–5 Dimension; G1 = Group 1; G2 = Group 2; N = sample size; NR = not reported; RCT = randomized controlled trial; SD = standard deviation; SFQ = Social Functioning Questionnaire; STAI = State-Trait Anxiety Inventory; TAU = treatment as usual.
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Dialectical Behavior Therapy vs. Wait-List/Treatment as Usual

Study characteristics and main results of DBT compared with WL or TAU
AE = adverse event; APsaA = American Psychoanalytic Association; BDI: Beck Depression Inventory; BEST = Borderline Evaluation of Severity Over Time; BIS-11 = Barrett Impulsiveness Scale–11; BPD = borderline personality disorder; BPDRF = Borderline Personality Disorder Research Foundation; BSL-23 = Borderline Symptom List–23; C&IHA = Camden and Islington Health Authority; CBT = cognitive-behavioral therapy; CORE-OM = Clinical Outcomes in Routine Evaluation–Outcome Measure; DBT = dialectical behavior therapy; DERS = Difficulties in Emotion Regulation Scale; DES = Dissociations Experiences Scale; DFG = German Research Foundation; DIB-R = Diagnostic Interview for Borderlines-Revised; DSH = deliberate self-harm; DSHI = Deliberate Self-Harm Inventory; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; GAF = Global Assessment of Functioning; GSI = Global Severity Index; Ham-A = Hamilton Rating Scale for Anxiety; LSASI = Lifetime Suicide Attempt Self-Injury Interview; N = sample size; NR = not reported; NSSI = nonsuicidal self-injury; NTRHA = North Thames Regional Health Authority; OAS-M = Overt Aggression Scale-Modified; RCT = randomized controlled trial; SCID-II = Structured Clinical Interview for DSM-IV Axis II Disorders; SCL-90-R = Symptom Checklist–90–Revised; SD = standard deviation; SDS = Sheehan Disability Scale; STAI = State-Trait Anxiety Inventory; STAXI = State-Trait Anger Expression Inventor; TAU = treatment as usual; WL = wait-list.
aGregory and Sachdeva (2016) is a three-arm trial. The two relevant arms to DBT vs. TAU are reported in this table; other eligible comparisons are reported in Tables D–11 and D–20.
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Dialectical Behavior Therapy vs. Mentalization-Based Treatment

Study characteristics and main results of DBT compared with MBT
Author (year) and/or trial nameStudy characteristicsParticipants, N; interventions; durationStudy population, including main inclusion and exclusion criteriaSample demographicsPrimary outcome; main results; attritionRisk of bias
Barnicot and Crawford (2019)
Design: Nonrandomized clinical trial
Setting: Outpatient, multicenter
Country: United Kingdom
Funding: Government, NIH
N = 90
G1 (58): DBT
G2 (32): MBT
Duration: 12 months
Inclusion: Met DSM-IV criteria for BPD; was about to begin either outpatient DBT or MBT
Exclusion: Intellectual disability; difficulty communicating in English; insufficient capacity to provide informed consent
Mean age, years (SD): 31 (13.0)
Female: 72%
Race/ethnicity:
 White: 64%
 Black and minority: 36%
Primary outcome: NR
No significant differences between G1 and G2 on BEST, DERS, and DES and in number of self-harm incidents at 12 months
Incidence of AEs: NR
Withdrawal due to AEs: NR
Attrition: 13%
Differential attrition: < 10 percentage points
High
AE = adverse event; BEST = Borderline Evaluation of Severity Over Time; BPD = borderline personality disorder; DBT = dialectical behavior therapy;  DERS = Difficulties in Emotion Regulation Scale; DES = Dissociative Experiences Scale; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; MBT = mentalization-based therapy; N = sample size; NIH = National Institutes of Health; NR = not reported; SD = standard deviation.
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Dialectical Behavior Therapy vs. General Psychiatric Management

Study characteristics and main results of DBT compared with GPM for BPD
AE = adverse event; BDI = Beck Depression Inventory; BPD = borderline personality disorder; DBT = dialectical behavior therapy; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; GPM = general psychiatric management; IIP = Inventory of Interpersonal Problems; N = sample size; NR = not reported; NSSI = nonsuicidal self-injury; RCT = randomized controlled trial; SCL-90-R = Symptom Checklist–90–Revised; SD = standard deviation; SUD = substance use disorder; ZAN-BPD = Zanarini Rating Scale for Borderline Personality Disorder.
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Dialectical Behavior Therapy vs. Systems Training for Emotional Predictability and Problem-Solving Behavior Therapy

