Recent evidence suggests that patients with Borderline Personality Disorder (BPD) experience less immediate distress while suppressing unwanted thoughts, despite the negative long-term outcomes of that strategy longitudinally and in treatment settings. The present study investigated the impact of 8-minute audiotaped suppression/thought control, acceptance, and monitoring instructions on moderately distressing and personally relevant thoughts in women (N = 51; 17 per condition) diagnosed with BPD. Strategies were applied in a 5-minute think-aloud period, followed by a similar period without the strategy, and then a wind-down task. Those in the suppression condition reported less subjective distress throughout but showed evidence of attempts at distraction through increased talking in the second period. Participants in the suppression group with higher experiential avoidance showed more thought intrusions during the main task period and lower positive affect during the wind-down task than those in other conditions. Suppression appears to produce some negative outcomes in this population despite resulting in less self-reported distress.

BACKGROUND:This study examines the therapeutic effect of fluoxetine, a selective serotonin reuptake inhibitor, added to dialectical behavior therapy (DBT), an empirically supported psychosocial therapy, for the treatment of borderline personality disorder.METHOD:This is a 12-week, randomized, double-blind, placebo-controlled study of patients with borderline personality disorder (identified using the Structured Clinical Interview for DSM-IV Axis II Disorders). All subjects received individual and group DBT. Of the 20 subjects that completed treatment, 9 were randomly assigned to receive up to 40 mg/day of fluoxetine and 11 were randomly assigned to the placebo condition. Subjects were evaluated at baseline and at week 10 or 11 on self-report measures of depression, anxiety, anger expression, dissociation, and global functioning. The study was conducted between January 1998 and February 2000.RESULTS:Time-by-group interaction effects revealed no significant group differences in scores from pre-treatment to posttreatment on any measure. However, within the DBT/placebo group, there were significant pretreatment/posttreatment differences in the direction of improvement on all measures. No significant pre-treatment/posttreatment differences were found within the DBT/fluoxetine condition.CONCLUSION:The data suggest that adding fluoxetine to an efficacious psychosocial treatment does not provide any additional benefits. Further studies with larger sample sizes are warranted.

Dialectical behavior therapy, an outpatient psychosocial treatment for chronically suicidal women with borderline personality disorder; has been adapted for use in a partial hospital program for women. Patients attend the program for a minimum of five days of individual and group therapy and full census is 12 women. About 65 percent of participants meet at least three criteria for borderline personality disorder, and most have suicidal and self-injurious behavior Their comorbid diagnoses include trauma-related diagnoses and anxiety disorders, severe eating disorders, substance abuse, and depression. The partial hospital program is linked to an aftercare program offering six months of outpatient skills training based on dialectical behavior therapy Both programs focus on teaching patients four skills: mindfulness (attention to one's experience), interpersonal effectiveness, emotional regulation, and distress tolerance. Two years of operation of the women's partial hospital program provides promising anecdotal evidence that dialectical behavioral therapy, an outpatient approach, can be effectively modified for partial hospital settings and a more diverse population.

Systematic research on effective treatment for survivors of childhood sexual abuse with posttraumatic stress disorder (PTSD) is virtually non-existent. The aim of the present study was to compare the effectiveness of an affect-management treatment (AM) group to a wait list control condition for female survivors of childhood sexual abuse with PTSD. Forty-eight female survivors of childhood sexual abuse with PTSD were randomly assigned to either a 15-week affect-management treatment group or to a wait list control condition. All subjects received individual psychotherapy and pharmacotherapy for the duration of the study, and for at least 1-month prior to the study. Controlling for pretreatment scores, subjects who completed the affect-management treatment group (n = 17) reported significantly fewer posttreatment symptoms of PTSD and dissociation than subjects in the wait list control condition (n = 16). Our findings suggest that an affect-management group treatment is beneficial as an adjunct to individual psychotherapy and pharmacotherapy for survivors of childhood sexual abuse with PTSD.

