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Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients
Abstract
A randomized clinical trial was conducted to evaluate the effectiveness of a cognitive-behavioral therapy, ie, dialectical behavior therapy, for the treatment of chronically parasuicidal women who met criteria for borderline personality disorder. The treatment lasted 1 year, with assessment every 4 months. The control condition was "treatment as usual" in the community. At most assessment points and during the entire year, the subjects who received dialectical behavior therapy had fewer incidences of parasuicide and less medically severe parasuicides, were more likely to stay in individual therapy, and had fewer inpatient psychiatric days. There were no between-group differences on measures of depression, hopelessness, suicide ideation, or reasons for living although scores on all four measures decreased throughout the year.
... DBT is a derivative of CBT, which was originally designed to treat suicidality and non-suicidal self-injury (NSSI), in those who experiences traits of borderline personality disorder [34]. DBT is a changed-focussed behavioural treatment, which utilises the development of skills training and how to implement these in everyday life, along with addressing barriers to motivation [35,36]. ...
... Teasdale et al., 2000). They have also been successful in managing anger (Speca et al., 2000) and mitigating maladaptive behaviors (Coffey & Hartman, 2008), including binge eating (Telch et al., 2001), substance use (Linehan et al., 1999), and parasuicidal tendencies (Linehan, 1991). Collectively, these ndings highlight the utility of mindfulness in mitigating PD across diverse conditions and behaviors. ...
Background Individuals with specific learning disabilities (SLD) often experience significant emotional challenges arising from negative learning experiences. Mindfulness interventions may provide support in addressing these difficulties. Objective This study examined how mindfulness, cultivated through an MBSR intervention, influences stress-related symptoms among individuals with SLD. It explored the relationships between mindfulness, psychological distress (PD), and learning-based stress symptoms (LBSS) while assessing its potential to foster post-traumatic growth (PTG). Methods A total of 127 participants (M = 37.1, SD = 10.6) were recruited through advertisements in learning disabilities and student groups. Participants officially diagnosed with SLD (n = 49) were randomly assigned to an experimental group (n = 25), which completed an MBSR program, or a waitlist control group (n = 24). Assessments of mindfulness, PD, and LBSS were conducted at baseline (T1), post-intervention (T2), and follow-up (T3, 4 months later). PTG was assessed only at follow-up. Participants without SLD (n = 78) served as a baseline comparison group. Results Participants with SLD reported significantly higher levels of PD and LBSS compared to the general population. The MBSR group showed significant reductions in PD and LBSS compared to the control group, with sustained benefits at follow-up. Mindfulness mediated the relationship between MBSR participation and reductions in PD and LBSS. No significant improvement in PTG was observed. Conclusion MBSR demonstrates effectiveness in reducing psychological distress and learning-based stress among individuals with SLD. While its impact on PTG remains inconclusive, mindfulness interventions offer promising support for addressing chronic stress in this population.
Personality development is closely linked to attachment security and mentalization or ToM. This chapter starts with listing the DSM categories for personality disorders, followed by a description of Borderline Personality Disorder or BPD in particular. In relation to ADHD and ASD, a discussion about BPD is of special clinical relevance as all three conditions are highly comorbid.
Moreover, there is substantial symptom overlap, thus complicating the diagnostic picture. In my clinical experience, the majority of adult women with untreated ADHD initially present with anxiety, depression, mood dysregulation, and unstable relationships. Executive dysfunction, even if present, may not be the most distressing symptom at that time. In several cases, especially with a history of trauma exposure, the presenting signs and symptoms are likely to fulfill the DSM-V diagnostic criteria for BPD.
The chapter explores the link between ASD and BPD in terms of differences in ToM and empathy. This is followed by a comparison between ADHD and BPD, both from a psychodynamic as well as cognitive-behavioral perspective. This includes a discussion of the pioneering works of Kernberg, Fonagy, and Linehan in the field of personality disorders. Lastly, the chapter examines the unique intersection of atypical neurodevelopment, trauma exposure, and early developmental processes, including mentalization.
This article explores the efficacy of dialectical behavior therapy (DBT) for young people aging out of the Department of Children and Families system. The project was conducted with participants at a residential program for “transitional youth” who have serious emotional disturbance and emerging mental illness (N = 15). The research method combined a posttest-only comparison group design, with pretest-posttest observations for the DBT group. The research question explored the efficacy of DBT for this population, and used a mixed-method approach combining both quantitative and qualitative data collection. All participants received individual therapy, with 24/7 wraparound residential services. The DBT intervention consisted of an additional two hours of weekly skills-training groups. The mean length of exposure to the DBT intervention was 12.4 months. The quantitative measures included the Modified Global Assessment of Functioning Scale, and the Purposeful Productive Activity and Quality of Life Scale. The qualitative portion of the study involved semi-structured interviews and focus groups.Members of the DBT group improved from pretest to posttest, and when judged against the comparison group improvement was in terms of global functioning, social relationships, and productive use of time or “intentionality,” but not in terms of vocational functioning. The qualitative data suggest that DBT group members used the groups to work on specific interpersonal relationship, emotion regulation, and distress tolerance skills, as well as to get feedback and support from others in the group. The potential implications of these findings for clinical practice may be to suggest DBT as a promising, evidence-based intervention for this vulnerable and heretofore underserved population.
This chapter examines the relationship between bipolar and related disorders and substance use in adolescents, focusing on diagnostic criteria, prevalence, neurobiology, and neuropsychological aspects outlined in the DSM-5-TR. It explores how symptoms like mood instability and impulsivity increase the risk of substance use. Studies show that early-onset bipolar disorder during adolescence significantly elevates the likelihood of developing substance-related issues, creating a cycle of risk behaviors. Furthermore, adolescents with bipolar disorder display a heightened tendency to use substances for mood regulation. The chapter also addresses how excessive substance use exacerbates academic, occupational, and treatment adherence challenges in individuals with bipolar disorder. It concludes by stressing the importance of integrated psychosocial interventions to address both bipolar symptoms and substance use, aiming to improve treatment outcomes for adolescents.
This paper deals with the presence of suicidal behavior in a mental health clinic and psychiatric emergency room, and its relationships to what has been described in the literature as the "dependent-dissatisfied" personality. Procedures included a suicidal potential scale, projective figure drawings, and a brief interview about past and present suicidal behavior. The scale used significantly differentiated between high and low potentially suicidal groups. The high suicidal group showed a significantly greater dissatisfaction with treatment both past and present. The implications for both evaluation and therapy of suicidal patients are discussed.
A careful reading of the letter from Drs Goldberg and Schulz leaves me feeling that they did not feel altogether "flattered" or "gratified" by my commentary in the July 1986 issue of the Archives
It seems ironic that I should be fearful about the overzealous application of their finding, while their concern is that its value will go inadequately recognized—ironic because my fears reflect the substantial impact I expect their work to have, while their concern seems to reflect more humble expectations.
Fortunately, the new scientism that has permeated psychiatry and has an increasing impact on clinical practices provides an appeal court by which history will document whether my caution about overutilization or the investigators' fear of underutilization is warranted. Drs Goldberg and Schulz have pioneered research in this difficult area that will set a mark against which future treatment research can measure itself and by which their contribution itself