OBJECTIVE Borderline personality disorder (BPD) is the most common personality disorder, affecting 1.8% of the general population, 10% of psychiatric outpatients, and 15%-25% of psychiatric inpatients. Practice guidelines recommend psychotherapies as first-line treatments. However, psychotherapies commonly used for the treatment of BPD are numerous, and little is known about the comparative effectiveness of each individual psychotherapy versus treatment as usual (TAU) or other psychotherapies. To systematically assess the comparative effectiveness of commonly used psychotherapies versus TAU or versus other psychotherapies for BPD treatment. METHOD We conducted systematic literature searches in MEDLINE, EMBASE, the Cochrane Library, and APA PsycINFO up to July 14, 2022, and searched reference lists of pertinent articles and reviews. Inclusion criteria were (a) patients 13 years or older with a diagnosis of BPD, (b) treatment with commonly used psychotherapies, (c) comparison with TAU or another psychotherapy, (d) assessment of relevant BPD-related health outcomes, and (e) randomized or nonrandomized trials or controlled observational studies. Two investigators independently screened abstracts and full-text articles and graded the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS We found 25 psychotherapy studies meeting inclusion criteria with data on 2,545 participants. Seventeen studies compared nine psychotherapies with TAU and nine studies compared eight psychotherapies with another psychotherapy for the treatment of BPD. Overall, both TAU and included psychotherapies were effective in treating the severity and symptoms of BPD. Moderate certainty of evidence suggests that systems training for emotional predictability and problem solving is more effective than TAU for the treatment of BPD; low certainty of evidence suggests that dialectical behavior therapy, schema therapy, transference-focused psychotherapy, acceptance and commitment therapy, manual-assisted cognitive therapy, and cognitive behavioral therapy are more effective than TAU for treating BPD. We were unable to draw conclusions from head-to-head comparisons of psychotherapies, which were limited to single studies with very low to low certainty of evidence. CONCLUSIONS All commonly used psychotherapies improve BPD severity, symptoms, and functioning. Our assessment found no strong evidence suggesting that any one psychotherapy is more beneficial than another. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

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治疗边缘性人格障碍的心理疗法：系统评价。

目的 边缘性人格障碍（BPD）是最常见的人格障碍，影响普通人群的 1.8%、精神科门诊患者的 10% 和精神科住院患者的 15%-25%。实践指南建议将心理治疗作为一线治疗。然而，通常用于治疗 BPD 的心理疗法有很多种，而每种心理疗法与常规治疗 (TAU) 或其他心理疗法的比较效果知之甚少。系统评估常用心理疗法与 TAU 或其他心理疗法治疗 BPD 的效果比较。方法 我们在 MEDLINE、EMBASE、Cochrane 图书馆和 APA PsycINFO 中进行了截至 2022 年 7 月 14 日的系统文献检索，并检索了相关文章和综述的参考文献列表。纳入标准为 (a) 诊断为 BPD 的 13 岁或以上患者，(b) 采用常用心理疗法进行治疗，(c) 与 TAU 或其他心理疗法进行比较，(d) 评估与 BPD 相关的相关健康结果，以及 ( e) 随机或非随机试验或对照观察研究。两名研究人员独立筛选摘要和全文文章，并使用建议评估、制定和评估分级方法对证据的确定性进行分级。结果 我们发现 25 项符合纳入标准的心理治疗研究涉及 2,545 名参与者的数据。17 项研究将 9 种心理疗法与 TAU 进行比较，9 项研究将 8 种心理疗法与另一种治疗 BPD 的心理疗法进行比较。总体而言，TAU 和纳入的心理治疗对于治疗 BPD 的严重程度和症状均有效。中等质量的证据表明，针对情绪可预测性和问题解决能力的系统训练对于治疗 BPD 而言比 TAU 更有效；低质量证据表明，辩证行为疗法、图式疗法、移情聚焦心理疗法、接受与承诺疗法、手动辅助认知疗法和认知行为疗法比 TAU 治疗 BPD 更有效。我们无法从心理治疗的面对面比较中得出结论，这些比较仅限于证据质量极低至极低的单一研究。结论 所有常用的心理疗法都能改善 BPD 的严重程度、症状和功能。我们的评估发现没有强有力的证据表明任何一种心理治疗比另一种更有益。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。