Dissociation predicts poor response to Dialectial Behavioral Therapy in female patients with Borderline Personality Disorder

J Pers Disord. 2011 Aug;25(4):432-47. doi: 10.1521/pedi.2011.25.4.432.


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.

MeSH terms

  • Adult
  • Behavior Therapy / methods*
  • Borderline Personality Disorder / epidemiology
  • Borderline Personality Disorder / psychology
  • Borderline Personality Disorder / therapy*
  • Comorbidity
  • Dissociative Disorders / epidemiology
  • Dissociative Disorders / psychology
  • Dissociative Disorders / therapy*
  • Female
  • Germany
  • Humans
  • Inpatients / statistics & numerical data*
  • Middle Aged
  • Psychometrics
  • Treatment Outcome
  • Young Adult