Dialectical Behavior Therapy: An Emotion-Focused Treatment for Borderline Personality Disorder

Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment for borderline personality disorder (BPD) that is based on the theory that emotion dysregulation is the core feature of BPD. This article focuses on aspects of DBT theory and techniques that specifically address emotion. The dialectical and biosocial theories that underlie DBT are reviewed with an emphasis on how each relates to emotional experiencing in BPD. Selected treatment strategies that address emotion dysregulation and their hypothesized mechanisms of change are also described. Relevant research findings are incorporated throughout to provide an empirical foundation for the DBT theories and strategies that are discussed.     

Strategies for Securing Commitment to Treatment from Individuals Diagnosed with Borderline Personality Disorder

Individuals diagnosed with borderline personality disorder (BPD) are notoriously difficult to engage in treatment. The purpose of this paper is to highlight therapeutic strategies that are likely to facilitate early alliance in therapy with individuals diagnosed with BPD. The seven strategies include, collaborative assessment, the use of contracts, motivational interviewing, linking treatment targets to client goals, commitment strategies, validation, and the use of metaphors. Clinical vignettes are presented to elucidate the concepts described and demonstrate their use in clinical practice.     

对边缘性人格障碍亚型的研究

边缘性人格障碍是一种最常见的人格障碍。描述性精神病学、心理测验和精神分析的研究发现,边缘性人格障碍可能是由若干个异质性的亚群体组成,不同的亚群在症状表现、病因、心理病理机制、对治疗干预的反应和预后等方面可能都存在着很大的差异,可以根据不同的维度将其进行亚型分类,而使同一个亚群中的个体差异小于不同亚群之间的个体差异。     

Associations Between Symptoms of Borderline Personality Disorder,Externalizing Disorders,and Suicide-Related Behaviors

Borderline personality disorder and externalizing disorders are associated with suicide-related behaviors. The present study examined whether symptoms of borderline personality disorder mediate the relationship between externalizing disorders and suicide-related behaviors. Diagnostic interviews were administered to 344 participants (n = 233 women). Results indicated that symptoms of antisocial personality disorder, alcohol use disorders, and drug use disorders each were significantly associated with suicide threats and self-injurious behavior in women and symptoms of antisocial personality disorder were associated with suicide attempts in women. With the exception of the association between symptoms of alcohol dependence and self-injurious behaviors, borderline personality disorder symptoms mediated or partially mediated all associations between externalizing disorders and suicide-related behaviors in women. These results highlight the importance of assessment and treatment of borderline personality disorder symptoms in individuals with externalizing disorders, particularly in the presence of suicide-related behaviors.

Integrating Individual and Family Systems Psychotherapy to Treat Borderline Personality Disorder

This paper focuses on two areas. The first is the framework for psychotherapy integration used by Unified Therapy, a psychotherapy approach that is an integration of psychodynamic, cognitive–behavioral, and family systems therapy. The second is the use of this treatment paradigm in the psychotherapy of adults with borderline personality disorder. The theory posits that continuing and recurrent interpersonal behavior patterns within the patient's family of origin serve as behavioral triggers to typical acting-out behaviors. Therapy is geared toward planning strategies to alter these destructive patterns. A case example is presented to demonstrate the use of the therapy's theories and techniques.     

The STEPPS Group Treatment Program for Outpatients with Borderline Personality Disorder

The authors describe a new cognitive-behavioral systems-based group treatment for outpatients diagnosed with borderline personality disorder (BPD). The program is identified by the acronym STEPPS, which stands for Systems Training for Emotional Predictability and Problem Solving. The STEPPS program was developed to address the cognitive distortions and behavioral dyscontrol typical of clients with BPD, and combines this with skills training and a systems component. The latter involves clients with BPD and those in their system including family members, significant others, and health care professionals. The program is fully manualized, and involves 20 two-hour weekly group meetings; specific goals (or lessons) are identified for each session. Preliminary data from the US and the Netherlands have shown that the group achieves high levels of acceptance from clients and therapists and that the model may be effective in helping to relieve the symptoms associated with BPD. Work is now underway to confirm the effectiveness of the model through a randomized controlled trial.     

Children At-Risk for Borderline Personality Disorder

Adult patients who have been diagnosed with borderline personality disorder (BPD) have provided valuable information about events and family dynamics that are frequently associated with BPD. Clinicians who work with children are frequently aware of family or individual characteristics that may put a child at risk for developing BPD. Such situations frequently involve attachment issues with the child's caregivers and can include sexual abuse, divorce, alcoholism/substance use, illness/ death, and neglect. Child characteristics such as learning difficulties and temperament may also predict BPD. Yet, many children are resilient and seemingly unaffected by these events or situations, especially when early intervention may prevent development of BPD.     

