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An examination of the role of PTSD and childhood trauma on treatment outcomes for individuals with borderline personality disorder in dialectical behavior therapy

Katherine E. Christensen,Shelley McMain,Alexander L Chapman,Janice R. Kuo

Published 2025 in Borderline Personality Disorder and Emotion Dysregulation

ABSTRACT

Borderline personality disorder (BPD) is a complex and severe mental health condition often accompanied by several co-occurring clinical problems. Posttraumatic stress disorder (PTSD) is one of the most common co-occurring disorders, with prevalence rates of PTSD reported to be between 25% and 58% among persons with BPD. The primary aim of the current study was to evaluate the association of a PTSD diagnosis and different forms of childhood trauma with changes in BPD severity, PTSD severity, and frequency of suicidal behaviors among suicidal individuals with BPD undergoing 12-months of standard dialectical behavior therapy (DBT). This was a secondary data analysis that included individuals with BPD (N = 120) in the 12-month DBT condition. Participants completed measures of childhood abuse, PTSD severity, BPD severity, and frequency of suicidal behaviors at baseline as well as at 3, 6, 9, and 12 months. Generalized Estimating Equations (GEE) were used to examine both study hypotheses. Results suggested that the presence of PTSD did not predict reduced rates of reduction in BPD severity, PTSD severity, or frequency of suicidal behaviors. Results also revealed that higher severity of childhood sexual and emotional abuse was associated with quicker reductions in BPD severity, whereas higher severity of childhood physical abuse was associated with slower reductions. Similarly, higher severity of emotional abuse was associated with quicker reductions in PTSD severity, while higher severity of physical abuse was associated with slower reductions in this outcome. Standard DBT appears to be comparably effective for both individuals with BPD without PTSD and BPD + PTSD. The addition of a PTSD diagnosis did not significantly predict slower recovery among those with BPD + PTSD. In addition, different forms of childhood trauma significantly affect the trajectories of individual treatment. Our findings suggest that DBT interventions may be particularly beneficial for individuals with higher levels of emotional abuse. NCT02387736. Registered February 20, 2015.

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