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Effect of 3 Forms of Early Intervention for Young People With Borderline Personality DisorderThe MOBY Randomized Clinical Trial

Educational Objective
To evaluate the effectiveness of 3 early interventions for borderline personality disorder (BPD) of differing complexity.
1 Credit CME
Key Points

Question  What combination of treatment components is sufficient for early intervention for young people with borderline personality disorder (BPD)?

Findings  In this randomized clinical trial with 139 youth with BPD, a dedicated BPD service model and a specialized BPD psychotherapy were associated with superior retention in care but not a superior rate of change in psychosocial functioning by 12 months, compared with general youth mental health care and a psychotherapy control condition.

Meaning  Effective early intervention for BPD is not reliant on availability of BPD psychotherapy.


Importance  Clinical trials have neither focused on early intervention for psychosocial impairment nor on the contribution of components of borderline personality disorder (BPD) treatment beyond individual psychotherapy.

Objective  To evaluate the effectiveness of 3 early interventions for BPD of differing complexity.

Design, Settings, and Participants  This single-blinded randomized clinical trial recruited young people between March 17, 2011, and September 30, 2015, into parallel groups. The study took place at 2 government-funded mental health services for young people in Melbourne, Australia. Inclusion criteria were age 15 to 25 years (inclusive), recent DSM-IV-TR BPD diagnosis, and never receiving evidence-based BPD treatment. A total of 139 participants were randomized (pool of 876; 70 declined, 667 excluded), balanced for sex, age, and depressive symptomatology. Data analysis completed May 2020.

Interventions  (1) The Helping Young People Early (HYPE) dedicated BPD service model for young people, combined with weekly cognitive analytic therapy (CAT); (2) HYPE combined with a weekly befriending psychotherapy control condition; and (3) a general youth mental health service (YMHS) model, combined with befriending. Therefore, the 3 treatment arms were HYPE + CAT, HYPE + befriending, and YMHS + befriending. Participants were randomly assigned both to 1 treatment arm (in a 1:1:1 ratio) and to a clinician.

Main Outcomes and Measures  Psychosocial functioning, measured with the Inventory of Interpersonal Problems Circumplex Version and the Social Adjustment Scale Self-report.

Results  One hundred twenty-eight participants (104 [81.3%] were female; mean [SD] age, 19.1 [2.8] years; HYPE + CAT: 40 [31.3%]; HYPE + befriending: 45 [35.2%]; YMHS + befriending: 43 [33.6%]) who provided postbaseline data were included in the intent-to-treat analysis. Regardless of group, from baseline to 12 months, there was a mean of 19.3% to 23.8% improvement in the primary outcomes and 40.7% to 52.7% for all secondary outcomes, except severity of substance use and client satisfaction. The latter remained high across all time points. Planned comparisons (YMHS + befriending vs HYPE; HYPE + CAT vs befriending) showed that neither the service model nor the psychotherapy intervention was associated with a superior rate of change in psychosocial functioning by the 12-month primary end point. The HYPE service model was superior to YMHS + befriending for treatment attendance (median [IQR], 22 [19] vs 3 [16] contacts; median duration, 200 [139.5] vs 94 [125] days) and treatment completion (44 of 92 [47.8%] vs 9 of 47 [19.2%]). HYPE + CAT was superior to befriending for treatment attendance (median [IQR], 12 [16.5] vs 3 [9.8] sessions) and treatment completion (24 of 46 [52.2%] vs 29 of 93 [31.2%]).

Conclusions and Relevance  In this randomized clinical trial of 3 interventions for young people with BPD, effective early intervention was not reliant on availability of specialist psychotherapy but did require youth-oriented clinical case management and psychiatric care. A dedicated early intervention BPD service model (HYPE), with or without individual psychotherapy, achieved greater treatment attendance and completion, making it more likely to meet service user, family, and community expectations of care.