Study characteristics and main results of DBT compared with STEPPS behavior therapy
AE = adverse event; BPD = borderline personality disorder; BSL-23 = Borderline Symptom List–23; DBT = dialectical behavior therapy; DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; G1 = Group 1; G2 = Group 2; N = sample size; NR = not reported; SD = standard deviation; STEPPS = systems training for emotional predictability and problem-solving.
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Dialectical Behavior Therapy vs. Dynamic Deconstructive Psychotherapy

Study characteristics and main results of DBT compared with DDP
AE = adverse event; APsaA = American Psychoanalytic Association; BDI = Beck Depression Inventory; BEST = Borderline Evaluation of Severity Over Time; BPD = borderline personality disorder; DBT = dialectical behavior therapy; DDP = dynamic deconstructive psychotherapy; G1 = Group 1; G2 = Group 2; N = sample size; NR = not reported; RCT = randomized controlled trial; SBQ = Suicidal Behaviors Questionnaire; SCID-II = Structured Clinical Interview for DSM-IV Axis II Personality Disorders; SD = standard deviation; SDS = Sheehan Disability Scale.
aGregory and Sachdeva (2016) is a three-arm trial. The two relevant arms to DBT vs. DDT are reported in this table; other eligible comparisons are reported in Tables D–7 and D–20.
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Dialectical Behavior Therapy vs. Transference-Focused Psychotherapy vs. Supportive Therapy

Study characteristics and main results of DBT compared with TFP and supportive therapy
AE = adverse event; BDI = Beck Depression Inventory; BPD = borderline personality disorder; BSI = Brief Symptom Inventory; DBT = dialectical behavior therapy; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; G3 = Group 3; GAF = Global Assessment of Functioning; N = sample size; NR = not reported; RCT = randomized controlled trial; SD = standard deviation; SUD = substance use disorder; TFP = transference-focused psychotherapy.
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Components of Dialectical Behavior Therapy vs. Other Components of Dialectical Behavior Therapy

Study characteristics and main results of components of DBT compared with other components of DBT for BPD
AE = adverse event; BHS = Beck Hopelessness Scale; BPD = borderline personality disorder; DBT = dialectical behavior therapy; DERS = Difficulties in Emotion Regulation Scale; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision; G1 = Group 1; G2 = Group 2; G3 = Group 3; Ham-A = Hamilton Rating Scale for Anxiety; Ham-D = Hamilton Rating Scale for Depression; IQ = intelligence quotient; N = sample size; NIMH = National Institute of Mental Health; NR = not reported; NSSI = nonsuicidal self-injury; RCT = randomized controlled trial; SD = standard deviation.
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Component of Dialectical Behavior Therapy Skills Training vs. Another Component of Dialectical Behavior Therapy Skills Training

Study characteristics and main results of component of DBT skills training compared with another component of DBT skills training for BPD
AE = adverse event; BDI = Beck Depression Inventory; BIS-11 = Barrett Impulsiveness Scale-11; BPD = borderline personality disorder; BSL-23 = Borderline Symptom List–23; DBT = dialectical behavior therapy; DERS = Difficulties in Emotion Regulation Scale; DIB-R = Diagnostic Interview for Borderlines-Revised; DMN = default mode network; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; EQ = European Quality of Life; G1 = Group 1; G2 = Group 2; IQ = intelligence quotient; MDE = major depressive episode; N = sample size; NR = not reported; RCT = randomized controlled trial; SCID-II = Structured Clinical Interview for DSM-IV Axis II Personality Disorders; SD = standard deviation; STAI‐S = State‐Trait Anxiety Inventory–State; STAI‐T = State‐Trait Anxiety Inventory–Trait; SUD = substance use disorder.
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Dialectical Behavior Therapy vs. Cognitive Therapy

Study characteristics and main results of DBT compared with CT
AE = adverse event; ASIQ-S = Adult Suicidal Ideation Questionnaire-Shortened Version; BPD = borderline personality disorder; BPDFS = Borderline Personality Disorder Features Scale; CMSADS-L = Chinese Version of the Modified Schedule of Affective Disorders and Schizophrenia–Lifetime; CT =cognitive therapy; DBT = dialectical behavior therapy; G1 = Group 1; G2 = Group 2; N = sample size; NR = not reported; RCT = randomized controlled trial; SD = standard deviation.
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Dialectical Behavior Therapy vs. Community Therapy by Experts

Study characteristics and main results of DBT compared with community therapy by experts
AE = adverse event; BPD = borderline personality disorder; DBT = dialectical behavior therapy; ED = emergency department; G1 = Group 1; G2 = Group 2; Ham-D = Hamilton Rating Scale for Depression; N = sample size; NIMH = National Institute of Mental Health; NR = not reported; NSSI = nonsuicidal self-injury; RCT = randomized controlled trial; RLI = Reasons for Living Inventory; SD = standard deviation.
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Dialectical Behavior Therapy Plus REMS Treatments vs. REMS Treatments

