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Extended Inpatient Treatment Can Improve BPD

J Affect Disord; ePub 2018 Jan 17; Fowler, et al

Extended inpatient treatment can result in significant and clinically meaningful symptomatic and functional improvement in patients with borderline personality disorder (BPD), without iatrogenic effects, according to a recent study, which indicated that there are a number of effective evidence-based outpatient treatments today for BPD. Beliefs about the effectiveness of extended inpatient treatment, however, have changed little in the past 25 years. Clinically significant and reliable change in symptoms, functional capacities, and adverse events were quantified for both inpatients with BPD (n=245) and a well-matched inpatient reference (n=220) sample. Researchers found:

  • Large effect size improvements were observed in depression, anxiety, suicidal ideation, and functional disability among patients with BPD (Cohen's d ≥ 1.0) and those in the reference sample (Cohen's d ≥ .80).
  • Clinical deterioration and adverse events were rare (occurring in no more than 1.1% of BPD and reference patients on any outcome) with no difference across patient cohorts.
  • BPD diagnosis failed to influence the trajectory of continuous depression severity.
  • Rather, trait emotion dysregulation was associated with initial depression severity.


Fowler JC, Clapp JD, Madan A, et al. A naturalistic longitudinal study of extended inpatient treatment for adults with borderline personality disorder: An examination of treatment response, remission and deterioration. [Published online ahead of print January 17, 2018]. J Affect Disord. doi:10.1016/j.jad.2017.12.054.

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