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Service Line: Rapid Response Service
Version: 1.0
Publication Date: February 22, 2018
Report Length: 17 Pages
CADTH RAPID RESPONSE REPORT: SUMMARY OF ABSTRACTS
Treatment of Personality Disorders in Adults with or without Comorbid Mental Health Conditions: Clinical Effectiveness and Guidelines
SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 2
Authors: Kristen Moulton, Sarah Visintini
Cite As: Treatment of personality disorders in adults with or without comorbid mental health conditions: clinical ef f ectiveness and guidelines. Ottawa: CADTH;
2018 Feb. (CADTH rapid response report: summary of abstracts).
Acknowledgments:
Disclaimer: The inf ormation in this document is intended to help Canadian health care decision-makers, health care prof essionals, health sy stems leaders,
and policy -makers make well-inf ormed decisions and thereby improv e the quality of health care serv ices. While pat ients and others may access this document,
the document is made av ailable f or inf ormational purposes only and no representations or warranties are made with respect to its f itness f or any particular
purpose. The inf ormation in this document should not be used as a substitute f or prof essional medical adv ice or as a substitute f or the application of clinical
judgment in respect of the care of a particular patient or other prof essional judgment in any decision-making process. The Canadian Agency f or Drugs and
Technologies in Health (CADTH) does not endorse any inf ormation, drugs, therapies, treatments, products, processes, or serv ic es.
While care has been taken to ensure that the inf ormation prepared by CADTH in this document is accurate, complete, and up-to-date as at the applicable date
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SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 3
Research Questions
1. What is the clinical evidence regarding the treatment and management of adults with
personality disorders who may or may not have comorbid mental health conditions?
2. What are the evidence-based guidelines associated with the treatment and
management of adults with personality disorders who may or may not have comorbid
mental health conditions?
Key Findings
Three systematic reviews and 14 randomized controlled trials were identified examining the
clinical evidence regarding the treatment and management of adults with personality
disorders using psychotherapeutic methods. Three of the RCTs included patients with
comorbid depression or post-traumatic stress disorder.
Methods
A limited literature search was conducted on key resources including PubMed, The
Cochrane Library, University of York Centre for Reviews and Dissemination (CRD)
databases, Canadian and major international health technology agencies, as well as a
focused Internet search. Methodological filters were applied to limit retrieval to health
technology assessments, systematic reviews, meta-analyses, randomized controlled trials
and guidelines. Where possible, retrieval was limited to the human population. The search
was also limited to English language documents published between January 1, 2013 and
February 13, 2018. Internet links were provided, where available.
Selection Criteria
One reviewer screened citations and selected studies based on the inclusion criteria
presented in Table 1.
Table 1: Selection Criteria
Population Adults with personality disorders, with or without comorbid post-traumatic stress disorder [PTSD] and/or depression
Intervention Psychotherapy
Comparators Q1: Psychotherapy Pharmacological therapy; Wait list Q2: No comparator
Outcomes Q1: Effectiveness of treatment (primarily interested in which condition [if any] should be treated first, the personality disorder or the comorbid mental health condition [PTSD or depression], how well the treatment or management strategies work, etc.) Q2: Guidelines
Study Designs Health technology assessment reports, systematic reviews, meta-analyses, randomized controlled trials, evidence-based guidelines
SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 4
Results
Rapid Response reports are organized so that the higher quality evidence is presented first.
Therefore, health technology assessment reports, systematic reviews, and meta-analyses
are presented first. These are followed by randomized controlled trials and evidence-based
guidelines.
Three systematic reviews and 14 randomized controlled trials regarding the treatment and
management of adults with personality disorders with or without comorbid post-traumatic
stress disorder and/or depression were identified. No relevant health technology
assessment reports or evidence-based guidelines were identified.
Additional references of potential interest are provided in the appendix.
