Trauma-specific treatment in patients with borderline personality disorder and co-occuring posttraumatic stress disorder Development and evaluation of dialectic behavioral therapy for complex posttraumatic stress disorder

Approximately half of the patients with borderline personality disorder (BPD) seeking treatment meet the diagnostic criteria of a comorbid posttraumatic stress disorder (PTSD). The comorbidity of BPD and PTSD is particularly prevalent in people who experienced sexual abuse during childhood and adolescence. In addition to pronounced problems in emotion regulation, self-concept and social interaction, problems of trauma memory with intrusions and flashbacks, dissociation and nightmares are core features of the disorder. Phenomenologically, these patients at best differ only slightly from patients with complex PTSD according to ICD-11. Without trauma-specific treatment, affected patients show significantly worse treatment outcomes even after evidence-based psychotherapy and thus a higher probability of chronification. We developed dialectic behavioral therapy for complex PTSD (DBT-PTSD) as a disorder spezific program. The effectiveness was investigated in two randomized controlled studies (inpatient and outpatient). Excellent improvements in trauma-specific (ITT effect size d & x202f;= 1.35) and typical borderline symptoms (ITT effect size d & x202f;= 1.11) were shown. Neither the presence and severity of a comorbid BPD nor self-harming behavior at the beginning of the therapy had a negative influence on the result. DBT-PTSD represents a highly effective, safe and easily performed treatment concept that can be used under inpatient and outpatient conditions for patients with pronounced borderline symptoms including persisting self-injuries and pronounced dissociative features. Accordingly, BPD-patients with co-occuring complex PTSD should be treated with a truma-focussed approach first.