Trial Registration  anzctr.org.au Identifier: ACTRN12610000100099

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Article Information

Corresponding Author: Andrew M. Chanen, MBBS(Hons), PhD, 35 Poplar Rd, Locked Bag 10, Parkville, VIC 3052, Australia (andrew.chanen@orygen.org.au).

Accepted for Publication: October 22, 2021.

Published Online: December 15, 2021. doi:10.1001/jamapsychiatry.2021.3637

Author Contributions: Profs Chanen and Cotton had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Chanen, Jackson, Cotton, Gleeson, Davey, McCutcheon.

Acquisition, analysis, or interpretation of data: Chanen, Betts, Cotton, Davey, Thompson, Perera, Rayner, Andrewes.

Drafting of the manuscript: Chanen, Betts, Jackson, Cotton, Gleeson, Davey, Andrewes.

Critical revision of the manuscript for important intellectual content: Jackson, Cotton, Gleeson, Davey, Thompson, Perera, Rayner, McCutcheon.

Statistical analysis: Betts, Cotton, Andrewes.

Obtained funding: Chanen, Jackson, Cotton, Gleeson, Davey, McCutcheon.

Administrative, technical, or material support: Chanen, Betts, Cotton, Gleeson, Davey, Perera, Rayner, McCutcheon.

Supervision: Chanen, Betts, Jackson, Gleeson, Davey, McCutcheon.

Conflict of Interest Disclosures: Prof Chanen reported grants from the Australian government’s National Health and Medical Research Council (NHMRC) during the conduct of the study and other support from the Helping Young People Early (HYPE) translational program outside the submitted work. Profs Chanen and McCutcheon cofounded and lead the HYPE clinical program, a government-funded program with continuous funding, and the HYPE translational program, which is a not-for-profit training program. No other disclosures were reported.

Funding/Support: This trial was funded by the National Health and Medical Research Council (NHMRC) (grant GNT0628739). NHMRC Career Development Fellowship supported Prof Cotton (APP1061998) and Prof Davey (APP1061757).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 3.

Additional Contributions: The authors wish to thank the clients, families, and staff of the Helping Young People Early program at Orygen and Headspace Sunshine, and also Sarah Bendall, PhD, PGDipClinPsych, MA, Orygen and the Centre for Youth Mental Health, University of Melbourne, for training and supervising clinicians performing the befriending intervention and Patrick McGorry, MD, PhD, Orygen and the Centre for Youth Mental Health, University of Melbourne, for feedback on an earlier version of this manuscript. Drs Bendall and McGorry did not receive compensation for their contribution. This study is dedicated to the 3 young participants who died during the course of this study and to their families and friends.