Overall Summary of Findings
Three systematic reviews (SR)1-3
and 14 randomized controlled trials (RCT)4-17
were
identified that examined the clinical evidence regarding the treatment and management of
adults with personality disorders (PD) using psychotherapeutic methods. Three of the
RCTs15-17
included patients with comorbid depression15,17
or post-traumatic stress disorder
(PTSD).16
Study details are included in Tables 2 and 3.
Psychotherapeutic interventions (type not specified) were observed to be more effective
than control interventions for the treatment of borderline personality disorder (BPD) of
differing severity in one SR.2 Although the authors of one SR
2 found that more intensive
treatment did not result in better outcomes than less intensive treatment, the authors of a
second SR3 found that self-harm was significantly reduced and social functioning was
significantly improved when patients had access to group therapy and when individual
therapy frequency was more than one time per week. A psychodynamic approach was also
observed to be effective in treating BPD symptoms in one SR.1
A dialectical behavioural therapy (DBT) approach to the treatment of BPD was found to be
effective in treating BPD symptoms in one SR1 and in two RCTs.
4,8 Specifically, DBT skills
training was observed to be effective in reducing suicidality,4 and non-suicidal self-injurious
behavior4,8
when compared with wait-list4 or with DBT without skills training.
8
Based on RCT evidence, other psychotherapeutic treatment options found to have some
effectiveness in patients with personality disorders were:
Democratic therapeutic community treatment was more effective than treatment as
usual (TAU), particularly for measures of aggression5
Manualized psychoanalytic-interactional therapy and non-manualized
psychodynamic therapy by experts were more effective than TAU and wait list for
improving levels of personality organization and psychological distress in in-
patients with cluster-B PDs6
Both cognitive rehabilitation and psychoeducational group interventions improved
daily functioning and clinical symptoms of BPD9
Schema therapy was associated with increased recovery from cluster-C PDs when
compared with TAU and clarification oriented therapy10
Emotion regulation group therapy was an effective add-on to TAU for female
patients with self-harm behaviours11
SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 5
Motive-oriented therapeutic relationship add-on to manualized ‘short variant’ of
general psychiatric management may be promising for patients with BPD12
Cognitive analytic therapy was more effective than TAU for patients with PD13
Both ‘intensive’ mentalization-based psychotherapy (MBT) and less intensive
group psychotherapy had effectiveness in treating BPD after 2 year follow-up.14
Psychoeducation and problem-solving therapy was not found to be an effective add-on
therapy to treatment as usual.7
Patients with Comorbid Depression or PTSD
For patients with comorbid cluster C personality disorders and depression, the authors of
one RCT observed that depression treatment as an add-on to PD treatment may be
beneficial.15
Authors of another RCT17
found that behavioural activation therapy was more
effective than antidepressant medication in treating depression in patients with and without
cluster-C personality disorders. Further, the PD was not associated in a difference in
treatment response.17
For female in-patients with PTSD and comorbid BPD, a dialectical behavior therapy
approach was found to be more effective than treatment as usual on the wait list.16
No relevant evidence-based guidelines were identified.
Table 2: Summary of Included Studies of the Clinical Evidence Regarding the Treatment and Management of Adults with Personality Disorders
First Author, Year
Study Design Details
Patient Group Details
Intervention, Comparator
Results and Author Conclusions
Systematic Reviews
Cristea, 20171 SR and MA of RCTs
33 trials examining 2,256 participants included
Adults diagnosed with BPD
Psychotherapy interventions Control interventions Psychotherapy add-on to treatment as usual vs treatment as usual also examined and reported separately
Post-test results: For combined BPD outcomes
(symptoms, self-harm, suicide), psychotherapy interventions and add-on psychotherapy interventions were ‘moderately’ better than control interventions (g = 0.32; 95% CI, 0.14-0.51 and g = 0.40; 95% CI, 0.15-0.65)
Psychotherapy superior to control regardless of add-on status for self-harm (g = 0.32; 95% CI, 0.09-0.54), suicide (g = 0.44; 95% CI, 0.15-0.74), health service use (g = 0.40; 95% CI, 0.22-0.58), and general psychopathology (g = 0.32; 95% CI, 0.09-0.55)
BPD relevant outcomes at follow-up (N = 13 trials):
Dialectical behavior therapy (g = 0.34; 95% CI, 0.15-0.53) and psychodynamic therapy (g = 0.41; 95% CI, 0.12-0.69) were
SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 6
First Author, Year
Study Design Details
Patient Group Details
Intervention, Comparator
Results and Author Conclusions
more effective than control interventions
Publication bias was identified as persistent
Authors concluded that psychotherapy treatment options (specifically dialectical and psychodynamic approaches) were effective at treating BPD symptoms.
