Chronotherapy synchronization strategies in borderline personality disorders

Abstract

Introduction: It is now evident that the disruption of circadian rhythm is one of the clinical phenotypes in individuals with Borderline Personality Disorder (BPD). Therefore, the use of chronotherapy in BPD is growing day by day. Consequently, in this systematic review, we assess chronotherapies either individually or in combination with conventional therapeutic interventions to determine the best possible therapy for the improvement of BPD symptomatology. Method: A systematic online literature search of PubMed, Google Scholar, Cochrane Central Register of Control Trials, Clinical Trials Registry (ClinicalTrials.gov), APA PsycNET, and BMJ Evidence-Based Medicine was conducted between 2000 and 2022. In these databases, search terms describing borderline personality disorder and circadian rhythm restoration were combined with the term of treatment. Results: From five selected studies, there are three types of chronotherapeutic interventions that were practiced: bright light therapy, physical exercise, and triple chronotherapy. Four out of the five studies we selected concluded that chronotherapy was a successful adjunctive therapy to pharmacotherapy and/or psychotherapy in improving the traits of BPD, especially depression (mean Hamilton Depression Rating Scale score decreased from 19.5 to 7.2) and suicidal thoughts (mean Columbia suicide severity rating scale score decreased from 19.5 to 7.2). Conclusion: According to the literature we evaluated, chronotherapy, particularly bright light therapy, could be a safe and effective addition to conventional therapeutic interventions for BPD. However, the predominant emphasis on depression and suicidal ideation in the studies might limit the broad applicability of the findings to encompass other symptomatic aspects related to BPD.