Shogren Nathaniel P, Tirpak Julianne Wilner, Porter Nicole P, Kaplan Cynthia, Ronzio Blake, Au Josephine S, Fruzzetti Alan E
McLean Hospital and Department of Psychiatry, Harvard Medical School, Belmont, MA, USA.
Evid Based Pract Child Adolesc Ment Health. 2025;10(1):33-45. doi: 10.1080/23794925.2024.2306625. Epub 2024 Jan 22.
OBJECTIVE: Borderline Personality Disorder (BPD) is characterized by extreme emotional dysregulation. Dialectical Behavioral Therapy (DBT) is an empirically supported and effective treatment for BPD in adolescents and adults. However, the extent to which exposure to childhood abuse (i.e. physical and sexual abuse) impacts treatment outcomes is not well understood. This open trial investigated the effectiveness of an intensive residential DBT program in reducing emotion dysregulation in adolescents with BPD symptoms, as well as the impact that severity and type of childhood abuse had on treatment outcomes. METHOD: Participants (N = 46) were female-identifying adolescents 13 to 20 years of age enrolled in an intensive residential DBT treatment program. Severity of abuse exposure and abuse subtype (Childhood Trauma Questionnaire, Short Form (CTQ-SF), and difficulties with emotional dysregulation (DERS) were assessed at admission and DERS again after one month of treatment. RESULTS: Bivariate correlation between DERS Total Score and Abuse Exposure Total Score indicated that severity of abuse exposure had a medium positive association with emotion dysregulation at admission. Mixed model ANOVA results showed significant reductions in emotion dysregulation following one month of treatment, with a large effect size. Exploratory analysis testing exposure to different subtypes of childhood abuse as a moderator of treatment effects was non-significant. CONCLUSIONS: Emotion dysregulation showed significant reductions following intensive residential DBT interventions. Reductions were consistent across subtypes of abuse exposure. Implications for the treatment of adolescents with abuse histories and current BPD-related problems, and the relationship between child abuse exposure and emotion dysregulation overall, are discussed.
目的:边缘性人格障碍(BPD)的特征是极端的情绪失调。辩证行为疗法(DBT)是一种经实证支持且对青少年和成人BPD有效的治疗方法。然而,童年期受虐经历(即身体虐待和性虐待)对治疗结果的影响程度尚未得到充分了解。这项开放性试验调查了强化住院DBT项目在减少有BPD症状的青少年情绪失调方面的有效性,以及童年期虐待的严重程度和类型对治疗结果的影响。 方法:参与者(N = 46)为13至20岁自我认同为女性的青少年,他们参加了一个强化住院DBT治疗项目。在入院时评估虐待暴露的严重程度和虐待亚型(儿童创伤问卷简表(CTQ-SF))以及情绪失调困难程度(DERS),治疗一个月后再次评估DERS。 结果:DERS总分与虐待暴露总分之间的双变量相关性表明,入院时虐待暴露的严重程度与情绪失调呈中等程度的正相关。混合模型方差分析结果显示,治疗一个月后情绪失调有显著降低,效应量较大。将接触不同类型的童年期虐待作为治疗效果调节因素的探索性分析无显著结果。 结论:强化住院DBT干预后情绪失调有显著降低。不同类型的虐待暴露导致的降低情况一致。讨论了对有受虐史和当前与BPD相关问题的青少年治疗的启示,以及童年期受虐暴露与总体情绪失调之间的关系。
Evid Based Pract Child Adolesc Ment Health. 2025
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