Links, 20172
SR of 5 years of literature 16 articles included
Patients with BPD Psychotherapy interventions Comparator unclear
Psychotherapy was beneficial to patients with BPD of various severities. More ‘intensive’ therapies were not more effective than less intensive therapies. More research needed to examine outcomes for comorbid BPD and PTSD.
Omar, 20143 SR examining the
impact of treatment duration, treatment frequency, and access to group therapy 12 RCTs
Patients with BPD Psychotherapy interventions Comparator unclear
Reductions in self-harm and depression were statistically significant when the number of psychotherapy sessions were more than 1 per week and when there was access to group therapy, as were improvements in social functioning. Further research suggested regarding short vs long-term interventions.
Randomized Controlled Trials
McMain, 20174 Adjunct therapy
Assessments at 10, 20, 32 weeks
Patients with BPD at high risk for suicide 84 patients; 42 randomized to each group
Brief DBT skills training (20 weeks duration) Wait-list
32 week results: Patients in the DBT group had
more reduction in suicidal behaviours and on NSSI
* than
those in the wait list group (P < 0.0001)
Improvements in anger, distress tolerance and emotion regulation were higher in the DBT group than wait list
Authors concluded that brief DBT could be a useful intervention for patients with BPD at high risk for suicide.
Pearce, 20175 Outcome measurement
at 12 and 24 months following randomization
Patients meeting criteria for a personality disorder
DTC Treatment as usual
12 and 24 months: In-patient psychiatric use was low
in both groups (no difference)
SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 7
First Author, Year
Study Design Details
Patient Group Details
Intervention, Comparator
Results and Author Conclusions
24 months: Self-directed aggression and
aggression toward others, as well as satisfaction with care significantly improved in DTC group compared to control
Authors concluded that DTC was more effective that treatment as usual; expressed need for further study.
Leichsenring, 2016
6
Occurred within an in-patient facility Two groups were randomized; a third ‘control’ group of patients either receiving treatment as usual or waiting for treatment was also examined
In-patients with cluster-B personality disorders 122 patients (n = 64 for manualized intervention; n = 58 for non-manualized) were randomized; 46 patients were further included as controls
Manualized PIT Non-manualized E-PDT Control (treatment as usual or wait list)
Control patients: No significant improvements
reported PIT and E-PDT patients: “Significant improvements” in all
outcome measures were reported and improvements were reported as being superior to those in the control group
PIT and E-PDT did not appear to be different from each other in terms of effectiveness. Unclear if the ‘all’ outcome measures included both primary (level of personality organization and overall psychological distress) and secondary (depression, anxiety and interpersonal problems) outcomes.
McMurran, 2016
7 Superiority trial; multi-site Randomization stopped after 306 people due to adverse events Social Functioning Questionnaire (SFQ) was primary outcome
Adults with personality disorders. N = 306 (n = 154 in treatment group; n = 152 in control group) Mean age: 38 67% women
Psychoeducation and problem-solving therapy (PEPS) as an add-on to usual treatment. PEPS involved 4 individual psychoeducational sessions, 12 group sessions TAU
72 week follow-up:
73% of PEPS and 65% of TAU participants completed follow-up
There were no significant differences in SFQ scores between the PEPS group and TAU group (P = 0.19)
There was more self-harm in the PEPS group than the TAU group, however, the difference was not statistically significant (adjusted incidence rate ratio 1.24, 95% CI 0.93 to 1.64)
Authors concluded that PEPS was not an effective add-on to treatment as usual.