Study characteristics and main results of DBT plus REMS treatments compared with REMS treatments alone
Author (year) and/or trial nameStudy characteristicsParticipants, N; interventions; durationStudy population, including main inclusion and exclusion criteriaSample demographicsPrimary outcome; main results; attritionRisk of bias
Bianchini et al. (2019)
Design: RCT
Setting: Inpatient, single center
Country: Italy
Funding: NR
N = 21
G1 (11): REMS (Residenze per l’Esecuzione delle Misure di Sicurezza, a small‐scale intensive therapeutic unit)
G2 (10): DBT plus REMS treatments
Duration: 12 months
Inclusion: Met criteria for BPD as measured by PAI; history of violence toward others
Exclusion: Cognitive deficit (IQ < 70) and/or comorbid neurological diseases
Mean age, years (SD): 42 (8.14)
Female: 0%
Race/ethnicity: NR
Primary outcome: NR
No between-group comparisons at end of treatment
Significant change on only two outcomes, DERS and BIS-11, within intervention group
Incidence of AEs: NR
Withdrawal due to AEs: NR
Attrition: NR
Moderate
AE = adverse event; BIS-11 = Barrett Impulsiveness Scale-11; BPD = borderline personality disorder; DBT = dialectical behavior therapy; DERS = Difficulties in Emotion Regulation Scale; G1 = Group 1; G2 = Group 2; IQ = intelligence quotient; N = sample size; NR = not reported; PAI = Personality Assessment Inventory; RCT = randomized controlled trial; REMS = Residenze per l’Esecuzione delle Misure di Sicurezza; SD = standard deviation.
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Dialectical Behavior Therapy vs. Conversational Model

Study characteristics and main results of DBT compared with conversational model
AE = adverse event; BDI-II = Beck Depression Inventory-II; BPD = borderline personality disorder; BPDSI-IV = Borderline Personality Disorder Severity Index-IV; DBT = dialectical behavior therapy; DERS = Difficulties in Emotion Regulation Scale; DES = Dissociative Experiences Scale; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; IIP = Inventory of Interpersonal Problems; N = sample size; NR = not reported; NSSI = nonsuicidal self-injury; RCT = randomized controlled trial; SD = standard deviation.
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Dialectical Behavior Therapy Skills Training vs. Standard Group Therapy

Study characteristics and main results of DBT compared with standard group therapy
AE = adverse event; BPD = borderline personality disorder; CGI-BPD = Clinical Global Impression Scale for Borderline Personality Disorder; CGI-S = Clinical Global Impression-Severity; DBT = dialectical behavior therapy; DIB-R = Diagnostic Interview for Borderlines–Revised; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; Ham-A = Hamilton Rating Scale for Anxiety; Ham-D = Hamilton Rating Scale for Depression; MDE = major depressive episode; N = sample size; NR = not reported; RCT = randomized controlled trial; SCID-II = Structured Clinical Interview for DSM-IV Axis II Disorders; SCL-90-R = Symptom Checklist–90–Revised; SD = standard deviation; SUD = substance use disorder.
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Dynamic Deconstructive Psychotherapy vs. Treatment as Usual

Study characteristics and main results of DDP compared with TAU
AE = adverse event; APsaA = American Psychoanalytic Association; BDI = Beck Depression Inventory; BEST = Borderline Evaluation of Severity Over Time; BPD = borderline personality disorder; DDP = dynamic deconstructive psychotherapy; G1 = Group 1; G2 = Group 2; N = sample size; NR = not reported; SCID-II = Structured Clinical Interview for DSM-IV Axis II Disorders; SD = standard deviation; SDS = Sheehan Disability Scale; TAU = treatment as usual.
aGregory and Sachdeva (2016) is a three-arm trial. The two relevant arms to DDP vs. TAU are reported in this table; other eligible comparisons are reported in Tables D–7 and D–11.
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Mentalization-Based Treatment vs. Other Active Comparators

Study characteristics and main results of MBT compared with other active comparators
AE = adverse event; ASPD = antisocial personality disorder; BDI = Beck Depression Inventory; BPD = borderline personality disorder; BPFS = Borderline Personality Features Scale; BPFS-C = Borderline Personality Features Scale for Children; DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; G1 = Group 1; G2 = Group 2; GAS = Global Assessment Scale; IQ = intelligence quotient; MBT = mentalization-based treatment; M-GAB = Mentalization-Based Treatment in Groups for Adolescents with Borderline Personality Disorder; N = sample size; NR = not reported; RCT = randomized controlled trial; SD = standard deviation; SUD = substance use disorder; ZAN-BPD = Zanarini Rating Scale for Borderline Personality Disorder.
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Mentalization-Based Treatment vs. Supportive Therapy

