Integrating Dialectical Behavior Therapy and Prolonged Exposure to Treat Co-Occurring Borderline Personality Disorder and PTSD: Two Case Studies

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Abstract

Despite the high rate of trauma and PTSD among individuals with borderline personality disorder (BPD), no studies have specifically evaluated the treatment of PTSD in a BPD population. These case studies illustrate the use of a protocol based on prolonged exposure therapy that can be integrated into standard dialectical behavior therapy to treat co-occurring PTSD in BPD clients. Two women with BPD and chronic PTSD were treated and results indicate a significant improvement in PTSD symptoms as well as a variety of secondary outcomes. Despite having recent and extensive histories of suicidal and nonsuicidal self-injurious behavior, as well as ongoing low to moderate urges to engage in these behaviors, neither client self-injured or attempted suicide during the PTSD treatment. These preliminary findings demonstrate the potential efficacy of combining an exposure treatment for PTSD with standard DBT, while also showing that exposure-based PTSD treatments can be implemented safely and effectively with BPD clients.

Section snippets

Standard DBT

The structure, treatment strategies, and protocols of standard DBT are described in two DBT treatment manuals (Linehan, 1993a, Linehan, 1993b) and were implemented without modification over 1 year of treatment with each of the cases presented here. For each client, standard DBT included four modes of service delivery: (a) weekly individual psychotherapy (1 hour/week), (b) group skills training (2.5 hours/week), (c) phone consultation (as needed), and (d) a weekly therapist consultation team

Identifying Information and Relevant History

“Emma” (the client's name has been changed to preserve anonymity) was a 30-year-old Caucasian female. She had never been married, had two preschool-age daughters, and was cohabiting with her boyfriend (who was also the father of her youngest daughter). Her oldest daughter was the result of a gang rape she experienced at age 25. She completed high school, obtained a Bachelor's degree, and worked in social services for approximately 4 years after graduating from college. One year after giving

Identifying Information and Relevant History

“Natalie” (the client's name has been changed to preserve anonymity) was a 48-year-old, married, Caucasian female who was living with her husband and the youngest of her two daughters. She completed high school and then went on to attend a community college before transferring to a university. Natalie never completed her Bachelor's degree due to being raped while she was a college student at age 23 and dropping out of the university. She married her husband shortly thereafter and then stayed at

Discussion

Despite the fact that 36% to 58% of treatment-seeking individuals with BPD also meet criteria for PTSD (Linehan et al., 2006, Zanarini et al., 1998, Zanarini et al., 2004, Zimmerman and Mattia, 1999), no treatments have specifically been developed or evaluated to treat co-occurring PTSD in a BPD population. The results of the two case studies presented here suggest that a modified version of PE that is implemented concurrently with standard DBT has the potential to significantly decrease PTSD

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    We are grateful to Dr. Elizabeth Dexter-Mazza for her contributions to this project. We also thank the two clients who not only courageously participated in this treatment, but who also gave their consent to the writing of this article in the hope that it will help others who are suffering.

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