Two new reviews of clinical studies conclude that no single treatment is especially effective for patients with borderline personality disorder, according to an article in Issue 1 (2006) of the Cochrane Database of Systematic Reviews.

British researchers concluded that patients with the disorder appear to respond more strongly to certain kinds of psychological “talk” therapies, but the psychological treatments that showed the most promise were relatively new and did not have enough supporting data to draw a conclusion with confidence.

Because both types of talk therapy are complex, intensive therapies that require long-term staff training, the authors noted they did not believe such therapy would become available for more than a few patients.

The team, led by Conor Duggan of the University of Nottingham and Clive Adams of the University of Leeds, UK, conducted separate reviews on psychological and drug therapies for borderline personality disorder. The team analyzed findings from seven studies on structured talking therapies, comprising 262 adult outpatients with either a formal diagnosis of borderline personality disorder or at least three criteria for the illness.

People undergoing a treatment called dialectical behavior therapy appeared to have fewer suicide attempts or thoughts of suicide at six months compared with patients in usual care. Introduced in 1991, the treatment involves individual psychotherapy sessions, telephone coaching, lengthy group therapy sessions and cognitive modification.

Treating patients in a day hospital unit geared to psychoanalytic treatment also seemed to “decrease admission and use of prescribed medication and increase social improvement and social adjustment,” the reviewers found.

Although both treatments are “difficult to apply to everyday care,” the researchers said that results so far suggest that “the problems of people with borderline personality disorder may be amenable to treatment.”

Roughly 2 percent of the general population and 20 percent of psychiatric inpatients have borderline personality disorder. Borderline patients are overwhelmingly female (75 percent).

“This group of people is often a challenge to health service providers,” said Doctor Mark Fenton, a coauthor of the study. He noted that patients have difficulty engaging in relationships, including relationships with therapists.

Unlike some other psychiatric conditions, there is no widely accepted drug regimen for borderline personality disorder.

The second review pooled results from 10 small, short-term randomized studies on drug therapies for borderline personality disorder involving 554 inpatients and outpatients.

Studies of various drugs used “show that antidepressants offered the best chance of improvement, but even here, results were not robust,” according to Fenton. “For ratings of anger, fluoxetine may offer some improvement over placebo.”

Although the antipsychotic drug haloperidol showed some improvement in symptoms of hostility, “the numbers are so small it is likely to be a false positive,” said Fenton. The reviewers do not recommend the use of antipsychotic drugs for borderline personality disorder outside of clinical trials.

Although the drug data were not encouraging, “that does not mean (medication) may not do considerable good, and there is no indication of significant harm,” the reviewers wrote. “People with borderline personality disorders or their caregivers are in a position to lobby for and facilitate good research in this area.”