The methodology used in the study by Bohus that examined the use of DBT to treat borderline personality disorder, especially in the context of suicidal tendency was also based on a relatively large sample of patients with a diagnosis of borderline personality disorder, although th authors note that this was not a truly random sample due to the use of a waiting list that was based on a “first come, first serve” basis. However, like the study mentioned above, it made use of a control group to allow for comparison between those receiving DBT and those who remained in their original treatment location and module, although it is noted that the treatment being received was more general and not geared specifically towards borderline personality disorder. Unlike the study conducted by Rinne and colleagues, this study eliminated the “danger factor” as it left the control group within treatment during the study and did not actively have them stop any previous treatments. Interestingly, both the study by Rinne and Bohus used exclusively female participants.

The Weinberg study of the MACT approach to treating the self-mutilating and suicidal symptoms of borderline personality disorder also used all female participants, just as the other two that have been noted did. Of all of the 30 participants, all must have had at least one instance of self-harm in the last month prior to enrollment in the study. Those with substance abuse or other serious co-morbid disorders were declined for participation. As in the other two studies mentioned previously, there was a control group and unlike in the Rinne study, this group remained in their normal courses of treatment. Following the selection and elimination process, the non-control group went for the sessions while the controls continued treatment elsewhere with a final follow-up with both groups between 6-8 weeks following the study.

Results

The results of the study conducted for the SSRI treatment using the placebo-controlled study (Rinne et al. 2002) revealed that fluvoxamine was effective in treating some of the quick changes in moods associated with borderline personality disorder, but it did not aid in the tempering of the aggressive behaviors or the tendency toward impulsivity in the all-female sample. The authors note that this might be because there are pre-existing differences in the nature of impulsiveness and aggression between genders.

While the results of the study by Rinne posed several more questions than answers in the results section, the study by Bohus that examined the effectiveness of a behavior-based approach to treatment known as DBT was more concise in its findings and offered more in the way of stability. It distinctly showed that of the sample, those who were in the DBT program for three months demonstrated far fewer signs of suicidal behaviors and in addition, according the Jacobson’s scale used to measure mood and current mental status, these patients were also higher functioning on other related aspects of mental health, seeing improvements in their abilities with other people and a decrease in self-mutilation, for example.

The results of the Weinberg study (2006) yielded positive correlations between a reduction in self-mutilating and/or suicidal actions or thoughts based on this intensive, short behavioral modification course of treatment. Furthermore, in comparison to the control group, “these treatment gains were maintained at a 6-month follow-up for DSH [deliberate self harm] frequency” (Weinberg et. al 2006). Just as in the cases of the other courses of treatment described in this comparative analysis, the results were favorable for the treatment proposed, although in this one, there were strong limitations based on the very small sample.

Conclusions

What the Rinne study that connected the use of the SSRI fluvoxamine and the mood swings with borderline personality disorder accomplished was not simply serve as a proving ground for SSRIs as useful treatment options for this criteria of borderline personality disorder, was to further offer more insights into the disorder. For instance, at the end of the study, the positive effects of the SSRI also benefited those who had other coexisting mood or other disorders, including depression or PTSD. They also found that the first plateau in the effectiveness of this treatment is around 6 weeks and that after the follow-up, which would be 18 weeks after taking the SSRI, the positive benefits continued.
Just as the study by Rinne and colleagues, this study demonstrated that symptoms of borderline personality can be treated. While the mood changes were most affected by the SSRI treatments, DBT as the main treatment in the study by Bohus was shown to greatly improve one’s tendency toward self-mutilation and/or suicidal ideation in a sustained way for around 50% of the females who received the DBT treatment.

General Conclusions and Analysis

One interesting component of the studies by Rinne (2002) and Bohus (2004) is that there appears to be a pattern of possible treatment emerging. Since the SSRI treatment was effective at treating the major mood shifts in persons with borderline personality disorder, if combined with DBT to control some of the other negative behaviors, such as suicidal ideation, for instance, this could be a breakthrough in treatment. Additionally, since the study by Bohus also showed a marked improvement in other aspects of the female sample, including their ability to have interact with others better, for instance, it seems that many of the criteria as set forth in the DSM-IV as classifying one with borderline personality disorder might be eliminated or, perhaps more realistically, diminished in severity.

One limitation of the study by Bohus (2004) which is openly stated is that it did not have a random selection process at the centerpiece of its methodology and, as the authors state, they “cannot rule out an alternate hypothesis that individuals who got on the waiting list first, and thus, had a better chance of getting into the DBT program different in some significant way from those who did not apply for treatment early enough” (Bohus 2004). While this is a legitimate concern regarding this study, it seems that with another attempt using a truly random sample, would be in order. While the study by Rinne did use a random sample, it seems that it was a highly risky study as it required patients to go off of their medications and halt treatment. Furthermore, in order to minimize this risk of having participants out of treatment, the study was especially short. While the study by Weinberg was also short (as it was based on a course of treatment that was created to not be lengthy) the sample was very small and in the discussion about the limitations, this was cited as one of the most important potential breeches in the reliability of the data since the statistics could so easily be overly weighted.

What these studies show is that there are many promising angles of treatment for borderline personality disorder, which range from those with the theoretical background rooted in the biological to the behavioral. Interestingly, although all three studies demonstrated a positive connection between the treatment being suggested and the results, more research is needed to determine whether or not a combined approach that uses the proven elements of all three of these studies (and others) would be most viable.

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References

The American Psychological Association. (2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (DSM-IV)(303.83). New York: American Psychological Association.

Bohus. (2004). Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behaviour Research and Therapy, 42(5), 487-499.

Rinne T, ., van den Brink W, ., Wouters L, ., & van Dyck R, . (2002). SSRI treatment of borderline personality disorder: a randomized, placebo-controlled clinical trial for female patients with borderline personality disorder. American Journal of Psychiatry, 159(12), 2048-2054.

Weinberg I, ., Gunderson JG, ., Hennen J, ., & Cutter CJ Jr, . (2006). Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients. Journal of Personality Disorders, 20(5), 482-492