Posttraumatic Stress Disorder in Patients With Borderline Personality Disorder: Treatment Outcomes and Mediators

Abstract

Posttraumatic stress disorder (PTSD) is highly comorbid with personality disorder (PD). We evaluated whether comorbid PTSD has a negative effect on patients’ ability to benefit from evidence‐based psychological treatments for PD and tested potential mediators of any effect. The effect of PTSD on self‐harm and borderline PD symptoms was evaluated in 90 patients with borderline PD who were receiving dialectical behavior therapy or mentalization‐based therapy. Self‐report and interview measures were administered every 3 months over a 12‐month period. Three‐quarters of participants met criteria for PTSD. In the 12 months after beginning treatment, participants with PTSD did not engage in self‐harm more often or present with more severe borderline PD symptoms. However, a higher level of PTSD symptom severity at baseline was associated with more frequent self‐harm during follow‐up, incidence rate ratio = 1.03, 95% CI [1.01, 1.06], p = .005. Participants whose PTSD did not improve or worsened were more likely to still self‐harm, odds ratio (OR) = 0.91, 95 % CI [0.85, 0.97], p = .004, and report more severe borderline PD symptoms, b = 0.53, 95% CI [0.34, 0.73], p < .001, at the end of 12 months. The negative effects of PTSD symptoms remained significant after adjusting for potential confounders and were partially mediated by high ongoing levels of emotional dysregulation, indirect effect b = 0.32, 95% CI [0.19, 0.50]. These findings identify subgroups at risk of poorer outcomes from evidence‐based psychological treatments for PD and support the idea that treating PTSD may improve outcomes.

The course of (comorbid) trauma-related, dissociative and personality disorders: two year follow up of the Friesland study cohort

“…Also, the follow-up period of Dorrepaal et al (2012) and Bae et al (2016) was shorter, making results hard to compare. Our findings, indicating that comorbid PTSD did not influence the course of BPD, are in line with those of Barnicot and Crawford (2018). However, our findings, indicating that history of trauma did not predict the course of PD, do not confirm those reported by Gunderson et al (2006), Skodol et al (2005) and Zanarini et al (2006).…”

“…The majority of studies on the course of PDs have focused on BPD. A recent study of Barnicot and Crawford (2018) on patients with BPD (72.2% female), of which 74.4% had a comorbid PTSD, showed that this comorbid diagnosis had no negative influence on the one-year course of BPD. However, less improvement in PTSD symptoms at one-year follow-up was associated with continued selfharming behaviour.…”

Identifying Change Targets for Posttraumatic Stress Disorder Among Suicidal and Self‐Injuring Women With Borderline Personality Disorder

“…The vacillation between overwhelming emotions and emotional numbing that is common in PTSD may exacerbate ED, which is also viewed as a core feature of BPD (Linehan, 1993). Researchers have found that a higher level of PTSD severity predicts less improvement in suicidal and self‐injurious behavior among individuals with BPD receiving DBT and that this association is mediated by high levels of ED (Barnicot & Crawford, 2018). Taken together, these findings suggest that targeting PTSD in individuals with BPD may be important for the improvement of both disorders.…”

Evidence-based psychological interventions for borderline personality disorder in the United Kingdom—who falls through the gaps?

“…Indeed, some argue that BPD Accepted version -Journal of Psychological Therapies -In Press (2020) should be reconceptualised as a developmental response to the experience of complex interpersonal trauma (Driessen et al, 2002). Comorbid PTSD, greater severity of PTSD symptoms or failure to improve PTSD during treatment have each been associated with less improvement in self-harm and BPD symptoms following DBT or MBT (Barnicot & Crawford, 2018;Barnicot & Priebe, 2013;Harned et al 2010). Meta-analysis has shown that the most effective treatments for PTSD include an element of re-exposure to traumatic experiences (Bisson et al, 2007).…”