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Letters to the Editor
May 2007

Knowledge of the Effectiveness of Treatments for Borderline Personality Disorder Is Not Yet Sufficient to Justify the Lack of a Control Condition

Arch Gen Psychiatry. 2007;64(5):609. doi:10.1001/archpsyc.64.5.609-b

The trial reported by Giesen-Bloo et al1 relies for its usefulness on the assumption, referred to in the article, that “specialized psychotherapeutic approaches are more effective than control conditions.” This is not a valid assumption. Research on the treatment of borderline personality disorder has not yet reached the stage where superiority over a treatment as usual control condition can be assumed, in particular when the treatments being investigated have not previously demonstrated efficacy. The articles cited in support of this approach represent trials in specific groups (for example, self-harming women between the ages of 18 and 45 years)2 with small numbers.2,3 Cognitive-behavioral therapy, of which schema-focused therapy is a form, has in the past failed to provide evidence of benefit,4 further calling into question the assumption of superiority over control in this particular trial. Outpatient psychodynamic psychotherapy has demonstrated effectiveness in treating personality disorder only under similar conditions to this trial (ie, no treatment as usual control).5 Indeed, Giesen-Bloo et al point out that a significant change to the underlying disorder has not been demonstrated convincingly in previous treatment trials for borderline personality disorder.

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