title: Dissociation predicts poor response to Dialectial Behavioral Therapy in female patients with Borderline Personality Disorder.
abstract: A substantial proportion of Borderline Personality Disorder (BPD) patients respond by a marked decrease of psychopathology when treated with Dialectical Behavioral Therapy (DBT). To further enhance the rate of DBT-response, it is useful to identify characteristics related to unsatisfactory response. As DBT relies on emotional learning, we explored whether dissociation-which is known to interfere with learning- predicts poor response to DBT. Fifty-seven Borderline Personality Disorder (BPD) patients (DSM-IV) were prospectively observed during a three-month inpatient DBT program. Pre-post improvements in general psychopathology (SCL-90-R) were predicted from baseline scores of the Dissociative Experiences Scale (DES) by regression models accounting for baseline psychopathology. High DES-scores were related to poor pre-post improvement (β = -0.017 ± 0.006, p = 0.008). The data yielded no evidence that some facets of dissociation are more important in predicting DBT-response than others. The results suggest that dissociation in borderline-patients should be closely monitored and targeted during DBT. At this stage, research on treatment of dissociation (e.g., specific skills training) is warranted.
authors.affiliation: Central Institute of Mental Health, Mannheim, Germany. nikolaus.kleindienst@zi-mannheim.de
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Kleindienst
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Limberger
authors.forename: Ulrich W
authors.initials: UW
authors.lastname: Ebner-Priemer
authors.forename: Jana
authors.initials: J
authors.lastname: Keibel-Mauchnik
authors.forename: Anne
authors.initials: A
authors.lastname: Dyer
authors.forename: Mathias
authors.initials: M
authors.lastname: Berger
authors.forename: Christian
authors.initials: C
authors.lastname: Schmahl
authors.forename: Martin
authors.initials: M
authors.lastname: Bohus
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D001883:Borderline Personality Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D015897:Comorbidity; D004213:Dissociative Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005858:Germany; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008875:Middle Aged; D011594:Psychometrics; D016896:Treatment Outcome; D055815:Young Adult