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.
    Full-text · Article · Jan 2016 · Journal of Personality Disorders
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    • "Patients suffering from PTSD in addition to BPD displayed a higher frequency (29.7 acts compared to 12.9 acts, p = .07) of nonsuicidal self-harm than patients with BPD alone (Harned, Rizvi, & Linehan, 2010). It is not yet clear, however, whether PTSD is an independent predictor of suicidal behavior when co-occurring with BPD. "
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    ABSTRACT: We investigated whether posttraumatic stress disorder (PTSD) was predictor of suicidal behavior even when adjusting for comorbid borderline personality disorder (BPD) and other salient risk factors. To study this, we randomly selected 308 patients admitted to a psychiatric hospital because of suicide risk. Baseline interviews were performed within the first days of the stay. Information concerning the number of self-harm admissions to general hospitals over the subsequent 6 months was retrieved through linkage with the regional hospital registers. A censored regression analysis of hospital admissions for self-harm indicated significant associations with both PTSD (β = .21, p < .001) and BPD (β = .27, p < .001). A structural model comprising two latent BPD factors, dysregulation and relationship problems, as well as PTSD and several other variables, demonstrated that PTSD was an important correlate of the number of self-harm admissions to general hospitals (B = 1.52, p < .01). Dysregulation was associated directly with self-harm (B = 0.28, p < .05), and also through PTSD. These results suggested that PTSD and related dysregulation problems could be important treatment targets for a reduction in the risk of severe self-harm in high-risk psychiatric patients.
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    • "As in the BPD group, PTSD comorbidity did not show a significant effect on instability of NA, hostility, or PA in our MDD/DYS clinical control group. Thus, our findings join those prior findings (e.g., Harned et al., 2010; Pagura et al., 2010) that have suggested an important impact of BPD-PTSD comorbidity on a core feature or features of one or both of these disorders, as opposed to finding only an increase in general impairments. In addition, our findings present evidence of disorder-specific patterns of emotion dysregulation—namely, a disparate effect of lifetime PTSD comorbidity on instability of fear and sadness across BPD and MDD/DYS outpatient samples. "
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    ABSTRACT: Ecological momentary assessment was utilized to examine affective instability (AI) in the daily lives of outpatients with borderline personality disorder (BPD; N = 78), with and without posttraumatic stress disorder (PTSD). A psychiatric control group (n = 50) composed of outpatients with major depressive disorder/dysthymia (MDD/DYS) was employed to compare across subgroups: BPD-only, BPD+PTSD, MDD/DYS-only, and MDD/DYS+PTSD. Compared with the BPD-only group, the BPD+PTSD group had significantly greater instability of fear and sadness, but did not significantly differ in instability of hostility or aggregate negative affect. This pattern of elevated instability of fear and sadness was not present—and, in fact, was reversed—in the MDD/DYS group. Results emphasize the importance of examining AI within the context of specific comorbidities and affect types. Treatment and research addressing AI in the context of BPD-PTSD comorbidity may benefit from a focus on fear and sadness as separate from hostility or general negative affect.
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