Crisis interventions for adults with borderline personality disorder

What is borderline personality disorder?

Borderline personality disorder (BPD) is a complex and severe mental disorder that affects about 2% of the general population. Many people diagnosed with BPD have unstable relationships and distressing and rapid changes in emotions, leading to frequent crises. These crises are critical periods, as they may lead to increased drug and alcohol use, fewer contacts with health professionals and self‐harm, which may be life‐threatening.

What did we want to find out?

To date, little is known about what might help people diagnosed with BPD when they are experiencing an acute crisis. In this review, we wanted to discover whether crisis interventions are effective for people diagnosed with BPD by looking at evidence from randomised controlled trials (where some participants (intervention group) are randomly assigned to receive an experimental treatment, and the others (control group) are randomly assigned to receive a dummy treatment (placebo), no treatment or the usual treatment).

What did we find?

We searched medical databases and found two studies that addressed this issue. 

In one study, the intervention group had a joint crisis plan (a document explaining their treatment preferences for the management of future crises, which they could carry with them and refer to in the event of a crisis). This document is similar to a wellness recovery action plan, but is written with a mental health professional, rather than only by the individual. The intervention group also had access to usual care, which was provided by a community mental health team and included regular contact with an allocated member of the team. The control group received usual care only.

In the other study, the intervention group could choose to be admitted to a mental health hospital for up to three days at a time of crisis (brief admission), in addition to receiving usual care. The control group received usual care only. 

Government research councils and non‐profit foundations funded the studies.

Main results

In the joint crisis plan study, there was no clear evidence of an effect on death, self‐harm, time spent in a mental health hospital, and quality of life. The written document may be more cost‐effective than usual treatment, but the study authors were not confident about this.

The brief admission study showed no clear evidence of a difference between brief admission and the usual treatment for death, self‐harm, suicide attempts, violence perpetration, and admission to a mental health hospital.

What are the limitations of the evidence?

We have little confidence in the evidence, because it does not cover all the people we were interested in, it was based on only one study, and the participants reported some results themselves.

Given that crises in people diagnosed with BPD are distressing and potentially dangerous periods associated with increased risk of suicide, further research is urgently needed to enhance the evidence base in this area. This research should be in the form of large, well‐designed trials so that we can be confident in the effect of the intervention.

How up‐to‐date is this review?

The searches were completed in January 2022. 

Read the full review here on the Cochrane Library.