Study characteristics and main results of MBT compared with supportive therapy
AE = adverse event; BDI = Beck Depression Inventory; BPD = borderline personality disorder; CI = confidence interval; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; GAF = Global Assessment of Functioning; GAF-F = Global Assessment of Functioning-Functioning; GAF-S = Global Assessment of Functioning-Symptoms; IIP = Inventory of Interpersonal Problems; MBT = mentalization-based treatment; N = sample size; NR = not reported; OR = odds ratio; RCT = randomized controlled trial; SCID-II = Structured Clinical Interview for DSM-IV Axis II Personality Disorders; SCL-90-R = Symptom Checklist–90–Revised; SCL-90-GSI = Symptom Checklist-90-Global Severity Index; SCM = structured clinical management; SD = standard deviation.
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Mentalization-Based Treatment vs. Psychodynamic Treatment Program

Study characteristics and main results of MBT compared with psychodynamic treatment program
AE = adverse event; BPD = borderline personality disorder; BSI-18 = Brief Symptom Inventory-18; CIP = Circumplex of Interpersonal Problems; DSM = Diagnostic and Statistical Manual of Mental Disorders; G1 = Group 1; G2 = Group 2; GAF = Global Assessment of Functioning; MBT = mentalization-based treatment; M.I.N.I. = Mini International Neuropsychiatric Interview; N = sample size; NR = not reported; RCT = randomized controlled trial; SCID-II = Structured Clinical Interview for DSM-IV Axis II Disorders; SD = standard deviation.
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Day-Hospital Mentalization-Based Treatment vs. Specialized Psychotherapy

Study characteristics and main results of day-hospital MBT compared with specialized psychotherapy
ADHD = attention-deficit/hyperactivity disorder; AE = adverse event; BPD = borderline personality disorder; BPDSI = Borderline Personality Disorder Severity Index; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; GSI = Global Severity Index; MBT = mentalization-based treatment; N = sample size; NR = not reported; RCT = randomized controlled trial; SD = standard deviation; SIPP-118 = Severity Indices of Personality Problems; SUD = substance use disorder.
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Systems Training for Emotional Predictability and Problem Solving vs. Treatment as Usual

Study characteristics and main results of STEPPS compared with TAU
AE = adverse event; BDI = Beck Depression Inventory; BDSI-IV = Borderline Syndrome Index IV; BEST = Borderline Evaluation of Severity Over Time; BIS = Barratt Impulsivity Scale; BPD = borderline personality disorder; BPD-40 = Borderline Personality Disorder checklist-40; CGI = Clinical Global Impressions; CGI-I = Clinical Global Impression-Improvement; CGI-S = Clinical Global Impression-Severity; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; G1 = Group 1; G2 = Group 2; GAS = Global Assessment Scale; IQ = intelligence quotient; N = sample size; NIMH = National Institute of Mental Health; NR = not reported; RCT = randomized controlled trial; SAS = Social Adjustment Scale; SCID-II = Structured Clinical Interview for DSM-IV Axis II Disorders; SCL-90 = Symptom Checklist-90; SD = standard deviation; STEPPS = systems training for emotional predictability and problem-solving; TAU = treatment as usual; WHOQOL-Bref = World Health Organization Quality of Life Bref; ZAN-BPD = Zanarini Rating Scale for Borderline Personality Disorder.
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Transference-Focused Psychotherapy vs. Treatment as Usual

Study characteristics and main results of TFP compared with TAU
AE = adverse event; ASPD = antisocial personality disorder; BDI = Beck Depression Inventory; BPD = borderline personality disorder; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; GAF = Global Assessment of Functioning; LOCF = last observation carried forward; N = sample size; NR = not reported; RCT = randomized controlled trial; SD = standard deviation; STAI = State-Trait Anxiety Inventory; SUD = substance use disorder; TAU = treatment as usual; TFP = transference-focused psychotherapy.
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Transference-Focused Psychotherapy vs. Schema-Focused Therapy

Study characteristics and main results of TFP compared with SFT
ADHD = attention-deficit/hyperactivity disorder; AE = adverse event; ASPD = antisocial personality disorder; BPD = borderline personality disorder; BPDSI-IV = Borderline Personality Disorder Severity Index-IV; CI = confidence interval; DID = dissociative identity disorder; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; N = sample size; NR = not reported; RCT = randomized controlled trial; RR = risk ratio; SD = standard deviation; SFT = schema-focused therapy; TFP = transference-focused psychotherapy.
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Special Populations

