(PS10-8) Dialectical Behavior Therapy Treatment Outcomes and Baseline Comparison of Individuals with and Without Self-disclosed Physical Illness

Intro

High comorbidity exists between physical and mental health disorders (El Gabalawy et al., 2010). Among individuals with chronic health conditions, high rates of personality disorders are observed, especially Borderline Personality Disorder (BPD). Furthermore, associations between BPD and chronic pain are well-recognised (Sansone & Sansone, 2012). Dialectical Behavior Therapy (DBT) is a well established treatment for borderline symptoms; however, the literature on outcomes of DBT in patients with comorbid physical illness is limited. As such, the current study aimed to explore differences in functional impairment, BPD symptoms, and coping strategies among individuals with and without comorbid physical conditions who were completing DBT.  

Methods

In a naturalistic design, participants enrolled in a comprehensive DBT program at an outpatient clinic in Southern California completed measures at baseline and every 2-3 months throughout their treatment (N = 414; Mage = 28.1 years; SDage = 11.8; Range=8 to 79)). Participants were coded into two categories: presence of physical illness (n = 74) or absence of physical illness (n = 340). Coding was conducted by two independent researchers following prespecified inclusion and exclusion criteria, with disagreements resolved via discussion with a moderator. Measures included the Work and Social Adjustment Scale (WSAS), Borderline Symptom List 23 (BSL-23), and the Brief Coping Orientation to Problems Experienced (Brief-COPE). Multi-level models were used to examine and analyze the data. 

Results

Significant improvements were observed per month in treatment for the WSAS (b = -0.35; p < .001) and BSL-23 (b = -0.95; p < .001) across both conditions. At baseline, individuals with a chronic physical condition presented with initially worse functional impairment (b = 3.35; p < .01). There was also a marginally significant increase in Problem-Focused Coping over time (b = .007; p = .058), and significant decreases in Emotion-Focused Coping (b = -.006; p = .015) and Avoidant Coping (b = -.012; p < .001). Moderation effects were not observed for any measure.

Discussion
The study aimed to investigate differences in functional impairment, BPD symptoms, and coping strategies among individuals with and without comorbid physical conditions undergoing DBT. Results showed that while those with chronic illness displayed more significant functional impairment at intake, improvement in functional impairment and BPD symptomatology as well as changes in coping strategies did not differ by chronic conditions status. These results contribute to the sparse literature examining links between physical and mental health ailments within the DBT framework. Limitations include that physical condition status was self-reported without confirmation from physician, high variability and limited nin disclosed physical conditions, as well as a primarily white and female sample. The exploratory nature of the study calls for further research with larger and more diverse samples to investigate whether specific physical conditions impact BPD symptoms and course of treatment in DBT.