Linehan, 20168 Single blind (assessor
blinded)
Women with BPD who had at 2 or more suicide
DBT-S DBT-I
Suicide attempts (frequency and severity), suicidal ideation, use of crisis services (due to suicidality), and
SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 8
First Author, Year
Study Design Details
Patient Group Details
Intervention, Comparator
Results and Author Conclusions
1 year of treatment, 1 year of follow-up
attempts or acts of NSSI in the previous 5 years, 1 NSSI or suicide attempt in the 8 weeks prior to randomization, and 1 suicide attempt in the year prior to randomization N = 99 Mean age 30.3 years; 71% white
Standard DBT (includes skills training)
reasons for living all improved similarly in the three groups The groups with skills training had greater improvements in NSSI:
DBT-I vs. Standard DBT P < 0.001
DBT-I vs DBT-S P < 0.001 The groups with skills training had greater improvements in depression:
DBT-I vs. Standard DBT P = 0.03
DBT-I vs DBT-S P = 0.004 The groups with skills training had greater improvements in anxiety:
DBT-I vs. Standard DBT P = 0.001
DBT-I vs DBT-S P = 0.01
Drop-out rates (P = 0.04), crisis services use (P = 0.02), and psychiatric hospitalizations (P = 0.03) were lower for standard DBT vs. DBT-I. Authors concluded that a variety if DBT interventions were effective in reducing suicide attempts and NSSI and that DBT that includes skills training is likely more effective for patients with BPD than DBT without kills training.
Pascual, 20159 Multicenter, positive
controlled trial Follow-up 16 weeks and 6 months
Outpatients with BPD N = 70
Cognitive rehabilitation Psychoeducational group interventions
Psychoeducational interventions tended to enhance depressive symptoms. The groups did not seem to differ with respect to functionality following the interventions. Authors concluded that both cognitive rehabilitation and psychoeducational group interventions seemed to improve daily functioning and clinical symptoms for patients with BPD. Additionally, they are likely easy to implement.
Bamelis, 201410
Multicenter; single blind Follow-up 3 years (primary outcome was recovery from personality disorder)
Out-patients with cluster C personality disorders N = 323
Schema therapy TAU Clarification-oriented psychotherapy
The number of patients who recovered from their personality disorders was ‘significantly’ (P not reported) higher in the schema therapy group than TAU and clarification oriented therapy. TAU
SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 9
First Author, Year
Study Design Details
Patient Group Details
Intervention, Comparator
Results and Author Conclusions
and clarification oriented therapy recovery rates were not significantly different from each other. Secondary outcomes (dropout rates and measures of personality disorder traits, depressive and anxiety disorders, general psychological complaints, general and social functioning, self-ideal discrepancy, and quality of life) improved for patients in all three treatment groups. Authors concluded that schema therapy was more effective than TAU and clarification oriented psychotherapy in improving recovery rates. Additionally, exercise-based schema therapy was more effective than lecture-based schema therapy.
Gratz, 201411
14 week duration plus 9 month un-controlled follow-up Outcomes measured pre-, post-treatment; 3 months, 9 months follow-up
Female out-patients with BPD and recently deliberate self-harm N = 61 (n = 30 in treatment group; n = 31 in control group)
ERGT add-on to TAU immediately; 14 weeks of treatment Waitlist for ERGT add-on to TAU (14 week wait)
ITT analysis:
ERGT had ‘significant’ effects on destructive self-harm, self-harm symptoms, emotional dysregulation, BPD symptoms, depressive symptoms, stress symptoms, and quality of life
Analysis of patients who began ERGT (at any point; n = 51):
Patients had ‘significant’ improvements in all outcomes when pre- and post- tests were compared
Deliberate self-harm, emotional dysregulation, BPD symptoms, and quality of life further improved through to the 9 month follow-up
Authors concluded that ERGT add-on therapy was effective and treatment improvements had ‘durability.’
