Psychological interventions for individuals with a diagnosis of borderline personality disorder in forensic settings: A systematic review

ABSTRACT

Borderline Personality Disorder (BPD) is a common diagnosis in forensic settings. Associated difficulties include impulsivity and emotional dysregulation, which can create a vulnerability to impulsive acts. A BPD diagnosis is also associated with significant distress and poor physical health, making it important to understand how to tailor interventions in forensic settings. This paper reviews evidence for the effectiveness of psychological interventions designed for individuals with a diagnosis of BPD when implemented in forensic settings. A systematic search found 3485 papers, of which 13 met the inclusion criteria. The papers reported nine separate studies that implemented four distinct interventions, often adapted for particular forensic settings. Six of the nine studies included control groups. Improvements in overall ‘BPD symptomatology’ and specific ‘BPD symptoms’ were reported for all intervention types, although few differences in outcome between intervention and control groups were found. There were also reported improvements in ‘BPD-related behaviours’, but data on offending behaviour were absent. Heterogeneity in study quality and design makes it challenging to draw any firm conclusions about the effectiveness of any one form of intervention over another, nor about which intervention may best suit a particular setting. Research of a higher quality is needed to answer these questions.

KEYWORDS:

• Borderline personality disorder
• forensic
• offending
• dialectical behaviour therapy
• schema therapy
• STEPPS

Acknowledgments

Thank you to Dr Cara Haines for acting as a second rater during study selection.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Improved = clinically significant improvement in behaviour from baseline to 12 months but functioning in the ‘impaired’ range at 12 months; Recovered = clinically significant improvement in behaviour from baseline to 12 months and functioning in the ‘normal’ range at 12 months.

2. Improved = participants with decreased use but not abstinence at follow-up; Recovered = participants reporting decreased use (moving to a category representing less use), with a negative urine screen and self-reported abstinence at the last follow-up.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.