Strategies Used in the Treatment of Borderline Personality Disorder: A Survey of Practicing Psychologists

One hundred and twenty three practicing psychologists completed surveys regarding the therapeutic techniques they employ for patients with Borderline Personality Disorder (BPD). Participants identified their predominant orientation and rated the frequency with which they used a range of 27 specific strategies. Logistic regression analyses identified an expected relationship between specific techniques and the theoretical orientations to which they are most closely linked. These findings suggest a high level of concordance between self-described theoretical orientation and the specific treatment techniques utilized, but also that some theoretical orientations are comprised of smaller independent clusters of strategies. The implications of these findings are discussed.     

Changing Ideas About the Treatment of Borderline Personality Disorder

Systematic treatment outcome studies and research on the structure and origins of the disorder are challenging many traditional ideas about the nature and treatment of borderline personality disorder. On the basis of this research, it is argued that a comprehensive treatment requires an eclectic approach that uses an array of interventions drawn from different therapeutic models that are delivered in an integrated and coordinated way. Such an approach conceptualizes treatment in terms of generic strategies designed to build an effective alliance and treat core self and interpersonal pathology and specific interventions to treat the various components of the disorder. It is also argued that there may be limits to the extent to which some aspects of borderline pathology can be changed. Borderline personality disorder is often a chronic condition that is best managed using a rehabilitation model.     

Cognitive-Behavioral Treatment of Depression with Comorbid Borderline Personality Traits

Personality dysfunction can influence the onset and maintenance of depressive symptoms. When both depression and personality dysfunction are present, it is important to develop an integrated treatment plan that addresses both conditions. A case example is used to illustrate how features of borderline personality disorder can influence the assessment and treatment of major depression. Specific challenges encountered by the therapist include: 1) differentiating borderline personality from depressive symptoms, 2) maintaining the therapeutic alliance, 3) managing impulsivity and self-destructive tendencies, 4) staying focused on long-term therapeutic goals, and 5) coping with noncompliance. Over the course of 27 sessions, the client was able to make positive changes in mood, self-image, and impulsive tendencies. Although the client's borderline personality traits complicated the course of treatment for depression, neglecting these personality problems would have left the client vulnerable to depressive relapse.     

The Treatment of Histrionic and Narcissistic Personality Disorder Behaviors: A Single-Subject Demonstration of Clinical Improvement Using Functional Analytic Psychotherapy

This article presents single-subject data for the treatment of histrionic and narcissistic personality disorder behaviors using a relatively brief course of an interpersonal therapy, Functional Analytic Psychotherapy (Kohlenberg & Tsai, 1991). The treatment produced significant changes in these behaviors both statistically and qualitatively. Empirical methods for analyzing the changes across sessions and for determining that the therapist engaged in the proposed mechanism of clinical change are discussed. While these data are for one subject, the results of treatment provide both a method of treating difficult and long-standing client behaviors such as these, and for assessing the progress of therapy.     

Treating Symptoms of Borderline Personality Disorder Through Narrative Therapy and Naltrexone

Abstract

Borderline Personality Disorder (BPD) is characterized by instability in interpersonal relationships, volatile perceptions of self-image and affects, and marked impulsivity, presenting in various contexts. Current BPD treatments are individual-centered, coping skills based, with a reduced emphasis on identifying etiology and systemic components. Narrative therapy focuses on deconstructing and reauthoring personal stories. A clinical case study shows narrative therapy to be efficacious, however, sometimes psychotherapeutic interventions alone are inadequate in managing these symptoms. Medication can serve as a useful adjunct in addressing self-injurious behaviors, suicidal ideation, and dissociation. Researchers further discuss the integration of naltrexone into treatment of BPD symptoms.     

Emotional responses to a negative emotion induction procedure in Borderline Personality Disorder

The aim of this study was to determine if patients with Borderline Personality Disorder (BPD) present higher emotional response than healthy controls in a laboratory setting. Fifty participants (35 patients with BPD and 15 healthy controls) underwent a negative emotion induction procedure (presentation of standardized unpleasant images). Subjective emotional responses were assessed by means of self-reported questionnaires while biological reactivity during the procedure was measured through levels of salivary cortisol (sCORT) and alphaamylase (sAA). Patients with BPD exhibited significant lower cortisol levels and higher sAA levels compared to controls. Self-reported emotional reactivity did not give rise to differences between groups but participants with BPD did present higher levels of negative emotional intensity at baseline and during the entire procedure. The findings do not give support to the emotional hyperreactivity hypothesis in BPD. However, BPD patients presented heightened negative mood intensity at baseline, which should be considered a hallmark of the disorder. Further studies using more BPD-specific emotion inductions are needed to confirm the trends observed in this study.     

