Schema therapy in borderline personality disorder with a history of emitional abuse: an efficacy analysis

Abstract

Borderline Personality Disorder (BPD) is frequently associated with early exposure to emotional abuse, a major etiological factor in the development of early maladaptive cognitive schemas. These manifest through affective instability, dysfunctional relationships, and persistent negative self-evaluation. To analyze the effectiveness of schema-focused therapies in reducing BPD symptomatology in patients with a documented history of childhood emotional abuse. A narrative review of the literature (2018–2024) was conducted using search terms such as “borderline personality disorder,” “schema-focused therapy,” “early maladaptive schemas,” and “emotional abuse” in the PubMed, PsycINFO, and Google Scholar databases. Twenty relevant articles were analyzed, of which five were included in the final review, comprising randomized controlled trials (RCTs) and cohort studies. Inclusion criteria targeted studies assessing the effectiveness of schema-focused therapy in reducing BPD-related symptoms in individuals with a documented history of childhood emotional abuse, with methodological validity and clinical relevance. Exclusion criteria included opinion articles, nonsystematic reviews, and studies involving non-adult populations. The analyzed studies reported a significant reduction in BPD symptoms, particularly impulsivity and unstable relationships, as measured by standardized instruments (e.g., Borderline Symptom List, BSL-23), with reductions ranging between 30% and 45% (p < 0.05). These findings are consistent with data from a multicenter study published in JAMA Psychiatry, which showed that after three years of treatment, the clinical recovery rate in the Schema Therapy (ST) group was 45.5%, compared to 23.8% in the Transference-Focused Psychotherapy (TFP) group. Furthermore, the proportion of patients achieving significant clinical improvement was 65.9% in ST versus 42.9% in TFP, confirming the superior efficacy of ST in improving core BPD symptomatology. Schema-focused therapy has proven effective in addressing BPD symptoms associated with emotional trauma, such as impulsivity and emotional instability. Deep restructuring of maladaptive schemas was accompanied by significant improvements in patients’ emotional and relational functioning.