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Effect of 3 forms of early intervention for young people with borderline personality disorder

JAMA Feb 05, 2022

Among young people with borderline personality disorder (BPD), findings demonstrated that effective early intervention did not depend on availability of specialist psychotherapy but did need youth-oriented clinical case management and psychiatric care.

  • This single-blinded randomized clinical trial was conducted to assess the effectiveness of 3 early interventions for BPD of differing complexity.

  • The included interventions were: (1) The Helping Young People Early (HYPE) dedicated BPD service model for young people, integrated with weekly cognitive analytic therapy (CAT); (2) HYPE plus a weekly befriending psychotherapy control condition; and (3) a general youth mental health service (YMHS) model, plus befriending; thus, the 3 treatment arms were HYPE + CAT, HYPE + befriending, and YMHS + befriending.

  • Main outcome was psychosocial functioning, evaluated with the Inventory of Interpersonal Problems Circumplex Version and the Social Adjustment Scale Self-report.

  • A mean of 19.3% to 23.8% improvement in the primary outcomes and 40.7% to 52.7% for all secondary outcomes, except severity of substance use and client satisfaction, was evident from baseline to 12 months irrespective of the group.

  • According to planned comparisons (YMHS + befriending vs HYPE; HYPE + CAT vs befriending), the service model or the psychotherapy intervention was not linked with a superior rate of change in psychosocial functioning by the 12-month primary endpoint.

  • Regarding treatment attendance and treatment completion, the HYPE service model was found to be better than YMHS + befriending.

  • Superiority of HYPE + CAT over befriending was found with regard to treatment attendance (median [IQR], 12 [16.5] vs 3 [9.8] sessions) and treatment completion (24 of 46 [52.2%] vs 29 of 93 [31.2%]).

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