Dialectical Behavior Therapy for High Suicide Risk in Individuals With Borderline Personality Disorder A Randomized Clinical Trial and Component Analysis

Linehan MM, Korslund KE, Harned MS, et al. Dialectical Behavior Therapy for High Suicide Risk in Individuals With Borderline Personality Disorder: A Randomized Clinical Trial and Component Analysis. JAMA Psychiatry. 2015;72(5):475–482. doi:10.1001/jamapsychiatry.2014.3039

I chose to present this article on Dialectical Behavior Therapy (DBT) as a treatment for patients with borderline personality disorder (BPD) and high risk of suicide in conjunction with my case of a 19-year-old female with an attempted suicide attempt, unstable relationships and likely BPD. 

 This was a single blind randomized clinical trial, it involved one year of treatment and then one year follow up. A total of 99 women were included in the trial all diagnosed with BPD and had either 2 suicide attempts or non suicidal self injury (NSSI) acts in the past 5 years and NSSI 8 weeks prior to screening and a suicide attempt in the last year. The patients were randomized to standard DBT, DBT-S, and DBT-I. They main outcome they measured was frequency of suicide attempts and NSSI. 

They found that all 3 types resulted in improvement in frequency and severity of suicide attempts. Compared to DBT-I group the DBT with skills training had greater improvement in the frequency of NSSI. Anxiety improved significantly in the DBT and DBT-S group but not in the DBT-I group. Patients in the DBT group were also less likely to drop out or seek crisis services as compared to the DBT-I group. 

The authors concluded that DBT that includes skill training is more effective than DBT without skills training in reducing suicide and NSSI in BPD patients. 

There are some limitations to this study, firstly its small sample size of only n=99 is difficult to draw far reaching conclusions. Additionally they had to be ethical in this study, if someone was found to be at an increased suicide risk while undergoing therapy, therapists reported it, and all therapists performed suicide risk assessments. Additionally the patients were treated by different providers, with therapy and it is not identical. They did not assess the difference between DBT-S and DBT so equivalence should not be assumed off of these results.

This entry is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license.