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: 13.56). 10/2010; 167(10):1210-7. DOI: 10.1176/appi.ajp.2010.09081213
Source: PubMed

ABSTRACT 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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    • "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.
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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.
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    • "Deliberate self-harm (DSH), whereby an individual deliberately causes tissue damage without suicidal intent (Gratz, 2001), is consistently and strongly associated with sexual victimization in both childhood (Gladstone et al., 2004; Mina and Gallop, 1998; Noll et al., 2003) and adulthood (Campbell et al., 2007; Gratz, 2006) and with mental health problems such as posttraumatic stress (Cloitre et al., 2002; Harned et al., 2006, 2010b; Nada-Raja and Skegg, 2011) and depression (Boudewyn and Liem, 1995; Hawton et al., 1999). "
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    ABSTRACT: Deliberate self-harm (DSH) among women in the general population is correlated separately with posttraumatic stress, depression, and abuse during childhood and adulthood. The prevalence of these DSH correlates is particularly high among women exposed to intimate partner violence (IPV), yet few studies have examined DSH among this high-risk population and none have examined these correlates simultaneously. Two hundred and twelve IPV-victimized women in the community participated in a 2-h retrospective interview. One-third reported current or past DSH. Discriminant analysis was used to examine which posttraumatic stress and depression symptoms and types of current IPV and childhood abuse were uniquely associated with current DSH. Findings show that women who currently use DSH reported greater severity of posttraumatic stress numbing symptoms and more severe sexual IPV compared to women who used DSH only in the past. Examining factors that are associated with women's current DSH in this population is critical so that a focus on DSH can be integrated into the treatment plans of women who are receiving mental health care, but also so that women who are not receiving such care can be referred to adequate mental health services
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