Category: Personality Disorders
According to Linehan’s (1993) biosocial theory, people with Borderline Personality Disorder (BPD) are thought to exhibit a deficit in coping skills. Neacsiu et al. (2010) developed a self-report measure (i.e., DBT-WCCL) of the frequency with which people use Dialectical Behavior Therapy (DBT) skills and dysfunctional coping skills in a month. People with likely BPD reported using DBT skills significantly less often than healthy controls (Neacsiu & Tkachuck, 2016). However, one limitation of the DBT-WCCL is that it is a proxy for skillful behavior (Neacsiu, Rizvi, & Linehan, 2010). That is, participants may report using skills more frequently but the quality with which they use these skills cannot be determined. To address this limitation and determine whether people with BPD exhibit a general skills deficit, we created a new measure of DBT skill quality, the DBT-Ways of Responding scale (DBT-WOR). Similar to the Ways of Responding scale (WOR; Barber & DeRubeis, 1992), the DBT-WOR presents participants with a series of nine vignettes, with three sets of three vignettes designed to assess skills in the domains of Distress Tolerance, Emotion Dysregulation, and Interpersonal Effectiveness. Participants provide free response descriptions of how they would handle each situation; independent coders rate the quality of the responses and identify individual DBT skills or dysfunctional coping skills described.
Two hundred seventy-two participants (mean age = 36.40, SD = 10.61, 59.2% female, 78.3% Caucasian), oversampled for elevated BPD traits and/or symptoms of depression completed the DBT-WOR and the DBT-WCCL online via Amazon’s Mechanical Turk. We created three groups: healthy controls (HC; n = 149), depression without BPD (MDD; n = 54), and BPD (n = 69) using cutoff scoring methods from the Patient Health Questionnaire (PHQ-9; Kroenke, Spencer, & Williams, 2001) and the Personality Assessment Inventory – Borderline scale (PAI-BOR; Morey, 1991). Independent coders are in the process of coding all DBT-WOR responses and will complete coding by May.
As a preliminary test of a skills deficit among those in the elevated BPD features group, we conducted two one-way ANOVAs comparing DBT skill use and dysfunctional coping skill use from the DBT-WCCL among the three groups. The omnibus test was significant in both models, Fs > 4.40, ps < .02. Post-hoc tests revealed that the BPD group reported using DBT skills significantly less often than the HC group, t(216) = 2.88, p < .01, but did not differ from the MDD group, t(121) = 1.33, p = .19. However, the BPD group reported using dysfunctional coping skills significantly more often than the HC group, t(216) = 10.40, p < .01, and the MDD group, t(121) = 2.35, p = .02.
These results suggest that BPD is associated with more frequent use of dysfunctional coping skills compared to HCs and those with elevated symptoms of depression but is associated with similar DBT skills deficits as those with elevated symptoms of depression. When data coding is complete in May 2017, correlations with the DBT-WCCL and similar ANOVA models will be run comparing groups on DBT-WOR scores to establish the validity of the DBT-WOR and provide a stronger empirical test of the hypothesized skill deficits in BPD.