Chanen  A , Sharp  C , Hoffman  P ; Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder.  Prevention and early intervention for borderline personality disorder: a novel public health priority.   World Psychiatry. 2017;16(2):215-216. doi:10.1002/wps.20429PubMedGoogle ScholarCrossref
Fok  ML-Y , Stewart  R , Hayes  RD , Moran  P .  Predictors of natural and unnatural mortality among patients with personality disorder: evidence from a large UK case register.   PLoS One. 2014;9(7):e100979. doi:10.1371/journal.pone.0100979PubMedGoogle Scholar
Gunderson  JG , Stout  RL , McGlashan  TH ,  et al.  Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study.   Arch Gen Psychiatry. 2011;68(8):827-837. doi:10.1001/archgenpsychiatry.2011.37PubMedGoogle ScholarCrossref
Zanarini  MC , Frankenburg  FR , Reich  DB , Fitzmaurice  G .  Time to attainment of recovery from borderline personality disorder and stability of recovery: a 10-year prospective follow-up study.   Am J Psychiatry. 2010;167(6):663-667. doi:10.1176/appi.ajp.2009.09081130PubMedGoogle ScholarCrossref
Chanen  AM , Jackson  HJ , McCutcheon  LK ,  et al.  Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial.   Br J Psychiatry. 2008;193(6):477-484. doi:10.1192/bjp.bp.107.048934PubMedGoogle ScholarCrossref
Schuppert  HM , Timmerman  ME , Bloo  J ,  et al.  Emotion regulation training for adolescents with borderline personality disorder traits: a randomized controlled trial.   J Am Acad Child Adolesc Psychiatry. 2012;51(12):1314-1323.e2. doi:10.1016/j.jaac.2012.09.002PubMedGoogle ScholarCrossref
Rossouw  TI , Fonagy  P .  Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial.   J Am Acad Child Adolesc Psychiatry. 2012;51(12):1304-1313.e3. doi:10.1016/j.jaac.2012.09.018PubMedGoogle ScholarCrossref
Pistorello  J , Fruzzetti  AE , Maclane  C , Gallop  R , Iverson  KM .  Dialectical behavior therapy (DBT) applied to college students: a randomized clinical trial.   J Consult Clin Psychol. 2012;80(6):982-994. doi:10.1037/a0029096PubMedGoogle ScholarCrossref
Mehlum  L , Tørmoen  AJ , Ramberg  M ,  et al.  Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial.   J Am Acad Child Adolesc Psychiatry. 2014;53(10):1082-1091. doi:10.1016/j.jaac.2014.07.003PubMedGoogle ScholarCrossref
Santisteban  DA , Mena  MP , Muir  J , McCabe  BE , Abalo  C , Cummings  AM .  The efficacy of two adolescent substance abuse treatments and the impact of comorbid depression: results of a small randomized controlled trial.   Psychiatr Rehabil J. 2015;38(1):55-64. doi:10.1037/prj0000106PubMedGoogle ScholarCrossref
McCauley  E , Berk  MS , Asarnow  JR ,  et al.  Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial.   JAMA Psychiatry. 2018;75(8):777-785. doi:10.1001/jamapsychiatry.2018.1109PubMedGoogle ScholarCrossref
Beck  E , Bo  S , Jørgensen  MS ,  et al.  Mentalization-based treatment in groups for adolescents with borderline personality disorder: a randomized controlled trial.   J Child Psychol Psychiatry. 2020;61(5):594-604. doi:10.1111/jcpp.13152PubMedGoogle ScholarCrossref
Mehlum  L , Ramleth  R-K , Tørmoen  AJ ,  et al.  Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self-harming and suicidal behavior.   J Child Psychol Psychiatry. 2019;60(10):1112-1122. doi:10.1111/jcpp.13077PubMedGoogle ScholarCrossref
Chanen  AM , Berk  M , Thompson  K .  Integrating early intervention for borderline personality disorder and mood disorders.   Harv Rev Psychiatry. 2016;24(5):330-341. doi:10.1097/HRP.0000000000000105PubMedGoogle ScholarCrossref
Hartmann  JA , McGorry  PD , Destree  L ,  et al.  Pluripotential risk and clinical staging: theoretical considerations and preliminary data from a transdiagnostic risk identification approach.   Front Psychiatry. 2021;11:553578. doi:10.3389/fpsyt.2020.553578PubMedGoogle Scholar