Kramer, 201412
RCT
Patients with BPD N = 85
MOTR add-on to manualized ‘short variant’ of general psychiatric management Manualized ‘short variant’ of general psychiatric management for 10
ITT analysis:
MOTR had ‘global efficacy’ and resulted in reduction of outcomes such as symptoms, interpersonal problems and social problems (P = 0.05)
MOTR did not result in reductions in specific BPD symptoms
Authors called MOTR ‘promising’ and
SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 10
First Author, Year
Study Design Details
Patient Group Details
Intervention, Comparator
Results and Author Conclusions
sessions suggested that shortening BPD treatment may have merit.
Clarke, 201313
‘Service-based’ Patients with personality disorder N = 78 (n = 38 intervention; n = 40 control)
CAT; 24 sessions TAU; 10 months
Patients in the CAT group had a reduction in symptoms and ‘experienced benefits’ compared to TAU. Those in the TAU group had significant deterioration throughout the treatment period. Authors concluded that CAT was more effective than TAU in improving personality disorder outcomes.
Jorgensen, 2013
14 2 years duration Patients with BPD
N = 85
‘Intensive’ (twice weekly) individual and group MBT Biweekly supportive group therapy
N = 58 completed 2 years of treatment Both treatment groups saw significant changes in self-reported measures of general functioning, depression, social functioning, and several BPD diagnostic symptoms. Therapist–rated global assessment of functioning was significantly higher in the MBT group than the control group. There was a trend toward BPD recovery in the MBT group. Authors concluded that both treatment options were effective when administered by ‘well-trained, experienced psychodynamic staff in a well-run clinic.’
BPD = borderline personality disorder; CAT = cognitiv e analy tic therapy ; DBT = dialectical behav ior therapy ; DBT-I = dialectical behav ior therapy indiv idual therapy plus
activ ities (no skills training); DBT-S = dialectical behav ior therapy skills training plus case management; DTC = democratic therapeutic community treatment; ERGT =
emotion regulation group therapy ; E-PDT = psy chody namic therapy by experts; ITT = intention to treat; MA = meta-analy sis; MBT = mentalization-based psy chotherapy ;
MOTR = motiv e-oriented therapeutic relationship; NSSI = non-suicidal self -injury ; PEPS = Psy choeducation and problem-solv ing therapy ; PIT = psy choanaly tic-
interactional therapy ; PTSD = post-traumatic stress disorder; RCT = randomized controlled trial; SFQ = Social Functioning Questionnaire; SR = sy stematic rev iew; TAU =
treatment as usual; v s = v ersus.
SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 11
Table 3: Summary of Randomized Controlled Trials Examining the Clinical Evidence
regarding the Treatment of Adults with Comorbid Personality Disorder and Depression or Post-Traumatic Stress Disorder
First Author, Year
Study Design Details
Patient Group Details
Intervention, Comparator
Results and Author Conclusions
Renner, 201415
Same study population as Bamelis, 2014
10
Patients with cluster-C personality disorders N = 320; number of patients with depression not reported
Schema therapy TAU Clarification-oriented therapy
Patients with comorbid depression had higher baseline PD severity than those without. Depression at baseline was associated with:
reduced rates of recovery from PD at the 3 year follow-up (P = 0.01)
higher rates of psychosocial impairment (P < 0.01)
Comorbid depression did not moderate the treatment effect (with the exception of one psychosocial measure). Authors concluded that patients with cluster-C PD and comorbid depression may benefit from add-on depression treatment while receiving treatment for a PD.
