Early Intervention for Adolescents with Borderline Personality Symptoms: Pragmatic Trial of a Short-Term Group

Background Early intervention is recommended for adolescents presenting with borderline personality disorder or subthreshold symptoms. However, access to evidence-based treatment remains challenging in resource-constrained mental health settings.Objective We undertook a pragmatic evaluation examining the effectiveness of a short-term therapy group for adolescents with borderline personality symptoms.Method A non-randomized clinical trial was undertaken in which outcomes from a naturalistic waitlist (n = 41) were compared to the intervention condition (n = 80) across primary outcomes of borderline symptom severity and overall personality functioning (including self and interpersonal dysfunction). Secondary outcomes included difficulties regulating emotions, hypomentalizing and psychosocial functioning. Participants were followed up 6 months after group completion. Linear mixed-regression modeling assessed whether those in the intervention improved on each of the outcomes relative to those “waiting” for the intervention. The clinical significance and maintenance of outcomes was also examinedResults Participants included N = 121 adolescents (Mage = 16.95, SD = 1.17). Those in the intervention condition reported a significant moderate reduction in borderline symptom severity and general personality dysfunction relative to those waiting for treatment. At group completion, 31% of those who completed the assessment reported reliable or clinically significant reduction in borderline symptom severity. All primary outcomes were significantly improved at 6-month follow-up compared to baselineConclusions This pragmatic non-randomized trial demonstrated that a 10-week group-based psychological intervention was more effective in reducing adolescents’ borderline symptom severity compared to “waiting” for treatment. Offering structured therapeutic support within a broader model of stepped care may be a useful approach to early intervention.Trial registration number/date Retrospectively registered June 16, 2022 on the Australian New Zealand Clinical Trials Registry (ACTRN12622000849796).