The British Journal of Psychiatry (2008) 193: 477-484. doi: 10.1192/bjp.bp.107.048934
© 2008 The Royal College of Psychiatrists
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Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial

Andrew M. Chanen, MBBS, MPM, FRANZCP

ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, and ORYGEN Youth Health, Northwestern Mental Health, Melbourne

Henry J. Jackson, PhD, FAPS

School of Behavioural Science, University of Melbourne

Louise K. McCutcheon, Dpsych

ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, and ORYGEN Youth Health, Northwestern Mental Health, Melbourne

Martina Jovev, PhD

ORYGEN Research Centre, Department of Psychiatry, University of Melbourne

Paul Dudgeon, PhD

School of Behavioural Science, University of Melbourne

Hok Pan Yuen, MSc

ORYGEN Research Centre, Department of Psychiatry, University of Melbourne

Dominic Germano, Mpsych and Helen Nistico, Mpsych

ORYGEN Youth Health, Northwestern Mental Health, Melbourne

Emma McDougall, BSc, Caroline Weinstein, BSc and Verity Clarkson, BSc

ORYGEN Research Centre, Department of Psychiatry, University of Melbourne

Patrick D. McGorry, MD, PhD, FRANZCP

ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, and ORYGEN Youth Health, Northwestern Mental Health, Melbourne, Australia

Correspondence: Dr Andrew Chanen, ORYGEN Research Centre, Locked Bag 10, Parkville, Victoria 3052, Australia. Email: achanen{at}unimelb.edu.au

Declaration of interest

None. Funding detailed in Acknowledgements.

Background

No accepted intervention exists for borderline personality disorder presenting in adolescence.

Aims

To compare the effectiveness of up to 24 sessions of cognitive analytic therapy (CAT) or manualised good clinical care (GCC) in addition to a comprehensive service model of care.

Method

In a randomised controlled trial, CAT and GCC were compared in out-patients aged 15–18 years who fulfilled two to nine of the DSM–IV criteria for borderline personality disorder. We predicted that, compared with the GCC group, the CAT group would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24 months.

Results

Eighty-six patients were randomised and 78 (CAT n=41; GCC n=37) provided follow-up data. There was no significant difference between the outcomes of the treatment groups at 24 months on the pre-chosen measures but there was some evidence that patients allocated to CAT improved more rapidly. No adverse effect was shown with either treatment.

Conclusions

Both CAT and GCC are effective in reducing externalising psychopathology in teenagers with sub-syndromal or full-syndrome bipolar personality disorder. Larger studies are required to determine the specific value of CAT in this population.


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