Borderline Personality Disorder and Substance Use Disorder: Comprehensive Validation Therapy Plus 12-Step vs. Dialectical Behavior Therapy

Study characteristics and main results of CVT+12S compared with DBT in patients with BPD and SUD
AE = adverse event; BPD = borderline personality disorder; BSI = Brief Symptom Inventory; CVT+12S = comprehensive validation therapy plus 12-step; DBT = dialectical behavior therapy; G1 = Group 1; G2 = Group 2; GAS = Global Assessment Scale; N = sample size; NA = Narcotics Anonymous; NIDA = National Institute on Drug Abuse; NIH = National Institute of Health; NR = not reported; PDE = Personality Disorders Exam; RCT = randomized controlled trial; SCID-I = Structured Clinical Interview for DSM-IV Axis I Disorders; SCID-II = Structured Clinical Interview for DSM-IV Axis II Disorders; SD = standard deviation; SUD = substance use disorder.
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Borderline Personality Disorder and Substance Use Disorder: Substance Use Disorder Treatment vs. Mentalization-Based Treatment Plus Substance Use Disorder Treatment

Study characteristics and main results of SUD treatment compared with MBT plus SUD treatment in patients with BPD and SUD
ASD = autism spectrum disorder; BPD = borderline personality disorder; BPDSI-IV = Borderline Personality Disorder Severity Index-IV; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; GSI = Global Severity Index; IIP = Inventory of Interpersonal Problems; MBT = mentalization-based treatment; N = sample size; NR = not reported; RCT = randomized clinical trial; SD = standard deviation; SUD = substance use disorder.
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Borderline Personality Disorder and Alcohol Use Disorder: Dynamic Deconstructive Psychotherapy vs. Treatment as Usual in the Community

Study characteristics and main results of DDP compared with TAU in the community in patients with BPD and AUD
AUD = alcohol use disorder; BEST = Borderline Evaluation of Severity Over Time; BPD = borderline personality disorder; DDP = dynamic deconstructive psychotherapy; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; MS = multiple sclerosis; N = sample size; PI = principal investigator; RCT = randomized clinical trial; SD = standard deviation; TAU = treatment as usual; TBI = traumatic brain injury.
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Borderline Personality Disorder and Eating Disorder: Cognitive-Behavioral Therapy vs. Dialectical Behavior Therapy

Study characteristics and main results of CBT compared with DBT in patients with BPD and eating disorder
AE = adverse event; BDI = Beck Depression Inventory; BPD = borderline personality disorder; CBT = cognitive-behavioral therapy; DBT =  dialectical behavioral therapy; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; GAF = Global Assessment of Functioning; N = sample size; NR = not reported; NSSI = nonsuicidal self-injury; SD = standard deviation; SUD = substance use disorder.
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Borderline Personality Disorder and Eating Disorder: Specialist Supportive Clinical Management vs. Modified Mentalization-Based Treatment

Study characteristics and main results of SSCM compared with modified MBT in patients with BPD and eating disorder
AE = adverse event; BMI = body mass index; BPD = borderline personality disorder; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; EDE = Eating Disorder Examination; G1 = Group 1; G2 = Group 2; MBT = mentalization-based treatment; N = sample size; NIHR = National Institute for Health Research; NOURISHED = Nice OUtcomes for Referrals with Impulsivity, Self Harm and Eating Disorders; NR = not reported; RCT = randomized clinical trial; SD = standard deviation; SSCM = specialist supportive clinical management; ZAN-BPD = Zanarini Rating Scale for Borderline Personality Disorder.
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Borderline Personality Disorder and Major Depressive Disorder: Cognitive Therapy Plus Fluoxetine vs. Interpersonal Therapy Plus Fluoxetine

Study characteristics and main results of CT plus fluoxetine compared with IPT plus fluoxetine in patients with BPD and MDD
AE = adverse event; BDI-II = Beck Depression Inventory–II; BPD = borderline personality disorder; CGI-S = Clinical Global Impression-Severity; CT = cognitive therapy; DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision; G1 = Group 1; G2 = Group 2; Ham-A = Hamilton Rating Scale for Anxiety; Ham-D = Hamilton Rating Scale for Depression; IPT = interpersonal psychotherapy; MDD = major depressive disorder; MDE = major depressive episode; N = sample size; NR = not reported; RCT = randomized clinical trial; SAT-P = Satisfaction Profile; SD = standard deviation; SOFAS = Social Occupational Functioning Assessment Scale; SUD = substance use disorder.
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Borderline Personality Disorder and Major Depressive Disorder: Interpersonal Psychotherapy Plus Fluoxetine vs. Clinical Management Plus Fluoxetine

