Treating PTSD in Patients With Borderline Personality Disorder
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 60 |
| Updated: | 4/21/2016 |
| Start Date: | August 2009 |
| End Date: | May 2013 |
Individuals with borderline personality disorder (BPD) are the quintessential multi-problem
patients, often presenting to treatment with numerous dysfunctional behaviors and comorbid
diagnoses. Dialectical Behavior Therapy (DBT) is a comprehensive, cognitive-behavioral
treatment for BPD that has been shown effective in reducing the primary problems it is
designed to treat; namely, the frequency and severity of self-injurious and suicidal
behavior, maintenance in treatment, and severe problems in living. However, the DBT
treatment manual does not currently include a protocol specifying when or how to treat
posttraumatic stress disorder (PTSD), a comorbid diagnosis that is prevalent in BPD patients
and may maintain or exacerbate BPD criterion behaviors. Similarly, many of the existing
treatment outcome studies for PTSD have excluded suicidal, substance abusing, and multiply
diagnosed patients, thereby making it difficult to determine the generalizability of these
approaches to individuals with BPD. The research proposed here is focused on the development
of a protocol based on Prolonged Exposure therapy to treat PTSD in BPD patients that can be
integrated into standard DBT, as well as the initial evaluation of this protocol's
feasibility, acceptability, and efficacy. The treatment development and pilot testing
process will occur in two phases, including measure development and standardization of the
treatment protocol via clinical pre-testing (Phase 1); and pilot and feasibility testing of
the intervention via a randomized controlled trial (RCT) comparing standard DBT + PTSD
Protocol to standard DBT Only (Phase 2). Information gathered during the pilot RCT will be
used to inform the design and conduct of a subsequent full-scale RCT. This research has the
potential to significantly expand and improve upon the most empirically supported treatment
currently available for BPD, while also demonstrating that exposure treatments for PTSD can
be implemented safely and effectively in a BPD population.
patients, often presenting to treatment with numerous dysfunctional behaviors and comorbid
diagnoses. Dialectical Behavior Therapy (DBT) is a comprehensive, cognitive-behavioral
treatment for BPD that has been shown effective in reducing the primary problems it is
designed to treat; namely, the frequency and severity of self-injurious and suicidal
behavior, maintenance in treatment, and severe problems in living. However, the DBT
treatment manual does not currently include a protocol specifying when or how to treat
posttraumatic stress disorder (PTSD), a comorbid diagnosis that is prevalent in BPD patients
and may maintain or exacerbate BPD criterion behaviors. Similarly, many of the existing
treatment outcome studies for PTSD have excluded suicidal, substance abusing, and multiply
diagnosed patients, thereby making it difficult to determine the generalizability of these
approaches to individuals with BPD. The research proposed here is focused on the development
of a protocol based on Prolonged Exposure therapy to treat PTSD in BPD patients that can be
integrated into standard DBT, as well as the initial evaluation of this protocol's
feasibility, acceptability, and efficacy. The treatment development and pilot testing
process will occur in two phases, including measure development and standardization of the
treatment protocol via clinical pre-testing (Phase 1); and pilot and feasibility testing of
the intervention via a randomized controlled trial (RCT) comparing standard DBT + PTSD
Protocol to standard DBT Only (Phase 2). Information gathered during the pilot RCT will be
used to inform the design and conduct of a subsequent full-scale RCT. This research has the
potential to significantly expand and improve upon the most empirically supported treatment
currently available for BPD, while also demonstrating that exposure treatments for PTSD can
be implemented safely and effectively in a BPD population.
Inclusion Criteria:
- Female
- Age 18-60
- Meet criteria for borderline personality disorder
- Meet criteria for post-traumatic stress disorder
- Can clearly remember at least some part of the traumatic event(s)
- Recent and recurrent self-injurious behavior
- Lives within commuting distance of University of Washington, Seattle campus
- Consents to all research protocols
Exclusion Criteria:
- Male
- Court ordered to treatment
- Diagnosis of psychotic disorder, bipolar disorder, or seizure disorder requiring
medication
- Less than 18 years of age or older than 60 years of age
- Problems which by their presence or severity preclude ability to attend or understand
treatment and/or requires priority treatment
- Familial or domestic relationship with a current study participant
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