Objective:

To evaluate the efficacy of psychological interventions for adolescents with borderline personality disorder (BPD) across multiple outcome domains, including symptom severity, emotion regulation, and quality of life.

Approach:

Key Findings:

• Twelve RCTs with 844 adolescents were included, showing small significant effects on BPD symptom severity (SMD=−0.27, 95% CI [−0.47, −0.06]), emotion regulation (SMD=−0.26, 95% CI [−0.48, −0.04]), and general psychopathology (SMD=−0.34, 95% CI [−0.56, −0.12]).
• No significant effects were found for depressive symptoms (SMD=−0.13, 95% CI [−0.35, 0.09]) or quality of life (SMD=0.05, 95% CI [−0.33, 0.43]).
• Heterogeneity was low across all outcomes, and no significant publication bias was detected.

Interpretation:

Psychological interventions for adolescent BPD produced statistically reliable but small improvements in BPD symptoms and emotion regulation, with effect sizes likely below clinically meaningful thresholds, indicating a need for more effective treatments.

Limitations:

• Exploratory subgroup analyses were limited by single-study subgroups, affecting the reliability of findings.
• Follow-up data suggested progressive erosion of treatment gains over time, indicating potential long-term challenges.

Conclusion:

Current treatments for adolescent BPD are beneficial but limited, necessitating future research on adequately powered trials, longer follow-up with maintenance interventions, and the development of treatments with broader impact across outcome domains.

Sources:

• Systematic Review Registration
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