Sex and gender in treatment response to dialectical behaviour therapy: current knowledge, gaps, and future directions

Abstract

Borderline personality disorder (BPD) is a mental health condition characterized by emotion dysregulation, interpersonal impairment, and high suicidality. Dialectical behaviour therapy (DBT) is the most widely studied psychotherapeutic treatment for BPD. To date, the vast majority of DBT research has focused on cisgender women, with a notable lack of systematic investigation of sex and/or gender differences in treatment response. In order to encourage effective, equitable treatment of BPD, further investigation into treatment targets in this population is critical. Here, we employed a systematic strategy to delineate gaps in the DBT literature pertaining to sex and gender differences and propose directions for future research. Findings demonstrate a significant discrepancy in measurement of sex and gender, particularly among gender-diverse individuals. Exploring DBT treatment response across the full spectrum of genders will facilitate the provision of more tailored, impactful care to all individuals who suffer from BPD. Key learning aims (1) To date, DBT treatment literature has focused almost exclusively on cisgender women, with only two of 253 DBT studies in current literature accounting for transgender and gender diverse (TGD) individuals. (2) Recognize how gender minority stress may impact the prevalence of BPD among TGD individuals. (3) Learn how future research initiatives can be employed to rectify this gap in the DBT literature.

A commentary on treating externalizing problems with dialectical behavioral therapy for adolescents.

“…This gender proportion is consistent with the existing literature, in which DBT is mainly studied in samples overrepresenting women. However, a systematic investigation of the effect of gender on treatment outcomes is missing (Penta et al, 2022), which is especially important as a higher prevalence of externalizing problems is found in males compared to females. Tomlinson (2018) reviewed data from 34 DBT programs in forensic settings and reported 62% females out of a total of 996 participants.…”

Clinical outcomes for sexual and gender minority adolescents in a dialectical behaviour therapy programme

“…The DBT model is thought to have useful applications for distress associated with SGM experiences ( Camp, 2023 ; Camp, Morris, et al, 2023 ; Cohen, Norona, Yadavia, & Borsari, 2021 ; Penta et al, 2022 ; Skerven, Whicker, & LeMaire, 2019 ; Sloan, Berke, & Shipherd, 2017 ). One reason for this is that DBT is principle-driven, which allows flexibility to integrate SGM-specific issues into the treatment as needed.…”

“…Another aspect of DBT thought to be applicable to SGM groups is the focus on the transdiagnostic construct of emotion dysregulation as the core treatment target, which is considered an important mediating factor between minority stress and mental health outcomes in the psychological mediation framework ( Hatzenbuehler, 2009 ). Finally, the use of validation, a dialectical world view, and teaching skills that are generalisable to varied life problems, makes DBT a potentially ideal candidate for supporting SGM young people experiencing psychological distress and discrimination ( Cohen et al, 2021 ; Penta et al., 2022 ; Skerven et al, 2019 ; Sloan et al, 2017 ). This should not be seen to imply that it is incumbent on minoritised individuals to take responsibility for managing societal oppression.…”