Impact of Co-Occurring Posttraumatic Stress Disorder on Suicidal Women With Borderline Personality Disorder

Department of Psychology, University of Washington, 3935 University Way NE, Seattle, WA 98105, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 10/2010; 167(10):1210-7. DOI: 10.1176/appi.ajp.2010.09081213
Source: PubMed


The authors examined the impact of co-occurring posttraumatic stress disorder (PTSD) on women with borderline personality disorder who had attempted suicide in the preceding year.
Female borderline personality disorder outpatients (N=94) either with (N=53, 56.4%) or without PTSD (N=41, 43.6%) and with recent and repeated suicidal or self-injurious behavior were compared in nine areas of functioning.
Borderline personality disorder patients with and without PTSD differed in the lethality, intent, and triggers for intentional self-injury, trauma history, emotion regulation, and axis I comorbidity. The two groups did not differ in borderline personality disorder severity, axis II comorbidity, psychosocial functioning, or mental health or medical treatment utilization.
The results indicate greater impairment among individuals with both disorders and suggest that there are some unique features associated with co-occurring borderline personality disorder and PTSD that require further attention in assessment and treatment.

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Available from: Melanie Harned, Feb 01, 2015
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    • ") and lower likelihood of remittance from BPD (Zanarini, Frankenburg, Hennen, Reich, & Silk, 2006). One possible explanation for the higher clinical severity found in individuals with BPD and comorbid PTSD versus those individuals with BPD without PTSD is that childhood trauma and PTSD may maintain or exacerbate BPD by further intensifying emotion dysregulation and increasing the frequency of impulsive and self-destructive behaviors, which are among the core features of the disorder (Harned et al., 2010b). For example, suicidal behaviors and NSSI may function as a way to cope with intense negative affect and cognitions associated with PTSD and trauma (Harned, 2013). "
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    ABSTRACT: The aim of this study was to determine the influence of posttraumatic stress disorder (PTSD) on treatment outcomes in patients with borderline personality disorder (BPD). Participants were 180 individuals diagnosed with BPD enrolled in a randomized controlled trial that compared the clinical and cost effectiveness of dialectical behavior therapy (DBT) and general psychiatric management (GPM). Multilevel linear models and generalized linear models were used to compare clinical outcomes of BPD patients with and without PTSD. BPD patients with comorbid PTSD reported significantly higher levels of global psychological distress at baseline and end of treatment compared to their non-PTSD counterparts. Both groups evidenced comparable rates of change on suicide attempts and non-suicidal self-injury (NSSI), global psychological distress, and BPD symptoms over the course of treatment and post-treatment follow-up. DBT and GPM were effective for BPD patients with and without PTSD across a broad range of outcomes.
    Journal of Personality Disorders 01/2016; DOI:10.1521/pedi_2015_29_207 · 2.31 Impact Factor
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    • "In clinical samples, the rates of comorbidity are higher. PTSD patients are reported to have BPD comorbidity ranging from 37 to 68% (Heffernan & Cloitre, 2000; Zlotnick, Franklin, & Zimmerman, 2002) and conversely, among BPD patients 25Á58% are diagnosed with comorbid PTSD (Golier et al., 2003; Harned, Rizvi, & Linehan, 2010; Zanarini et al., 1998). Despite these high rates of comorbidity, the key clinical features of Complex PTSD and BPD differ and lead to different treatment implications, a consequence of significance when considering the clinical utility of diagnostic formulation. "
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    ABSTRACT: Background There has been debate regarding whether Complex Posttraumatic Stress Disorder (Complex PTSD) is distinct from Borderline Personality Disorder (BPD) when the latter is comorbid with PTSD. Objective To determine whether the patterns of symptoms endorsed by women seeking treatment for childhood abuse form classes that are consistent with diagnostic criteria for PTSD, Complex PTSD, and BPD. Method A latent class analysis (LCA) was conducted on an archival dataset of 280 women with histories of childhood abuse assessed for enrollment in a clinical trial for PTSD. Results The LCA revealed four distinct classes of individuals: a Low Symptom class characterized by low endorsements on all symptoms; a PTSD class characterized by elevated symptoms of PTSD but low endorsement of symptoms that define the Complex PTSD and BPD diagnoses; a Complex PTSD class characterized by elevated symptoms of PTSD and self-organization symptoms that defined the Complex PTSD diagnosis but low on the symptoms of BPD; and a BPD class characterized by symptoms of BPD. Four BPD symptoms were found to greatly increase the odds of being in the BPD compared to the Complex PTSD class: frantic efforts to avoid abandonment, unstable sense of self, unstable and intense interpersonal relationships, and impulsiveness. Conclusions Findings supported the construct validity of Complex PTSD as distinguishable from BPD. Key symptoms that distinguished between the disorders were identified, which may aid in differential diagnosis and treatment planning.
    European Journal of Psychotraumatology 09/2014; 5. DOI:10.3402/ejpt.v5.25097 · 2.40 Impact Factor
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    • "Patients with this comorbidity also showed a trend for more severe BPD symptoms throughout the course of treatment. These results are concurrent with the only other study to assess the influence of PTSD comorbidity on the outcome of psychotherapy for BPD, that of Harned et al. (2010b). Evidence suggests that PTSD symptoms can aggravate BPD traits and vice versa, in particular leading to increased anger, anxiety, depression, impulsivity and suicide proneness (Vignarajah & Links, 2009). "
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    ABSTRACT: Individuals with borderline personality disorder (BPD) and comorbid post-traumatic stress disorder (PTSD) have a worse prognosis than individuals with BPD alone. A common view is that the emotional instability and impulsivity of BPD should be treated before attempting to address trauma. However, PTSD symptoms may interfere with patients' ability to benefit from such 'stabilizing' treatments. The effect of BPD-PTSD comorbidity on self-harm and BPD symptom outcomes was evaluated in 89 patients receiving dialectical behaviour therapy, using multilevel modelling. Patients with comorbid BPD-PTSD showed a trend towards elevated BPD symptoms throughout the treatment year (β = 2.12, 95% CI = -0.21-4.44, p = 0.07). There was a three-way interaction between PTSD comorbidity, treatment completion and time, whereby PTSD comorbidity was associated with less reduction in self-harm frequency over time, but only in those completing the full 12 months of treatment (incident risk ratio = 1.16, 95% CI = 1.04-1.30, p < 0.01). Patients with comorbid PTSD had a poorer outcome from dialectical behaviour therapy than those with BPD alone, possibly because of the negative impact of unaddressed trauma. The results provide further grounds for recently developed treatments targeting BPD traits and PTSD symptoms simultaneously. Copyright © 2013 John Wiley & Sons, Ltd.
    Personality and Mental Health 08/2013; 7(3):181-90. DOI:10.1002/pmh.1227 · 1.10 Impact Factor
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