Effects of psychotherapy and psychoanalytic-based approaches in the treatment of adults with Borderline Personality Disorder: a systematic review

Objective: Borderline Personality Disorder (BPD) is characterized by persistent patterns of emotional dysregulation and interpersonal difficulties. This systematic review aimed to evaluate the therapeutic effects of psychotherapy and approaches of psychoanalytic origin in adults with BPD and explore related clinical and neurobiological studies. Method: This systematic review included randomized controlled trials (RCTs) and non-randomized clinical trials (non-RCTs), published between 2019 and 2024 in the electronic databases: MEDLINE, LILACS, ScienceDirect, SciELO, and PubMed. Results: Of 1,433 articles identified, 15 met the inclusion criteria (12 RCTs and 3 non- RCTs). Dialectical Behavior Therapy (DBT) was the most frequently studied modality (5 studies), followed by Schema Therapy (ST, 3 studies) and Manual-Assisted Aggression Psychotherapy (MAAP, 3 studies). Psychoanalytic-based interventions—such as Transference-Focused Psychotherapy (TFP), Psychodynamic Psychotherapy (PDT), and Supportive Analytic Psychotherapy (SAP)—were analyzed in 2 studies. Both psychotherapeutic and psychoanalytic treatments showed benefits in improving quality of life, symptom relief, emotional regulation, and social functioning in patients with BPD. Conclusion: Psychotherapy and approaches of psychoanalytic origin both demonstrate efficacy in the treatment of BPD, particularly when applied in combination. However, few studies have evaluated these approaches in an integrated manner, underscoring the need for further research on combined therapeutic strategies.