Dissociation Predicts Poor Response to Dialectial Behavioral Therapy in Female Patients with Borderline Personality Disorder

Abstract

A substantial proportion of Borderline Personality Disorder (BPD) patients respond by a marked decrease of psychopathology when treated with Dialectical Behavioral Therapy (DBT). To further enhance the rate of DBT-response, it is useful to identify characteristics related to unsatisfactory response. As DBT relies on emotional learning, we explored whether dissociation-which is known to interfere with learning- predicts poor response to DBT. Fifty-seven Borderline Personality Disorder (BPD) patients (DSM-IV) were prospectively observed during a three-month inpatient DBT program. Pre-post improvements in general psychopathology (SCL-90-R) were predicted from baseline scores of the Dissociative Experiences Scale (DES) by regression models accounting for baseline psychopathology. High DES-scores were related to poor pre-post improvement (β = -0.017 ± 0.006, p = 0.008). The data yielded no evidence that some facets of dissociation are more important in predicting DBT-response than others. The results suggest that dissociation in borderline-patients should be closely monitored and targeted during DBT. At this stage, research on treatment of dissociation (e.g., specific skills training) is warranted.

The Applicability and Efficacy of Transdiagnostic Cognitive Behavior Therapy on Reducing Signs and Symptoms of Borderline Personality Disorder With Co-Occurring Emotional Disorders: A Pilot Study

“…Among participants, patient 3 reported no symptoms associated with BPD at the end of the treatment and met no BPD criteria based on SCHID-II; this improvement was maintained on the follow-up. As it seems that patients responded honestly to questionnaires, a good therapeutic alliance and the absence of dissociative symptoms and childhood traumatic experiences may influence treatment outcomes, as Kleindienst et al and Barnicot et al also cited them as good prognostic factors in BPD treatment (33,34). Also, contrary to some researchers, who believe that male gender predicts poor treatment outcomes, the male patient in the present research experienced the greatest improvement.…”

Emotions and Memory in Borderline Personality Disorder

“…An established learning procedure outside the laboratory is psychotherapy, which implies a relearning of habits and learning new strategies to think in a more helpful way. Dissociative symptoms correlated negatively with improvements in BPD patients' general psychopathology after psychotherapy [133]. A similar influence of dissociative pathology on therapy outcome was found in patients with panic disorder [134], obsessive-compulsive disorder [135], depression [136], and anxiety disorder [136].…”

The overlap between dissociative symptoms and symptom over-reporting

“…As well, our clinical sample was small, and future research testing the effects of adjustment for over-reporting in larger clinical samples is warranted. A crucial next step would be to test whether criterionrelated validity (e.g., dissociation predicting poor therapy outcome 29 ) increases when symptom reports are adjusted for over-reporting tendencies.…”