Study characteristics and main results of IPT plus fluoxetine compared with clinical management plus fluoxetine in patients with BPD and MDD
BPD = borderline personality disorder; CGI-S = Clinical Global Impression-Severity; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; Ham-A = Hamilton Rating Scale for Anxiety; Ham-D = Hamilton Rating Scale for Depression; IPT = interpersonal psychotherapy; MDD = major depressive disorder; MDE = major depressive episode; N = sample size; NR = not reported; RCT = randomized clinical trial; SD = standard deviation; SUD = substance use disorder.
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Borderline Personality Disorder and Posttraumatic Stress Disorder: Dialectical Behavior Therapy Alone vs. Dialectical Behavior Therapy Plus Dialectical Behavior Therapy-Prolonged Exposure

Study characteristics and main results of DBT alone compared with DBT plus DBT-PE in patients with BPD and PTSD
AE = adverse event; BPD = borderline personality disorder; DBT = dialectical behavior therapy; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; GSI = Global Severity Index; Ham-A = Hamilton Rating Scale for Anxiety; Ham-D = Hamilton Rating Scale for Depression; N = sample size; NIMH = National Institute of Mental Health; NR = not reported; NSSI = nonsuicidal self-injury; PE = prolonged exposure; PSS-I = PTSD Symptom Scale–Interview; PTSD = posttraumatic stress disorder; RCT = randomized clinical trial; SASII = Suicide Attempt Self-Injury Interview; SD = standard deviation.
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Adolescents With Borderline Personality Disorder: Manualized Good Clinical Care vs. Cognitive Analytic Therapy

Study characteristics and main results of manualized good clinical care compared with CAT in adolescents with BPD
AE = adverse event; BPD  = borderline personality disorder; CAT = cognitive analytic therapy; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; N = sample size; NHMRC = National Health and Medical Research Council; NR = not reported; RCT = randomized clinical trial; SOFAS = Social Occupational Functioning Assessment Scale.
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Adolescents with Borderline Personality Disorder and Substance Use Disorder: Individual Drug Counseling vs. Integrative Borderline Personality Disorder-Oriented Adolescent Family Therapy

Study characteristics and main results of individual drug counseling compared with I-BAFT in adolescents with BPD and SUD
AE = adverse event; BPD = borderline personality disorder; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; I-BAFT = integrative borderline personality disorder–oriented adolescent family therapy; N = sample size; NR = not reported; RCT = randomized clinical trial; SD = standard deviation; SUD = substance use disorder.
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Pharmacotherapy

Second-Generation Antipsychotics vs. Placebo

Study characteristics and main results of SGAs compared with placebo
AE = adverse event; BIS = Barratt Impulsiveness Scale; BMI = body mass index; BPD = borderline personality disorder; CGI = Clinical Global Impression Scale; CGI-BPD = Clinical Global Impression Scale for Borderline Personality Disorder; CGI-S = Clinical Global Impression-Severity; DBT = dialectical behavior therapy; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; ER = extended release; G1 = Group 1; G2 = Group 2; G3 = Group 3; GAF = Global Assessment of Functioning; Ham-A = Hamilton Rating Scale for Anxiety; Ham-D = Hamilton Rating Scale for Depression; MADRS = Montgomery-Åsberg Depression Rating Scale; MDD = major depressive disorder; MDE = major depressive episode; MOAS = Modified Overt Aggression Scale; N = sample size; NR = not reported; OCD = obsessive compulsive disorder; PTSD = posttraumatic stress disorder; RCT = randomized controlled trial; SCID-II = Structured Clinical Interview for DSM-IV Axis II Disorders; SCL-90 = Symptom Checklist-90; SCL-90-R = Symptom Checklist–90–Revised; SD = standard deviation; SDS = Sheehan Disability Scale; SGA = second-generation antipsychotic; STAXI = State-Trait Anger Expression Inventory; SUD = substance use disorder; ZAN-BPD = Zanarini Rating Scale for Borderline Personality Disorder.
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Second-Generation Antipsychotics vs. Antidepressants

Study characteristics and main results of SGAs compared with antidepressants
AE = adverse event; BPD = borderline personality disorder; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; G3 = Group 3; MADRS = Montgomery-Åsberg Depression Scale; MDD = major depressive disorder; MOAS = Modified Overt Aggression Scale; N = sample size; NR = not reported; RCT = randomized controlled trial; SD = standard deviation; SGA = second-generation antipsychotic.
Open in viewer

