Treatment Moderators of Symptom Severity in Psychotherapy for People with Borderline Personality Disorder: Systematic Review with Meta-Analyses of Individual Participant Data
Bibliographic record
Abstract
INTRODUCTION: Borderline personality disorder (BPD) is a complex and heterogeneous condition. Psychotherapy reduces symptom severity; however, characteristics of the individual may influence treatment outcomes. This systematic review examined whether specific baseline variables moderate the effect of psychotherapy on BPD severity through individual participant data meta-analysis (IPD-MA). METHODS: A literature search up to 12 May 2025 across 10 databases (including PubMed, Medline, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane CENTRAL) identified randomised clinical trials (RCTs) comparing psychotherapy to treatment as usual (TAU) or clinical management control interventions (CM) for BPD. Authors of included trials were contacted to retrieve IPD. IPD-MAs employed a one-stage random-effects approach to estimate treatment effects and potential moderators in bivariate linear mixed-effects models. The study was registered with PROSPERO (CRD42021210688). RESULTS: Out of 33,696 records identified, 42 RCTs (3,848 participants) were eligible. IPD was obtained from 19 trials (1,482 participants). All trials had an overall high risk of bias or some concerns regarding risk of bias. There was a high rate of missing data across trials (378/1,482, 25.1%). IPD-MA showed that psychotherapy significantly reduced BPD severity compared to TAU/CM (β: -0.25, 95% CI: -0.43 to -0.07, SE: 0.09, p = 0.0065; 19 trials, 1,104 participants). Significant negative moderators were co-occurring depressive disorder(s) (β: 0.31, 95% CI: 0.03 to 0.59) and exposure to sexual trauma (β: 0.60, 95% CI: 0.16 to 1.04), while positive moderators were co-occurring anxiety disorder(s) (β: -0.34, 95% CI: -0.64 to -0.03) and alcohol use disorder(s) (AUD) (β: -0.34, 95% CI: -0.67 to -0.01). CONCLUSION: Psychotherapy may be especially beneficial for BPD with co-occurring anxiety. Patients with co-occurring AUD should not be excluded from treatment; rather, treatment motivation should be emphasised. Further, clinicians should prioritise trauma-informed care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".