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Post‐traumatic stress disorder and the outcome of dialectical behaviour therapy for borderline personality disorder
Author(s) -
Barnicot Kirsten,
Priebe Stefan
Publication year - 2013
Publication title -
personality and mental health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 22
eISSN - 1932-863X
pISSN - 1932-8621
DOI - 10.1002/pmh.1227
Subject(s) - borderline personality disorder , comorbidity , dialectical behavior therapy , impulsivity , psychology , clinical psychology , psychiatry
Abstract Background Individuals with borderline personality disorder (BPD) and comorbid post‐traumatic stress disorder (PTSD) have a worse prognosis than individuals with BPD alone. A common view is that the emotional instability and impulsivity of BPD should be treated before attempting to address trauma. However, PTSD symptoms may interfere with patients' ability to benefit from such ‘stabilizing’ treatments. Methods The effect of BPD–PTSD comorbidity on self‐harm and BPD symptom outcomes was evaluated in 89 patients receiving dialectical behaviour therapy, using multilevel modelling. Results Patients with comorbid BPD–PTSD showed a trend towards elevated BPD symptoms throughout the treatment year ( β = 2.12, 95% CI = −0.21–4.44, p = 0.07). There was a three‐way interaction between PTSD comorbidity, treatment completion and time, whereby PTSD comorbidity was associated with less reduction in self‐harm frequency over time, but only in those completing the full 12 months of treatment (incident risk ratio = 1.16, 95% CI = 1.04–1.30, p < 0.01). Conclusion Patients with comorbid PTSD had a poorer outcome from dialectical behaviour therapy than those with BPD alone, possibly because of the negative impact of unaddressed trauma. The results provide further grounds for recently developed treatments targeting BPD traits and PTSD symptoms simultaneously. Copyright © 2013 John Wiley & Sons, Ltd.