McGorry  P , Nelson  B .  Why we need a transdiagnostic staging approach to emerging psychopathology, early diagnosis, and treatment.   JAMA Psychiatry. 2016;73(3):191-192. doi:10.1001/jamapsychiatry.2015.2868PubMedGoogle ScholarCrossref
Chanen  AM , Nicol  K , Betts  JK , Thompson  KN .  Diagnosis and treatment of borderline personality disorder in young people.   Curr Psychiatry Rep. 2020;22(5):25. doi:10.1007/s11920-020-01144-5PubMedGoogle ScholarCrossref
Chanen  AM , Nicol  K .  Five failures and five challenges for prevention and early intervention for personality disorder.   Curr Opin Psychol. 2021;37:134-138. doi:10.1016/j.copsyc.2020.12.005PubMedGoogle ScholarCrossref
Chanen  A , Jackson  H , Cotton  SM ,  et al.  Comparing three forms of early intervention for youth with borderline personality disorder (the MOBY study): study protocol for a randomised controlled trial.   Trials. 2015;16:476. doi:10.1186/s13063-015-1001-xPubMedGoogle ScholarCrossref
First  MB , Gibbon  M , Spitzer  RL , Benjamin  LS , Williams  JB .  User’s Guide for the Structured Clinical Interview for DSM-IV Axis II Personality Disorders: SCID-II. American Psychiatric Press; 1997.
First  MB , Gibbon  M , Spitzer  RL , Williams  JB .  Structured Clinical Interview for DSM-IV Axis I disorders-patient version. Biometrics Research Department, New York State Psychiatric Institute; 1996.
Eaton  WW , Smith  C , Ybarra  M , Muntaner  C , Tien  A . Center for Epidemiologic Studies Depression Scale: review and revision (CESD and CESD-R). In: Maruish  M , ed.  The Use of Psychological Testing For Treatment Planning and Outcome Assessment. Lawrence Erlbaum Associates Publishers; 2004.
Chanen  AM , McCutcheon  L , Kerr  IB . HYPE: a cognitive analytic therapy-based prevention and early intervention programme for borderline personality disorder. In: Sharp  C , Tackett  JL , eds.  Handbook of Borderline Personality Disorder in Children and Adolescents. Springer; 2014:361-383. doi:10.1007/978-1-4939-0591-1_23
Chanen  AM , McCutcheon  LK , Germano  D , Nistico  H , Jackson  HJ , McGorry  PD .  The HYPE Clinic: an early intervention service for borderline personality disorder.   J Psychiatr Pract. 2009;15(3):163-172. doi:10.1097/01.pra.0000351876.51098.f0PubMedGoogle ScholarCrossref
Seidler  ZE , Rice  SM , Dhillon  HM ,  et al.  Patterns of youth mental health service use and discontinuation: population data from Australia’s headspace model of care.   Psychiatr Serv. 2020;71(11):1104-1113. doi:10.1176/appi.ps.201900491PubMedGoogle ScholarCrossref
Ryle  A .  Cognitive Analytic Therapy and Borderline Personality Disorder: The Model and the Method. John Wiley; 1997.
McCutcheon  LK , Kerr  IB , Chanen  AM . Cognitive analytic therapy: a relational approach to young people with severe personality disorder. In: Kramer  U , ed.  Case Formulation for Personality Disorders. Academic Press; 2019:95-111. doi:10.1016/B978-0-12-813521-1.00006-0
Ryle  A , Kerr  IB .  Introducing Cognitive Analytic Therapy: Principles and Practice of a Relational Approach to Mental Health. 2nd Ed. John Wiley & Sons; 2020. doi:10.1002/9781119375210
Bendall  S , Jackson  HJ , Killackey  E ,  et al  The credibility and acceptability of befriending as a control therapy in a randomized controlled trial of cognitive behaviour therapy for acute first episode psychosis.   Behav Cogn Psychother. 2006;34(03):277-291. doi:10.1017/S1352465806002815Google ScholarCrossref
Bennett  D , Parry  G.   A measure of psychotherapeutic competence derived from cognitive analytic therapy.   Psychother Res. 2004;14(2):176-192. doi:10.1093/ptr/kph016Google ScholarCrossref
