RESUMEN

Dialectical behavior therapy (DBT) is an empirically supported treatment for borderline personality disorder (BPD) in adults, however fewer studies have examined outcomes in adolescents. This study tested the effectiveness of an intensive 1-month, residential DBT treatment for adolescent girls meeting criteria for BPD. Additionally, given well-established associations between BPD symptoms and childhood abuse, the impact of abuse on treatment outcomes was assessed. Participants were female youth (n = 53) aged 13-20 years (M = 17.00, SD = 1.89) completing a 1-month residential DBT program. At pre-treatment, participants were administered a diagnostic interview and self-report measures assessing BPD, depression, and anxiety symptom severity. Following one month of treatment, participants were re-administered the self-report instruments. Results showed significant pre- to post-treatment reductions in both BPD and depression symptom severity with large effects. However, there was no significant change in general anxious distress or anxious arousal over time. The experience of childhood abuse (sexual, physical, or both) was tested as moderator of treatment effectiveness. Although experiencing multiple types of abuse was related to symptom severity, abuse did not moderate the effects of treatment. Collectively, results indicate that a 1-month residential DBT treatment with adolescents may result in reductions in BPD and depression severity but is less effective for anxiety. Moreover, while youth reporting abuse benefitted from treatment, they were less likely to achieve a clinically significant reduction in symptoms.

RESUMEN

BACKGROUND: Borderline personality disorder (BPD) is characterized by greater engagement in non-suicidal self-injury (NSSI) and suicidality. The aim of the study is to test whether the occurrence of child abuse contributes to these high-risk behaviors in BPD youth. MATERIALS AND METHODS: BPD female youth aged 13-21years with (n=29) and without (n=29) a history of child abuse were administered clinical interviews assessing diagnostic history, child abuse, NSSI and suicidality (i.e., ideation, plans, and attempts). NSSI and suicidality were subsequently reevaluated at the 1- and 2-month follow-up assessments. RESULTS: Several findings emerged. First, relative to BPD youth without abuse, the abuse group reported greater past NSSI; however, no significant differences emerged in the follow-up period. Second, the occurrence of child abuse was associated with a 5-fold increase in the rate of lifetime suicide attempts relative to the no abuse group and additionally, prospectively predicted suicide ideation (but not attempts). Last, exploratory analyses indicated that the co-occurrence of physical and sexual abuse was associated with greater past NSSI and suicidality as compared to the no abuse and sexual abuse only participants. CONCLUSION: As a whole, child abuse - particularly co-occurring physical and sexual abuse - increases risk for NSSI and suicidality among BPD youth, which may have important treatment implications in this high-risk population.

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RESUMEN

We investigated the potential impact of abuse history on autonomic regulation and psychological wellbeing in a sample of women who reported a history of abuse without Post Traumatic Stress Disorder. To measure autonomic regulation, heart rate data was collected before and after the participant rode a stationary bike for one mile. We found that abuse history was associated with less vagal regulation of the heart (i.e., respiratory sinus arrhythmia) and an inability to rapidly re-engage vagal regulation immediately following mild exercise to support a calm physiological state. These findings are consistent with clinical impressions that abused individuals may have a lower threshold to express fight/flight behaviors in response to stress and have difficulty shifting from mobilization to calmness. We also found that abuse history was related to psychological wellbeing. Women with an abuse history reported a greater use of dysfunctional coping methods and lower self-concept. Further, analyses indicated that there was a cumulative effect, whereby women who reported more recent abuse reported using more dysfunctional coping methods, having more mood disturbance, and lower self-concept. The findings underscore the importance of evaluating both the psychological and physiological effects of trauma, even in the absence of a diagnosis of PTSD.

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