The Impact of Psychological Interventions on Functioning in the Context of Borderline Personality Disorder Features for Adolescents and Young Adults: A Systematic Review and Meta‐Analysis

TL;DR

This study reviews how psychological treatments affect functioning in adolescents and young adults with borderline personality disorder features.

Contribution

The paper provides a systematic review and meta-analysis of psychological interventions for BPD features in youth, revealing similar outcomes between specialized and generalist treatments.

Findings

Psychological interventions improved functioning from baseline to post-treatment and follow-up.

Specialized interventions did not significantly outperform generalist treatment as usual.

Effect sizes were small with substantial heterogeneity across studies.

Abstract

Adolescents recruited from clinical samples with borderline personality disorder (BPD) often experience significant functional impairment across multiple domains. Evidence indicates that borderline personality features emerging before adulthood can predict long‐term difficulties and may worsen over time. However, the role of assessment methods and the impact of psychological interventions on functional outcomes remain unclear.

A systematic review and meta‐analysis of randomised controlled trials (RCTs) was conducted to evaluate the impact of psychological interventions on functioning in adolescents and young adults with BPD features. Four databases (PsycINFO, Medline, Embase and CINAHL) were searched up to June 2023.

From 1859 identified studies, seven trials (N = 657) met the inclusion criteria. Across studies, psychological interventions were associated with improvements in functioning from baseline to both post‐treatment and final follow‐up. However, when comparing specialised psychological interventions to generalist treatment as usual (TAU), differences were not statistically significant. Effect sizes were small at post‐treatment (SMD = 0.13, 95% CI = [−0.05, 0.31]) and remained small at final follow‐up (SMD = 0.12, 95% CI = [−0.08, 0.33]). Substantial heterogeneity was observed across studies, and risk of bias was noted in several trials, with only two studies rated as low risk.

The findings suggest that both specialised psychological interventions and generalist interventions yield similar outcomes in terms of functional improvement. These results have implications for clinical service design and underscore the importance of addressing the needs of this underrepresented population. More high‐quality, large‐scale trials are needed to strengthen the evidence base.

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