Early Intervention for Adolescents with Borderline Personality Disorder: Quasi-Experimental Comparison with Treatment as Usual

Author:

Chanen Andrew M.12,Jackson Henry J.3,McCutcheon Louise K.12,Jovev Martina4,Dudgeon Paul3,Yuen Hok Pan4,Germano Dominic2,Nistico Helen2,McDougall Emma4,Weinstein Caroline4,Clarkson Verity4,McGorry Patrick D.12

Affiliation:

1. ORYGEN Youth Health Research Centre, University of Melbourne, Locked Bag 10, Parkville, Vic, 3052, Australia

2. ORYGEN Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia

3. School of Behavioural Science, University of Melbourne, Melbourne, Victoria, Australia

4. ORYGEN Youth Health Research Centre, University of Melbourne, Melbourne, Victoria, Australia

Abstract

Objective: The aim of the present study was to compare the effectiveness of specialized team-based early intervention for borderline personality disorder (BPD) with treatment as usual. Method: In a quasi-experimental design, 32 outpatients who received historical treatment as usual (H-TAU) were compared with 78 participants from a recently published randomized controlled trial of cognitive analytic therapy (CAT; n = 41) versus manualized good clinical care (GCC; n = 37), conducted in a specialized early intervention service for BPD (the Helping Young People Early (HYPE) programme). All participants were 15–18-year-old outpatients who fulfilled 2–9 DSM-IV BPD criteria. It was predicted that, compared with H-TAU, HYPE + GCC and HYPE + CAT would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24months. Results: At 24month follow up: (i) HYPE + CAT had lower standardized levels of, and a significantly faster standardized rate of improvement in, internalizing and externalizing psychopathology, compared with H-TAU; and (ii) HYPE + GCC had lower standardized levels of internalizing psychopathology and a faster rate of improvement in global functioning than H-TAU. HYPE + CAT yielded the greatest median improvement on the four continuous outcome measures over 24months. No adverse effects were shown with any of the treatments. Conclusions: Specialized early intervention for subsyndromal or full-syndrome BPD is more effective than TAU, with HYPE + CAT being the most effective intervention. Reform of existing services using the HYPE model might yield substantial improvements in patient outcomes.

Publisher

SAGE Publications

Subject

Psychiatry and Mental health,General Medicine

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