Crisis interventions for adults with borderline personality disorder

Area of Science:

• Psychiatry and Mental Health
• Clinical Psychology
• Evidence-Based Practice

Background:

• Individuals with borderline personality disorder (BPD) frequently experience acute crises, often involving suicidal ideation or behaviors.
• Effective management strategies for acute crises in BPD populations remain poorly understood.
• This review updates previous Cochrane reviews on crisis interventions for adults with BPD.

Purpose of the Study:

• To assess the effects of crisis interventions in adults diagnosed with BPD.
• To evaluate interventions designed to ensure safety and recovery during acute distress, lasting no longer than one month.

Main Methods:

• Searched multiple databases (CENTRAL, MEDLINE, Embase) and trials registers up to January 2022.
• Included randomized controlled trials (RCTs) comparing crisis interventions with usual care, no intervention, or waiting list in adults with BPD.
• Utilized standard Cochrane methodological procedures for data collection and analysis.

Main Results:

• Two RCTs involving 213 participants were included, examining joint crisis plans (JCPs) and brief admissions (BA).
• Evidence from these studies suggests no clear difference between JCPs or BA and treatment as usual (TAU) on outcomes like deaths, self-harm, or inpatient care.
• The certainty of evidence was judged as low to very low, with ongoing RCTs expected to inform future updates.

Conclusions:

• There is a significant lack of high-quality RCT-based evidence for managing acute crises in individuals with BPD.
• Current evidence does not clearly support the effectiveness of JCPs or BA over TAU.
• Urgent need for large-scale, high-quality RCTs and development of novel crisis interventions for BPD.