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Dialectical Behavior Therapy in the Treatment of Comorbid Borderline Personality Disorder and Eating Disorder in a Naturalistic Setting: A Six-Year Follow-up Study

Abstract

Background

Dialectical Behavior Therapy (DBT) has shown evidence of its effectiveness in the treatment of borderline personality disorder (BPD) and eating disorders (EDs) separately, and there is preliminary evidence for co-occurrent BPD and EDs. However, the long-term effectiveness of DBT for this specific population is still unknown. The main goal of this study was to assess long-term treatment effectiveness in people diagnosed with BPD and ED.

Methods

Participants (N = 109) had previously received a 6-month treatment during a clinical trial (DBT = 64 vs. Treatment as Usual, Cognitive Behavior Therapy; TAU CBT = 45). Outcome measures (emotional eating, depressive symptoms, anger, emotion regulation, impulsiveness, and resilience) were evaluated prospectively at 4- and 6-year follow-ups.

Results

There was a statistically significant improvement in most study outcomes from pre-treatment to the follow-ups in the DBT condition, and in depression, resilience and trait anger in the TAU CBT. No statistically significant between-group differences were found. Nonetheless, a high percentage of participants showed a clinically significant improvement over time in the DBT condition.

Conclusions

Findings of this study contribute to determinate the long-term treatment effectiveness of DBT for people with BPD and ED in routine psychotherapeutic practice. Longitudinal studies with larger sample sizes are needed to confirm these results.

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Acknowledgements

This research was supported by the Gobierno de Aragón (Group reference: S31_20D) and by Feder 2014–2020 “Construyendo Europa desde Aragón”.

Funding

The research presented in this paper was funded by Ministerio de Economía y Competitividad, Spain, “Proyectos de investigación fundamental no orientada” (PSI2010-21423/PSIC), “Plan de Formación de la investigación en la Universitat Jaume I” (P11B2005-32) and by Generalitat Valenciana, Redes de Excelencia ISIC (ISIC/2012/012).

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by VGB, LBR, LB. The first draft of the manuscript was written by MVNH and AG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to María V. Navarro-Haro.

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Navarro-Haro, M.V., Botella, V.G., Badenes-Ribera, L. et al. Dialectical Behavior Therapy in the Treatment of Comorbid Borderline Personality Disorder and Eating Disorder in a Naturalistic Setting: A Six-Year Follow-up Study. Cogn Ther Res 45, 480–493 (2021). https://doi.org/10.1007/s10608-020-10170-9

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Keywords

  • Personality disorders
  • Borderline personality disorder
  • Eating disorders
  • Dialectical behavior therapy
  • Cognitive-behavior therapy
  • Naturalistic setting