Bohus, 201316
Assessor blinded Outcomes measured after treatment, 6-weeks, and 12-weeks follow-up
Female in-patients with CSA-related PTSD with and without BPD N = 74
DBT-PTSD residential program TAU waitlist
Diagnosis of BPD did not affect the efficacy of the DBT-PTSD program. Authors concluded that a DBT-PTSD program was effective for female patients with CSA-related PTSD and comorbid BPD
Moradveisi, 2013
17
Outcomes assessed at 0, 4, 13, and 49 weeks
Out-patients with major depressive disorder with and without PD N = 100 (50 in each group)
Behavioural activation therapy Antidepressant medication
Patients with cluster-C PDs had higher depression scores at baseline than those without PD. Patients with PD did not respond to treatment differently than those without, both at the short- and long-term follow-ups. Behavioural activation therapy was more effective in reducing depressive symptoms than antidepressant medication in patients with or without PD. PD was associated with higher drop-out rates. Cluster-C PDs was associated with higher depression severity but not to
SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 12
First Author, Year
Study Design Details
Patient Group Details
Intervention, Comparator
Results and Author Conclusions
differences in treatment response.
BPD = borderline personality disorder; CSA = childhood sexual abuse; DBT = dialectical behav ioural therapy ; PD = personality disorder; PTSD = post-traumatic stress
disorder; RCT = randomized controlled trial; TAU = treatment as usual.
References Summarized
Health Technology Assessments
No literature identified
Systematic Reviews and Meta-analyses
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SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 13
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Personality Disorders with Comorbid Depression or Post-Traumatic Stress
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SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 14
16. Bohus M, Dyer AS, Priebe K, Kruger A, Kleindienst N, Schmahl C, et al. Dialectical
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17. Moradveisi L, Huibers MJ, Renner F, Arasteh M, Arntz A. The influence of comorbid
personality disorder on the effects of behavioural activation vs. antidepressant
medication for major depressive disorder: results from a randomized trial in Iran. Behav
Res Ther. 2013 Aug;51(8):499-506.
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Guidelines and Recommendations
No literature identified
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SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 15
Appendix — Further Information
Previous CADTH Reports
18. Intensive day treatment programs for mental health treatment: a review of clinical
effectiveness, cost-effectiveness, and guidelines [Internet]. Ottawa: CADTH; 2017.
[cited 2018 Feb 22]. (CADTH Rapid response report: summary with critical appraisal).
Available from: https://www.cadth.ca/intensive-day-treatment-programs-mental-health-
treatment-review-clinical-effectiveness-cost
Qualitative Systematic Review
19. Lana F, Fernandez-San Martin MI. To what extent are specific psychotherapies for
borderline personality disorders efficacious? A systematic review of published
randomised controlled trials. Actas Esp Psiquiatr. 2013 Jul;41(4):242-52.
PubMed: PM23884616
Randomized Controlled Trials (RCTs)
Secondary Analyses of RCTs of Patients With or Without Comorbidities
20. Erkens N, Schramm E, Kriston L, Hautzinger M, Harter M, Schweiger U, et al.
Association of comorbid personality disorders with clinical characteristics and outcome
in a randomized controlled trial comparing two psychotherapies for early-onset
persistent depressive disorder. J Affect Disord. 2018 Mar 15;229:262-8.
PubMed: PM29329058
21. Berthoud L, Pascual-Leone A, Caspar F, Tissot H, Keller S, Rohde KB, et al. Leaving
distress behind: a randomized controlled study on change in emotional processing in
borderline personality disorder. Psychiatry. 2017;80(2):139-54.
