December 1993

Naturalistic Follow-up of a Behavioral Treatment for Chronically Parasuicidal Borderline Patients

Author Affiliations

From the Departments of Psychology (Dr Linehan and Ms Heard) and Psychiatry and Behavioral Sciences (Dr Armstrong), University of Washington, Seattle.

Arch Gen Psychiatry. 1993;50(12):971-974. doi:10.1001/archpsyc.1993.01820240055007

Background:  A randomized clinical trial was conducted to evaluate whether the superior performance of dialectical behavior therapy (DBT), a psychosocial treatment for borderline personality disorder, compared with treatment-as-usual in the community, is maintained during a 1-year posttreatment follow-up.

Methods:  We analyzed 39 women who met criteria for borderline personality disorder, defined by Gunderson's Diagnostic Interview for Borderline Personality Disorder and DSM-III-R criteria, and who had a history of parasuicidal behavior. Subjects were randomly assigned either to 1 year of DBT, a cognitive behavioral therapy that combines individual psychotherapy with group behavioral skills training, or to treatment-as-usual, which may or may not have included individual psychotherapy. Efficacy was measured on parasuicidal behavior (Parasuicide History Interview), psychiatric inpatient days (Treatment History Interview), anger (State-Trait Anger Scale), global functioning (Global Assessment Scale), and social adjustment (Social Adjustment Scale—Interview and Social Adjustment Scale—Self-Report). Subjects were assessed at 6 and 12 months into the follow-up year.

Results:  Comparison of the two conditions revealed that throughout the follow-up year, DBT subjects had significantly higher Global Assessment Scale scores. During the initial 6 months of the follow-up, DBT subjects had significantly less parasuicidal behavior, less anger, and better self-reported social adjustment. During the final 6 months, DBT subjects had significantly fewer psychiatric inpatient days and better interviewer-rated social adjustment. Conclusion: In general, the superiority of DBT over treatmentas-usual, found in previous studies at the completion of 1 year of treatment, was retained during a 1-year follow-up.