Bendall  S , Allott  K , Jovev  M ,  et al.  Therapy contamination as a measure of therapist treatment adherence in a trial of cognitive behaviour therapy versus befriending for psychosis.   Behav Cogn Psychother. 2015;43(3):314-327. doi:10.1017/S1352465813000921PubMedGoogle ScholarCrossref
Williams  JBW , Kobak  KA .  Development and reliability of a structured interview guide for the Montgomery Asberg Depression Rating Scale (SIGMA).   Br J Psychiatry. 2008;192(1):52-58. doi:10.1192/bjp.bp.106.032532PubMedGoogle ScholarCrossref
Arntz  A , van den Hoorn  M , Cornelis  J , Verheul  R , van den Bosch  WMC , de Bie  AJHT .  Reliability and validity of the borderline personality disorder severity index.   J Pers Disord. 2003;17(1):45-59. doi:10.1521/pedi. ScholarCrossref
Alden  LE , Wiggins  JS , Pincus  AL .  Construction of circumplex scales for the Inventory of Interpersonal Problems.   J Pers Assess. 1990;55(3-4):521-536. doi:10.1080/00223891.1990.9674088PubMedGoogle ScholarCrossref
Horowitz  LM , Alden  LE , Wiggins  JS , Pincus  AL .  Inventory of Interpersonal Problems Manual. Mindgarden; 2003.
Weissman  MM , Bothwell  S .  Assessment of social adjustment by patient self-report.   Arch Gen Psychiatry. 1976;33(9):1111-1115. doi:10.1001/archpsyc.1976.01770090101010PubMedGoogle ScholarCrossref
Beck  AT , Brown  GK , Steer  RA .  Psychometric characteristics of the Scale for Suicide Ideation with psychiatric outpatients.   Behav Res Ther. 1997;35(11):1039-1046. doi:10.1016/S0005-7967(97)00073-9PubMedGoogle ScholarCrossref
Linehan  MM , Comtois  KA , Brown  MZ , Heard  HL , Wagner  A .  Suicide Attempt Self-Injury Interview (SASII): development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury.   Psychol Assess. 2006;18(3):303-312. doi:10.1037/1040-3590.18.3.303PubMedGoogle ScholarCrossref
Saunders  JB , Aasland  OG , Babor  TF , de la Fuente  JR , Grant  M .  Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption: II.   Addiction. 1993;88(6):791-804. doi:10.1111/j.1360-0443.1993.tb02093.xPubMedGoogle ScholarCrossref
Darke  S , Ward  J , Hall  W , Heather  N , Wodak  A.   The Opiate Treatment Index (OTI) Manual. National Drug and Alcohol Research Centre; 1991.
Larsen  DL , Attkisson  CC , Hargreaves  WA , Nguyen  TD .  Assessment of client/patient satisfaction: development of a general scale.   Eval Program Plann. 1979;2(3):197-207. doi:10.1016/0149-7189(79)90094-6PubMedGoogle ScholarCrossref
Goldman  HH , Skodol  AE , Lave  TR .  Revising axis V for DSM-IV: a review of measures of social functioning.   Am J Psychiatry. 1992;149(9):1148-1156. doi:10.1176/ajp.149.9.1148PubMedGoogle Scholar
Richardson  J , Iezzi  A , Khan  MA , Maxwell  A .  Validity and reliability of the Assessment of Quality of Life (AQoL)-8D multi-attribute utility instrument.   Patient. 2014;7(1):85-96. doi:10.1007/s40271-013-0036-xPubMedGoogle ScholarCrossref
Mallinckrodt  CH , Lane  PW , Schnell  D , Peng  Y , Mancuso  JP .  Recommendations for the primary analysis of continuous endpoints in longitudinal clinical trials.   Drug Information Journal. 2008;42(4):303-319. doi:10.1177/009286150804200402Google ScholarCrossref
Chanen  AM , Jackson  HJ , McCutcheon  LK ,  et al.  Early intervention for adolescents with borderline personality disorder: quasi-experimental comparison with treatment as usual.   Aust N Z J Psychiatry. 2009;43(5):397-408. doi:10.1080/00048670902817711PubMedGoogle ScholarCrossref
Chanen  AM , Betts  JK , Jackson  H ,  et al.  A comparison of adolescent versus young adult outpatients with first-presentation borderline personality disorder: findings from the MOBY Randomized Controlled Trial: Une comparaison entre patients ambulatoires adolescents et jeunes adultes à la première présentation du trouble de la personnalité limite : résultats de L'essai Randomisé Contrôlé MOBY.   Can J Psychiatry. Published online February 12, 2021. doi:10.1177/0706743721992677Google Scholar