PubMed: PM28767333
22. Kredlow MA, Szuhany KL, Lo S, Xie H, Gottlieb JD, Rosenberg SD, et al. Cognitive
behavioral therapy for posttraumatic stress disorder in individuals with severe mental
illness and borderline personality disorder. Psychiatry Res. [Internet] 2017 Mar [cited
2018 Feb 22];249:86-93. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325773
PubMed: PM28086181
23. Thylstrup B, Schroder S, Fridell M, Hesse M. Did you get any help? A post-hoc
secondary analysis of a randomized controlled trial of psychoeducation for patients with
antisocial personality disorder in outpatient substance abuse treatment programs. BMC
Psychiatry. [Internet] 2017 Jan 9 [cited 2018 Feb 22];17(1):7. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223491
PubMed: PM28068951
24. Bateman A, O'Connell J, Lorenzini N, Gardner T, Fonagy P. A randomised controlled
trial of mentalization-based treatment versus structured clinical management for
patients with comorbid borderline personality disorder and antisocial personality
disorder. BMC Psychiatry. [Internet] 2016 Aug 30 [cited 2018 Feb 22];16:304. Available
from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006360
PubMed: PM27577562
https://www.cadth.ca/intensive-day-treatment-programs-mental-health-treatment-review-clinical-effectiveness-costhttps://www.cadth.ca/intensive-day-treatment-programs-mental-health-treatment-review-clinical-effectiveness-costhttp://www.ncbi.nlm.nih.gov/pubmed/23884616http://www.ncbi.nlm.nih.gov/pubmed/29329058http://www.ncbi.nlm.nih.gov/pubmed/28767333http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325773http://www.ncbi.nlm.nih.gov/pubmed/28086181http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223491http://www.ncbi.nlm.nih.gov/pubmed/28068951http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006360http://www.ncbi.nlm.nih.gov/pubmed/27577562
SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 16
25. Keefe JR, Webb CA, DeRubeis RJ. In cognitive therapy for depression, early focus on
maladaptive beliefs may be especially efficacious for patients with personality disorders.
J Consult Clin Psychol. [Internet] 2016 Apr [cited 2018 Feb 22];84(4):353-64. Available
from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936187
PubMed: PM26727410
26. Kikkert MJ, Driessen E, Peen J, Barber JP, Bockting C, Schalkwijk F, et al. The role of
avoidant and obsessive-compulsive personality disorder traits in matching patients with
major depression to cognitive behavioral and psychodynamic therapy: A replication
study. J Affect Disord. 2016 Nov 15;205:400-5.
PubMed: PM27598693
Follow-up to Original Randomized Studies
27. Antonsen BT, Kvarstein EH, Urnes O, Hummelen B, Karterud S, Wilberg T. Favourable
outcome of long-term combined psychotherapy for patients with borderline personality
disorder: Six-year follow-up of a randomized study. Psychother Res. 2017 Jan;27(1):51-
63.
PubMed: PM26261865
28. Kramer U, Stulz N, Berthoud L, Caspar F, Marquet P, Kolly S, et al. The shorter the
better? A follow-up analysis of 10-session psychiatric treatment including the motive-
oriented therapeutic relationship for borderline personality disorder. Psychother Res.
2017 May;27(3):362-70.
PubMed: PM26684670
29. Antonsen BT, Klungsoyr O, Kamps A, Hummelen B, Johansen MS, Pedersen G, et al.
Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6 -
year follow-up of the Ulleval personality project. BMC Psychiatry. [Internet] 2014 Apr 23
[cited 2018 Feb 22];14:119. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000615
PubMed: PM24758722
Non-Randomized Studies – Current or Veteran Military
30. Holder N., Holliday R., Pai A., and Surís A. Role of borderline personality disorder in the
treatment of military sexual trauma-related posttraumatic stress disorder with cognitive
processing therapy. Behavioral Medicine. [Internet] 2017 [cited 2018 Feb 22].
