The purpose of the study is to determine the feasibility and effectiveness of a modified
form of psychodynamic psychotherapy for persons suffering from co-occurring borderline
personality disorder and an alcohol use disorder.
Borderline Personality Disorder (BPD) is a condition that can cause significant distress and
increased risk of death. Many persons with BPD also have an alcohol use disorder (AUD) and
there is evidence that this can worsen the outcome and course of both disorders.
A manual-based form of psychodynamic therapy (PT), labeled dynamic deconstructive
psychotherapy, has been developed for particularly challenging patients with BPD, especially
those with co-occurring substance use disorders. It aims to remediate specific
neurocognitive capacities that are responsible for processing of emotional experiences, and
so diminishes symptoms of BPD and promotes the development of a coherent and differentiated
self-structure. PT has been shown to be helpful for BPD, but has not been tested for people
who have BPD with co-occurring substance use disorders.
The proposed study is a randomized controlled trial of PT for persons with BPD and
co-occurring AUD that will generate some initial data that can be used to determine the need
and feasibility for further outcome studies. Participants are randomized to either a study
group receiving weekly PT or to a control group receiving usual care. Enrollment is 15
participants in each group. The study group will receive 12-18 months of PT, with
naturalistic follow-up. Outcome measures are administered by a research assistant at
enrollment, 3 months, 6 months, 9 months, 12 months, and 30 months.
The investigators anticipate that the PT group will show trends towards better retention in
treatment and greater reduction in parasuicides, alcohol misuse, and institutional care. If
so, this would have important and positive implications for the large group of patients who
suffer from BPD and co-occurring AUD.
- Age between 18 and 45 years
- Meets diagnostic criteria for borderline personality disorder and for active alcohol
abuse or dependence
- At least average intelligence
- Meets diagnostic criteria for schizophrenia, or schizoaffective disorder