This study examined the construct validity of the Trauma Symptom Checklist-40 (TSC-40; Elliot & Briere, 1992) in a sample of 130 female psychiatric inpatients. Consistent with other findings, the TSC-40 displayed criterion-related validity in relation to childhood sexual abuse. Survivors of sexual abuse obtained significantly higher scores than those without such a history on the overall TSC-40 and on each of the six subscales, except the Depression subscale. Convergent validity of three subscales was demonstrated, and divergent validity on the total TSC-40 and each of its subscales was established. Further, among a range of abuse-effects measures, the Sexual Abuse Trauma Index (SATI) subscale was the most powerful predictor of sexual abuse. The SATI and Dissociation subscales were the subscales most sensitive to the specific features of the sexual abuse.

The overall purpose of the present study was to further our understanding of the mechanisms of self-mutilative behavior in a sample of female inpatients. The study found that self-mutilators (n = 103) displayed a greater degree of dissociative symptoms and alexithymia and a greater number of self-injurious behaviors, as well as higher rates of childhood sexual abuse, than nonmutilators (n = 45). In addition, the study found that among these variables, the number of self-injurious behaviors had the strongest relationship to self-mutilation. However, both dissociative symptoms and alexithymia were independently associated with self-mutilatioe behavior. Implications of our findings for clinicians and researchers are discussed.

This study examined the relationship between childhood sexual abuse and symptoms of a newly proposed complex posttraumatic stress disorder or disorder of extreme stress not otherwise specified (DESNOS). Compared to 34 women without histories of sexual abuse, 74 survivors of sexual abuse showed increased severity on DESNOS symptoms of somatization, dissociation, hostility, anxiety, alexithymia, social dysfunction, maladaptive schemas, self-destruction, and adult victimization In addition, a logistic regression found that a complex of symptoms representing DESNOS was significantly related to a history of sexual abuse. Consistent with other studies, the results of this study provide support for the idea that symptoms of DESNOS characterize survivors of sexual abuse.

Zlotnick, Caron Ph.D.; Shea, M. Tracie Ph.D.; Pearlstein, Teri M.D.; Begin, Ann Ph.D.; Simpson, Elizabeth M.D.; Costello, Ellen Ph.D. Author Information

The purpose of this study was to examine which childhood events were associated with more extensive use of adult dissociative states in 90 female inpatients with histories of sexual abuse. The study found that childhood stressors of maltreatment (physical neglect, witnessing sexual abuse, and witnessing physical abuse) were associated with higher levels of dissociative symptoms. In contrast, childhood stressors of loss (parental separation and death of a close relative) were not related to increased severity of dissociative symptoms. The study also demonstrated that a close relationship with either a parent, sibling, extraparental adult, or friend did not have a mediating effect on the degree of adult dissociative symptoms. Directions for future research are presented.

Childhood sexual abuse has been associated with adult dissociative symptomatology. The purpose of this study was to examine the relationship between specific characteristics of sexual abuse and dissociative experiences in adulthood. Fifty-six female inpatients with a history of physical abuse and severe sexual abuse reported on their history of abuse and dissociative experiences. A logistic regression that controlled for physical revictimization showed that sexual abuse by a greater number of different sex abuse offenders was significantly related to an elevated level of dissociation. In exploring how many sex abuse offenders are associated with dissociative experiences, a logistic regression revealed a significant relationship between four or more sex abuse offenders and greater dissociative symptomatology. The reported age of onset of the sexual abuse was not a significant predictor of dissociation when sexual revictimization was included in the analysis. These findings suggest that severely traumatized patients with a history of multiple sex abuse offenders are highly likely to use dissociation as a primary psychological defense. The implications of the study are discussed.

Studies on sexual behavior frequently require that subject volunteers engage in intrusive/sensitive assessment procedures. While earlier investigators have found that these demands may result in volunteer bias (volunteers differing from nonvolunteers), these studies were limited to nonclinical samples. The present study involved 182 males admitted to an inpatient alcoholism rehabilitation program. Those patients who volunteered to participate in an intrusive study examining sexual functioning were dissimilar to nonvolunteers. Compared to nonvolunteers, volunteers reported a greater interest in sex, less satisfaction with sex, more concerns about sexual functioning, a greater incidence of premature ejaculation, and a greater incidence of negative sexual experience. Volunteers also had a higher MAST score, used outpatient substance-abuse counseling more often, and more frequently had a diagnosis of cocaine/amphetamine dependence and cannabis dependence. These differences between volunteers and nonvolunteers suggest a need to use caution when generalizing the results of similar studies to the overall population. Procedures that may help to minimize volunteer bias are offered.