Second-Generation Antipsychotics vs. Second-Generation Antipsychotics

Study characteristics and main results of SGAs compared with SGAs
AE = adverse event; BIS = Barratt Impulsiveness Scale; BPD = borderline personality disorder; BPDSI = Borderline Personality Disorder Severity Index; CGI-S = Clinical Global Impression-Severity; DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; ED = emergency department; G1 = Group 1; G2 = Group 2; Ham-D = Hamilton Rating Scale for Depression; LAI = long-acting injectable; MDE = major depressive episode; MOAS = Modified Overt Aggression Scale; N = sample size; NR = not reported; SD = standard deviation; SE = standard error; SGA = second-generation antipsychotic; SHI = Self-Harm Inventory.
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Anticonvulsants vs. Placebo

Study characteristics and main results of anticonvulsants compared with placebo
AE = adverse event; ALS = Affective Liability Scale; AQ = Aggression Questionnaire; BEST = Borderline Evaluation of Severity Over Time; BIS = Barratt Impulsiveness Scale; BPD = borderline personality disorder; CGI-I = Clinical Global Impression-Improvement; DIB-R = Diagnostic Interview for Borderlines-Revised; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; EQ-5D-3L = European Quality of Life–5 Dimension-3 level version; G1 = Group 1; G2 = Group 2; GAS = Global Assessment Scale; IIP = Inventory of Interpersonal Problems; LABILE = Lamotrigine and Borderline Personality Disorder: Investigating Long-Term Effects; MDD =  major depressive disorder; MDE = major depressive disorder; MOAS = Modified Overt Aggression Scale; NIHR = National Institute for Health Research; NIMH = National Institute of Mental Health; N = sample size; NR = not reported; RCT = randomized controlled trial; SCID-II = Structured Clinical Interview for DSM-IV Axis II Disorders; SCL-90 = Symptom Checklist-90; SCL-90-R = Symptom Checklist–90–Revised; SD = standard deviation; SF-36 = Short Form Survey; SFQ = Social Functioning Questionnaire; SHI = Self-Harm Inventory; STAXI = State-Trait Anger Expression Inventory; SUD = substance use disorder; ZAN-BPD = Zanarini Rating Scale for Borderline Personality Disorder.
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Antidepressants vs. Placebo

Study characteristics and main results of antidepressants compared with placebo
AE = adverse event; BPD = borderline personality disorder; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; G1 = Group 1; G2 = Group 2; GAF = Global Assessment of Functioning; MOAS = Modified Overt Aggression Scale; N = sample size; NR = not reported; RCT = randomized controlled trial; SD = standard deviation; STAXI = State-Trait Anger Expression Inventory; SUD = substance use disorder.
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Go to The American Psychiatric Association Practice Guideline for the Treatment of                 Patients With Borderline Personality Disorder
The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder
November 2024
©American Psychiatric Association Publishing

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Figures

Tables

Study characteristics and main results of psychoeducation compared with WL control
Study characteristics and main results of IPT compared with WL plus clinical management
Study characteristics and main results of IPT plus fluoxetine compared with clinical management plus fluoxetine
Study characteristics and main results of ACT compared with TAU
Study characteristics and main results of MACT compared with TAU
Study characteristics and main results of CBT compared with TAU
Study characteristics and main results of DBT compared with WL or TAU
Study characteristics and main results of DBT compared with MBT
Study characteristics and main results of DBT compared with GPM for BPD
Study characteristics and main results of DBT compared with STEPPS behavior therapy
Study characteristics and main results of DBT compared with DDP
Study characteristics and main results of DBT compared with TFP and supportive therapy
Study characteristics and main results of components of DBT compared with other components of DBT for BPD
Study characteristics and main results of component of DBT skills training compared with another component of DBT skills training for BPD
Study characteristics and main results of DBT compared with CT
Study characteristics and main results of DBT compared with community therapy by experts
Study characteristics and main results of DBT plus REMS treatments compared with REMS treatments alone
Study characteristics and main results of DBT compared with conversational model
Study characteristics and main results of DBT compared with standard group therapy
Study characteristics and main results of DDP compared with TAU
Study characteristics and main results of MBT compared with other active comparators
Study characteristics and main results of MBT compared with supportive therapy
Study characteristics and main results of MBT compared with psychodynamic treatment program
Study characteristics and main results of day-hospital MBT compared with specialized psychotherapy
Study characteristics and main results of STEPPS compared with TAU
Study characteristics and main results of TFP compared with TAU
Study characteristics and main results of TFP compared with SFT
Study characteristics and main results of CVT+12S compared with DBT in patients with BPD and SUD
Study characteristics and main results of SUD treatment compared with MBT plus SUD treatment in patients with BPD and SUD
Study characteristics and main results of DDP compared with TAU in the community in patients with BPD and AUD
Study characteristics and main results of CBT compared with DBT in patients with BPD and eating disorder
Study characteristics and main results of SSCM compared with modified MBT in patients with BPD and eating disorder
Study characteristics and main results of CT plus fluoxetine compared with IPT plus fluoxetine in patients with BPD and MDD
Study characteristics and main results of IPT plus fluoxetine compared with clinical management plus fluoxetine in patients with BPD and MDD
Study characteristics and main results of DBT alone compared with DBT plus DBT-PE in patients with BPD and PTSD
Study characteristics and main results of manualized good clinical care compared with CAT in adolescents with BPD
Study characteristics and main results of individual drug counseling compared with I-BAFT in adolescents with BPD and SUD
Study characteristics and main results of SGAs compared with placebo
Study characteristics and main results of SGAs compared with antidepressants
Study characteristics and main results of SGAs compared with SGAs
Study characteristics and main results of anticonvulsants compared with placebo
Study characteristics and main results of antidepressants compared with placebo

