We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters to the Editor |

Knowledge of the Effectiveness of Treatments for Borderline Personality Disorder Is Not Yet Sufficient to Justify the Lack of a Control Condition

Steve Pearce, MRCPsych
Arch Gen Psychiatry. 2007;64(5):609. doi:10.1001/archpsyc.64.5.609-b.
Text Size: A A A
Published online


The trial reported by Giesen-Bloo et al1 relies for its usefulness on the assumption, referred to in the article, that “specialized psychotherapeutic approaches are more effective than control conditions.” This is not a valid assumption. Research on the treatment of borderline personality disorder has not yet reached the stage where superiority over a treatment as usual control condition can be assumed, in particular when the treatments being investigated have not previously demonstrated efficacy. The articles cited in support of this approach represent trials in specific groups (for example, self-harming women between the ages of 18 and 45 years)2 with small numbers.2,3 Cognitive-behavioral therapy, of which schema-focused therapy is a form, has in the past failed to provide evidence of benefit,4 further calling into question the assumption of superiority over control in this particular trial. Outpatient psychodynamic psychotherapy has demonstrated effectiveness in treating personality disorder only under similar conditions to this trial (ie, no treatment as usual control).5 Indeed, Giesen-Bloo et al point out that a significant change to the underlying disorder has not been demonstrated convincingly in previous treatment trials for borderline personality disorder.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.