43(3):184-190. Available from:
http://www.tandfonline.com/doi/abs/10.1080/08964289.2016.1276430?journalCode=vb
md20
31. Meyers, L., Voller, E. K., McCallum, E. B., Thuras, P., Shallcross, S., Velasquez, T. and
Meis, L. Treating veterans with PTSD and borderline personality symptoms in a 12-
week intensive outpatient setting: findings from a pilot program. Journal of Traumatic
Stress. [Internet] 2017 [cited 2018 Feb 22]; 30: 178–181. Available from:
http://onlinelibrary.wiley.com/doi/10.1002/jts.22174/abstract
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936187http://www.ncbi.nlm.nih.gov/pubmed/26727410http://www.ncbi.nlm.nih.gov/pubmed/27598693http://www.ncbi.nlm.nih.gov/pubmed/26261865http://www.ncbi.nlm.nih.gov/pubmed/26684670http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000615http://www.ncbi.nlm.nih.gov/pubmed/24758722http://www.tandfonline.com/doi/abs/10.1080/08964289.2016.1276430?journalCode=vbmd20http://www.tandfonline.com/doi/abs/10.1080/08964289.2016.1276430?journalCode=vbmd20http://onlinelibrary.wiley.com/doi/10.1002/jts.22174/abstract
SUMMARY OF ABSTRACTS Treatment of Personality Disorders in Adults With or Without Comorbid Mental Health Conditions 17
Consensus Statements, Quality Standards, or Guidelines with Unclear or Non-Rigorous Methods
32. Shining the light in dark corners of people’s lives: The consensus statement for people
with complex mental health difficulties who are diagnosed with a personality disorder.
[Internet] Cardiff (GB): Mind.org; 2018 [cited 2018 Feb 22]. Available from:
https://www.mind.org.uk/media/21163353/consensus-statement-final.pdf
33. Borderline personality disorders: psychological treatments [Internet]. Atlanta (GA):
Division 12 of the American Psychological Association; 2016 [cited 2018 Feb 22].
Available from: https://www.div12.org/psychological-treatments/disorders/borderline-
personality-disorder/
34. Personality disorders: borderline and antisocial [Internet]. London (GB): National
Institute for Health and Care Excellence; 2015 [cited 2018 Feb 22]. (Quality Standard
QS88). Available from: https://www.nice.org.uk/guidance/qs88
35. National clinical guideline for the treatment of emotionally unstable personality disorder,
borderline type [Internet]. Copenhagen (DK): Danish Health Authority; 2016 [cited 2018
Feb 22]. Available from:
https://www.sst.dk/en/publications/2015/~/media/D39B3600DE4A49DC8D3FF0FC2B8C
4B9E.ashx
Clinical Practice Guidelines – Rigour of Methodology Unclear
36. Clinical practice guideline for the management of borderline personality d isorder
[Internet]. Canberra (AU): Australian Government National Health and Medical
Research Council; 2013 [cited 2018 Feb 22]. Available from:
https://www.nhmrc.gov.au/guidelines-publications/mh25
Patient Care Pathways
37. Personality disorders [Internet]. London (GB): National Institute for Health and Care
Excellence; 2017 [cited 2018 Feb 22]. Available from:
https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-
behavioural-conditions/personality-disorders
Note: See also flowchart https://pathways.nice.org.uk/pathways/personality-disorders
38. Personality disorder service pathway [Internet]. Inverness (GB): NHS Highland; 2015
[cited 2018 Feb 22]. Available from:
http://www.nhshighland.scot.nhs.uk/Services/Pages/Personalitydisorderservice.aspx
See: PDFs embedded midway down page
https://www.mind.org.uk/media/21163353/consensus-statement-final.pdfhttps://www.div12.org/psychological-treatments/disorders/borderline-personality-disorder/https://www.div12.org/psychological-treatments/disorders/borderline-personality-disorder/https://www.nice.org.uk/guidance/qs88https://www.sst.dk/en/publications/2015/~/media/D39B3600DE4A49DC8D3FF0FC2B8C4B9E.ashxhttps://www.sst.dk/en/publications/2015/~/media/D39B3600DE4A49DC8D3FF0FC2B8C4B9E.ashxhttps://www.nhmrc.gov.au/guidelines-publications/mh25https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions/personality-disordershttps://www.nice.org.uk/guidance/conditions-and-diseases/mental-health-and-behavioural-conditions/personality-disordershttps://pathways.nice.org.uk/pathways/personality-disordershttp://www.nhshighland.scot.nhs.uk/Services/Pages/Personalitydisorderservice.aspx