Cailhol L, Bui E, Rouillon L, Bruno N, Lemoalle A, Faure K, Klein R, Lamy P, Guelfi J-D, Schmitt L
Inserm CIC 9302 Toulouse, hôpital Purpan, CHU de Toulouse, pavillon Riser, TSA 40031, 31059 Toulouse cedex 09, France.
Encephale. 2011 May;37 Suppl 1:S77-82. doi: 10.1016/j.encep.2010.04.002. Epub 2010 May 23.
Borderline personality disorder (BPD) accounts for 10% of outpatient psychiatric practice. The risk of suicide attempts is high and the psychosocial impairment significant. Different theoretical streams have suggested psychotherapeutical approaches for BPD.
to examine the efficacy of psychotherapy for BPD patients on affective symptoms, behavioural outcomes, interpersonal and social functioning, as well as BPD criteria.
We reviewed the medical literature from 1990 to 2008 on Medline by combining the following keywords "borderline personality disorder" and "psychotherapy" (inclusion criteria). We restricted the analysis to "randomised control trial" or "meta analysis".
Of the 39 abstracts that came out from the search, we selected 17 (44%) after applying the exclusion criteria. According to our review, different types of psychotherapies have shown some efficacy on reducing affective symptoms and BPD criteria, as well as improving behavioural outcomes and psychosocial functioning. Dialectical behavioural therapy presents the best-documented efficacy, notably on reducing self-mutilating and suicidal behaviours (five randomized controlled trials [RCT]). Mentalization based treatment seems to be efficient on the four types of outcomes, but has been the object of only one RCT. Finally, some evidence suggests that Manual Assisted Cognitive Treatment and Systems Training for Emotional Predictability and Problem Solving are the most cost-effective and easiest to be implemented.
According to our review, some evidence supports an efficiency of psychotherapies in the management of several features of BPD. It is likely that, depending on the target symptoms, one type of therapy might be more efficient than another. The acceptability of these long-term treatments is however unknown.
边缘型人格障碍（BPD）占门诊精神科诊疗病例的10%。自杀未遂风险高，社会心理损害严重。不同的理论流派提出了针对BPD的心理治疗方法。
研究心理治疗对BPD患者情感症状、行为结果、人际及社会功能以及BPD诊断标准的疗效。
我们通过组合关键词“边缘型人格障碍”和“心理治疗”（纳入标准），检索了1990年至2008年Medline上的医学文献。分析限于“随机对照试验”或“荟萃分析”。
在检索出的39篇摘要中，应用排除标准后我们选择了17篇（44%）。根据我们的综述，不同类型的心理治疗在减轻情感症状和BPD诊断标准、改善行为结果及社会心理功能方面均显示出一定疗效。辩证行为疗法的疗效记录最为充分，尤其是在减少自残和自杀行为方面（五项随机对照试验[RCT]）。基于心理化的治疗似乎对四种类型的结果均有效，但仅有一项RCT以其为研究对象。最后，一些证据表明，手册辅助认知治疗和情绪可预测性及问题解决系统训练是最具成本效益且最易于实施的。
根据我们的综述，一些证据支持心理治疗对BPD若干特征的治疗有效。根据目标症状的不同，一种治疗类型可能比另一种更有效。然而，这些长期治疗的可接受性尚不清楚。