高边缘性人格障碍特质者负性沉浸的自我反思倾向

采用自我参照范式考察边缘性人格障碍(BPD)的自我反思特点。实验1对比高、低BPD特质被试在自我和姓名参照条件下正负性词汇的再认成绩,发现高BPD特质者在自我参照条件下的负性词汇记忆成绩显著高于低BPD特质组。实验2对高BPD特质被试进行正念自我反思训练,结果发现相对于对照组,训练组在自我参照条件下负性词汇的记忆成绩显著降低。高BPD特质者的自我反思存在负性沉浸倾向,且正念自我反思训练可以改善该倾向。     

Daily Occupations and Adaptation to Daily Life Described by Women Suffering from Borderline Personality Disorder

Clients suffering from Borderline Personality Disorder have significant impairments in relation to health. Despite this, their occupational status is rarely described. The aim of this study was to examine how women with Borderline Personality Disorder describe their daily occupations and adaptation to daily life. The study included nine participants. The data were collected using a semi-structured interview and were analyzed using content analysis.

Theme: Having few organized daily activities and poor personal causation prevent changes in adaptation to daily life. Two categories: performance and self-image, and four subcategories: competent or incompetent to perform, positive self-image, and lack of self-image were identified.     

Emotion Differentiation as a Protective Factor Against Nonsuicidal Self-Injury in Borderline Personality Disorder

Evidence that nonsuicidal self-injury (NSSI) serves a maladaptive emotion regulation function in borderline personality disorder (BPD) has drawn attention to processes that may increase risk for NSSI by exacerbating negative emotion, such as rumination. However, more adaptive forms of emotion processing, including differentiating broad emotional experiences into nuanced emotion categories, might serve as a protective factor against NSSI. Using an experience-sampling diary, the present study tested whether differentiation of negative emotion was associated with lower frequency of NSSI acts and urges in 38 individuals with BPD who reported histories of NSSI. Participants completed a dispositional measure of rumination and a 21-day experience-sampling diary, which yielded an index of negative emotion differentiation and frequency of NSSI acts and urges. A significant rumination by negative emotion differentiation interaction revealed that rumination predicted higher rates of NSSI acts and urges in participants with difficulty differentiating their negative emotions. The results extend research on emotion differentiation into the clinical literature and provide empirical support for clinical theories that suggest emotion identification and labeling underlie strategies for adaptive self-regulation and decreased NSSI risk in BPD.     

克恩伯格边缘性人格组织理论述评

边缘性人格组织是人格障碍的内在结构。克恩伯格主要从非特异性自我虚弱性、现实检验、原始防御机制、病理性的内在客体关系以及身份认同紊乱五个方面阐述了边缘性人格组织理论。该理论弥补了DSM-Ⅳ中人格障碍诊断标准的无理论化倾向的缺陷,并为深入理解人格障碍的心理病理学提供了一个系统框架。     

God Diagnosed with Narcissistic Personality Disorder

This article endorses the contention that God suffers from a mental disorder, but challenges J. Henry Jurgens’ diagnosis of bipolar disorder as reported in The Onion (“God diagnosed with bipolar disorder”, 2001) and proposes narcissistic personality disorder instead. It uses the diagnostic criteria for narcissistic personality disorder from The Diagnostic and Statistical Manual of Mental Disorders—DSM-IV (American Psychiatric Association, Washington, DC, 1994) and various biblical citations in support of this diagnosis. It rejects the idea that a major personality change is reflected in the New Testament and claims that God did not experience a major transformation of his narcissistic personality structure as described by Heinz Kohut (Forms and transformations of narcissism, in A. P. Morrison, Ed., Essential papers on narcissism, pp. 61–87, New York University Press, New York, 1966/1986). However, it concludes that God’s creativity accounts for the stability of his narcissistic personality structure and helps to explain his lack of empathy toward human beings.

Autonomic impairment in Borderline Personality Disorder: A laboratory investigation

Recent research suggests that emotional dysfunction in psychiatric disorders can be reflected in autonomic abnormalities. The present study examines sympathetic and parasympathetic autonomic nervous system activity in individuals with Borderline Personality Disorder (BPD) before, during, and following a social stressor task. Data were obtained from an analogue sample of participants screening positive for BPD (n = 12) and healthy controls (n = 28). In general, BPD participants exhibited increased sympathetic activity (indexed by Cardiac Sympathetic Index, CSI; Toichi et al., 1997) and decreased parasympathetic activity (indexed by Respiratory Sinus Arrhythmia, RSA) compared to controls. During the stressful task, BPD and control participants exhibited different trajectories of sympathetic activation: estimates of sympathetic activity increased for BPD participants and decreased for controls. Furthermore, BPD participants reported the task (but not baseline or recovery phases) to be more frustrating than controls. Findings are interpreted in the context of Polyvagal theory.