Psychoanalytic Treatment of Borderline Personality Disorder
By Anthony W. Bateman, M.A., F.R.C.Psych |
July 1, 2001
Dr. Bateman is consultant psychiatrist in psychotherapy at St. Ann's Hospital in London and honorary senior lecturer at Royal Free and University College Medical School.
It is no longer tenable to suggest that personality disorder is untreatable. Patients deserve treatment. There is increasing evidence that psychoanalytic treatment is effective in treating borderline personality disorder. Our trial had a longer follow-up period than any other RCT of BPD and a low dropout rate. It has demonstrated long-lasting changes, with patients showing a marked reduction in service usage.
The questions now concern who should be treated, where and with what type of therapy. We neither know who should be treated as an inpatient, day patient, or outpatient nor who responds best to a psychoanalytically based program and who to a behavioral program, or if patients need both for different aspects of their problems.
What we do know is that both types of treatment are helpful in improving the lives of individuals with BPD, and managed care companies need to support services with appropriate conceptual models and an organized and thoughtful pattern of service.
Bateman A, Fonagy P (1999), Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 156(10):1563-1569.
Bateman AW, Fonagy P (2000), Effectiveness of psychotherapeutic treatment of personality disorder. Br J Psychiatry 177:138-143.
Bateman A, Fonagy P (2001), Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. Am J Psychiatry 158(1):36-42.
Kächele H, Krause R, Jones E et al. (2000), An Open Door Review of Outcome Studies in Psychoanalysis. Fonagy P, ed. London: International Psychoanalytical Association. Available at: www.ipa.org.uk/research. Accessed May 10, 2001.
Linehan MM, Armstrong HE, Suarez A et al. (1991), Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry 48(12):1060-1064 [see comment].
Linehan MM, Heard HL, Armstrong HE (1993), Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. [Published erratum Arch Gen Psychiatry 1994; 51(5):422.] Arch Gen Psychiatry 50(12):971-974.
Meares R, Stevenson J, Comerford A (1999), Psychotherapy with borderline patients: I. A comparison between treated and untreated cohorts. Aust N Z J Psychiatry 33(4):467-472.
Stevenson J, Meares R (1992), An outcome study of psychotherapy for patients with borderline personality disorder. Am J Psychiatry 149(3):358-362 [see comment].
Zanarini MC, Frankenburg FR (1997), Pathways to the development of borderline personality disorder. J Personal Disord 11(1):93-104.