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Table 1
Study characteristics and main results of psychoeducation compared with WL control
Table 2
Study characteristics and main results of IPT compared with WL plus clinical management
Table 3
Study characteristics and main results of IPT plus fluoxetine compared with clinical management plus fluoxetine
Table 4
Study characteristics and main results of ACT compared with TAU
Table 5
Study characteristics and main results of MACT compared with TAU
Table 6
Study characteristics and main results of CBT compared with TAU
Table 7
Study characteristics and main results of DBT compared with WL or TAU
Table 8
Study characteristics and main results of DBT compared with MBT
Table 9
Study characteristics and main results of DBT compared with GPM for BPD
Table 10
Study characteristics and main results of DBT compared with STEPPS behavior therapy
Table 11
Study characteristics and main results of DBT compared with DDP
Table 12
Study characteristics and main results of DBT compared with TFP and supportive therapy
Table 13
Study characteristics and main results of components of DBT compared with other components of DBT for BPD
Table 14
Study characteristics and main results of component of DBT skills training compared with another component of DBT skills training for BPD
Table 15
Study characteristics and main results of DBT compared with CT
Table 16
Study characteristics and main results of DBT compared with community therapy by experts
Table 17
Study characteristics and main results of DBT plus REMS treatments compared with REMS treatments alone
Table 18
Study characteristics and main results of DBT compared with conversational model
Table 19
Study characteristics and main results of DBT compared with standard group therapy
Table 20
Study characteristics and main results of DDP compared with TAU
Table 21
Study characteristics and main results of MBT compared with other active comparators
Table 22
Study characteristics and main results of MBT compared with supportive therapy
Table 23
Study characteristics and main results of MBT compared with psychodynamic treatment program
Table 24
Study characteristics and main results of day-hospital MBT compared with specialized psychotherapy
Table 25
Study characteristics and main results of STEPPS compared with TAU
Table 26
Study characteristics and main results of TFP compared with TAU
Table 27
Study characteristics and main results of TFP compared with SFT
Table 28
Study characteristics and main results of CVT+12S compared with DBT in patients with BPD and SUD
Table 29
Study characteristics and main results of SUD treatment compared with MBT plus SUD treatment in patients with BPD and SUD
Table 30
Study characteristics and main results of DDP compared with TAU in the community in patients with BPD and AUD
Table 31
Study characteristics and main results of CBT compared with DBT in patients with BPD and eating disorder
Table 32
Study characteristics and main results of SSCM compared with modified MBT in patients with BPD and eating disorder
Table 33
Study characteristics and main results of CT plus fluoxetine compared with IPT plus fluoxetine in patients with BPD and MDD
Table 34
Study characteristics and main results of IPT plus fluoxetine compared with clinical management plus fluoxetine in patients with BPD and MDD
Table 35
Study characteristics and main results of DBT alone compared with DBT plus DBT-PE in patients with BPD and PTSD
Table 36
Study characteristics and main results of manualized good clinical care compared with CAT in adolescents with BPD
Table 37
Study characteristics and main results of individual drug counseling compared with I-BAFT in adolescents with BPD and SUD
Table 38
Study characteristics and main results of SGAs compared with placebo
Table 39
Study characteristics and main results of SGAs compared with antidepressants
Table 40
Study characteristics and main results of SGAs compared with SGAs
Table 41
Study characteristics and main results of anticonvulsants compared with placebo
Table 42
Study characteristics and main results of antidepressants compared with placebo