The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder

A De Jongh, G N Groenland, S Sanches, H Bongaerts, E M Voorendonk, A Van Minnen, A De Jongh, G N Groenland, S Sanches, H Bongaerts, E M Voorendonk, A Van Minnen

Abstract

Background: It is generally recommended to exercise caution in applying trauma-focused treatment to individuals with posttraumatic stress disorder (PTSD) and comorbid borderline personality disorder (BPD). Objective: To investigate the effects of a brief, intensive, direct trauma-focused treatment programme for individuals with PTSD on BPD symptom severity. Methods: Individuals (n = 72) with severe PTSD (87.5% had one or more comorbidities; 52.8% fulfilled the criteria for the dissociative subtype of PTSD) due to multiple traumas (e.g. 90.3% sexual abuse) participated in an intensive eight-day trauma-focused treatment programme consisting of eye movement desensitization and reprocessing (EMDR) and prolonged exposure (PE) therapy, physical activity, and psychoeducation. Treatment did not include any form of stabilization (e.g. emotion regulation training) prior to trauma-focused therapy. Assessments took place at pre- and post-treatment (Borderline Symptom List, BSL-23; PTSD symptom severity, Clinician Administered PTSD Scale for DSM-5, CAPS-5), and across the eight treatment days (PTSD Checklist, PCL-5). Results: Treatment resulted in significant decreases of BPD symptoms (Cohen's d = 0.70). Of the 35 patients with a positive screen for BPD at pre-treatment, 32.7% lost their positive screen at post-treatment. No adverse events nor dropouts occurred during the study time frame, and none of the patients experienced symptom deterioration in response to treatment. Conclusion: The results suggest that an intensive trauma-focused treatment is a feasible and safe treatment for PTSD patients with clinically elevated symptoms of BPD, and that BPD symptoms decrease along with the PTSD symptoms.

Keywords: EMDR therapy; Posttraumatic stress disorder; borderline personality disorder; intensive trauma-focused treatment; prolonged exposure; • One of the few studies that investigated the effects of trauma-focused treatment on symptoms of borderline personality disorder (BPD) outside the context of Dialectic Behaviour Therapy.• No detrimental effects of intensive trauma-focused treatment on BPD symptoms occurred.• A combination of Exposure therapy and EMDR therapy is a valuable option to consider when PTSD patients are diagnosed with additional BPD..

© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Figures

Figure 1.
Figure 1.
Participant flow chart used in analysis.
Figure 2.
Figure 2.
Mean BSL-23 item scores pre- and post-treatment.
Figure 3.
Figure 3.
Mean PTSD symptom scores as measured with PCL-5 at each treatment day for individuals with positive and negative screens for BPD.

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