O’Dwyer  N , Rickwood  D , Buckmaster  D , Watsford  C .  Therapeutic interventions in Australian primary care, youth mental health settings for young people with borderline personality disorder or borderline traits.   Borderline Personal Disord Emot Dysregul. 2020;7:23. doi:10.1186/s40479-020-00138-2PubMedGoogle ScholarCrossref
Winograd  G , Cohen  P , Chen  H .  Adolescent borderline symptoms in the community: prognosis for functioning over 20 years.   J Child Psychol Psychiatry. 2008;49(9):933-941. doi:10.1111/j.1469-7610.2008.01930.xPubMedGoogle ScholarCrossref
Moran  P , Romaniuk  H , Coffey  C ,  et al.  The influence of personality disorder on the future mental health and social adjustment of young adults: a population-based, longitudinal cohort study.   Lancet Psychiatry. 2016;3(7):636-645. doi:10.1016/S2215-0366(16)30029-3PubMedGoogle ScholarCrossref
Moran  P , Coffey  C , Romaniuk  H ,  et al.  The natural history of self-harm from adolescence to young adulthood: a population-based cohort study.   Lancet. 2012;379(9812):236-243. doi:10.1016/S0140-6736(11)61141-0PubMedGoogle ScholarCrossref
Johnson  JG , Cohen  P , Kasen  S , Skodol  AE , Hamagami  F , Brook  JS .  Age-related change in personality disorder trait levels between early adolescence and adulthood: a community-based longitudinal investigation.   Acta Psychiatr Scand. 2000;102(4):265-275. doi:10.1034/j.1600-0447.2000.102004265.xPubMedGoogle ScholarCrossref
Smith  D , Roche  E , O’Loughlin  K ,  et al.  Satisfaction with services following voluntary and involuntary admission.   J Ment Health. 2014;23(1):38-45. doi:10.3109/09638237.2013.841864PubMedGoogle ScholarCrossref
Barr  KR , Jewell  M , Townsend  ML , Grenyer  BFS .  Living with personality disorder and seeking mental health treatment: patients and family members reflect on their experiences.   Borderline Personal Disord Emot Dysregul. 2020;7(1):21. doi:10.1186/s40479-020-00136-4PubMedGoogle ScholarCrossref
McMain  SF , Links  PS , Gnam  WH ,  et al.  A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder.   Am J Psychiatry. 2009;166(12):1365-1374. doi:10.1176/appi.ajp.2009.09010039PubMedGoogle ScholarCrossref
Bateman  A , Fonagy  P .  Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder.   Am J Psychiatry. 2009;166(12):1355-1364. doi:10.1176/appi.ajp.2009.09040539PubMedGoogle ScholarCrossref
Clarke  S , Thomas  P , James  K .  Cognitive analytic therapy for personality disorder: randomised controlled trial.   Br J Psychiatry. 2013;202:129-134. doi:10.1192/bjp.bp.112.108670PubMedGoogle ScholarCrossref
Cristea  IA , Gentili  C , Cotet  CD , Palomba  D , Barbui  C , Cuijpers  P .  Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis.   JAMA Psychiatry. 2017;74(4):319-328. doi:10.1001/jamapsychiatry.2016.4287PubMedGoogle ScholarCrossref
Storebø  OJ , Stoffers-Winterling  JM , Völlm  BA ,  et al.  Psychological therapies for people with borderline personality disorder.   Cochrane Database Syst Rev. 2020;5:CD012955.PubMedGoogle Scholar
Bateman  AW , Gunderson  J , Mulder  R .  Treatment of personality disorder.   Lancet. 2015;385(9969):735-743. doi:10.1016/S0140-6736(14)61394-5PubMedGoogle ScholarCrossref
McGorry  PD , Mei  C , Chanen  AM , Hodges  C , Alvarez  M , Killackey  E .  The mental health of young people: designing and scaling up integrated youth mental health care.   World Psychiatry. 2022;21:1-16. doi:10.1002/wps.20938Google ScholarCrossref
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