Category: Treatment - DBT
The diagnosis of borderline personality disorder (BPD) in adolescence is associated with significant functional impairments, heightened distress, risk of suicide, and poor prognosis (Miller, Rathus, & Linehan, 2007). There is strong support for the treatment of BPD using Dialectical Behavior Therapy (DBT); however there is limited research examining the efficacy of DBT in adolescent populations. The present study examined the effectiveness of a 4-week intensive DBT residential program for adolescent girls (N=80, Mage=17.02yrs, SD=1.86) demonstrating behavioral criteria for BPD, including self-harm and suicidality. Additionally, this study evaluated the clinical utility of distinguishing between patients meeting full criteria for BPD and those exhibiting sub-threshold criteria, as well as explored the efficacy of treatment across levels of diagnostic severity. Pre- and post-treatment BPD, depression, and anxiety symptoms were assessed using the Zanarini Rating Scale for BPD, BDI-II, and MASQ-Anxious Arousal subscale. Two-way ANOVA was used to test pre- to post-treatment symptom severity in patients meeting full criteria (5 or more; N=53) and sub-threshold BPD (2 to 4 criteria; N=27). The main effect of treatment was significant for BPD (F(1)=16.84, p < .01) and depression symptoms (F(1)=22.97, p < .01), suggesting that on average patients improved in these domains over 4 weeks of intensive DBT treatment. However, there was no significant change in anxiety symptoms during this same period. Comparing sub-threshold and full criteria BPD diagnostic groups, the group-by-treatment interaction was significant for changes in BPD symptoms (F(1)=5.56, p=.02), but not symptoms of depression or anxiety. This suggests that BPD severity did not distinguish relative response to treatment of depression or anxiety symptoms. For BPD symptoms, patients meeting full criteria showed greater improvement in symptoms relative to sub-threshold patients (F(1,70)=1.42, p=.24). In contrast, patients with sub-threshold BPD did not report any significant changes in BPD symptoms (t(17)=1.44, p=.17). These results suggest that a 4-week residential DBT program may be particularly effective for reducing BPD symptoms in adolescents meeting full, as compared to sub-threshold, criteria for BPD and may help reduce the severity of depression symptoms in adolescents irrespective of severity of baseline BPD. However, these results also suggest that symptoms of anxiety were not adequately addressed and future research is needed to explore additional treatment components that may be necessary to effectively target anxiety in this population.