Treating PTSD in Patients with Borderline Personality Disorder

描述(由申请人提供)：边缘性人格障碍(BPD)患者是典型的多问题患者，经常出现许多功能障碍行为和共病诊断。辩证行为疗法(DBT)是一种治疗BPD的综合认知行为疗法，已被证明有效地减少了它旨在治疗的主要问题，即自残和自杀行为的频率和严重程度，治疗中的维持，以及严重的生活问题。然而，DBT治疗手册目前没有包括规定何时或如何治疗创伤后应激障碍(PTSD)的方案，创伤后应激障碍(PTSD)是一种在BPD患者中普遍存在的并存诊断，可能会维持或加剧BPD的标准行为。同样，许多现有的创伤后应激障碍的治疗结果研究都排除了自杀、滥用药物和多个确诊的患者，因此很难确定这些方法对患有BPD的个人的普适性。这里提出的研究集中在开发一种基于长时间暴露疗法的方案来治疗BPD患者的PTSD，并将其整合到标准DBT中，以及对该方案的可行性、可接受性和有效性进行初步评估。治疗开发和中试测试过程将分两个阶段进行，包括通过临床预测试(第一阶段)制定措施并使治疗方案标准化；通过随机对照试验(RCT)比较标准DBT PTSD方案和仅标准DBT(第二阶段)进行干预的中试和可行性测试。在试点区域工作队期间收集的信息将被用来为随后的全面区域工作队的设计和实施提供信息。这项研究有可能极大地扩展和改进目前可用于BPD的经验性最强的治疗方法，同时也证明了暴露治疗PTSD可以在BPD人群中安全有效地实施。交界性人格障碍(BPD)是一种严重的、往往是致命的、代价高昂的公共卫生问题。至关重要的是，研究人员继续扩大和改进现有的BPD有效治疗方法，这一应用程序通过开发可添加到辩证行为疗法手册中的治疗PTSD的方案来解决这一问题。

DESCRIPTION (provided by applicant): Individuals with borderline personality disorder (BPD) are the quintessential multi-problem patients, often presenting to treatment with numerous dysfunctional behaviors and comorbid diagnoses. Dialectical Behavior Therapy (DBT) is a comprehensive, cognitive-behavioral treatment for BPD that has been shown effective in reducing the primary problems it is designed to treat; namely, the frequency and severity of self-injurious and suicidal behavior, maintenance in treatment, and severe problems in living. However, the DBT treatment manual does not currently include a protocol specifying when or how to treat posttraumatic stress disorder (PTSD), a comorbid diagnosis that is prevalent in BPD patients and may maintain or exacerbate BPD criterion behaviors. Similarly, many of the existing treatment outcome studies for PTSD have excluded suicidal, substance abusing, and multiply diagnosed patients, thereby making it difficult to determine the generalizability of these approaches to individuals with BPD. The research proposed here is focused on the development of a protocol based on Prolonged Exposure therapy to treat PTSD in BPD patients that can be integrated into standard DBT, as well as the initial evaluation of this protocol's feasibility, acceptability, and efficacy. The treatment development and pilot testing process will occur in two phases, including measure development and standardization of the treatment protocol via clinical pre-testing (Phase 1); and pilot and feasibility testing of the intervention via a randomized controlled trial (RCT) comparing standard DBT + PTSD Protocol to standard DBT Only (Phase 2). Information gathered during the pilot RCT will be used to inform the design and conduct of a subsequent full-scale RCT. This research has the potential to significantly expand and improve upon the most empirically supported treatment currently available for BPD, while also demonstrating that exposure treatments for PTSD can be implemented safely and effectively in a BPD population. Borderline Personality Disorder (BPD) is a serious, often lethal, and expensive public health problem. It is critical that researchers continue to expand and improve upon existing efficacious treatments for BPD, and this application addresses this by developing a protocol for treating PTSD that can be added to the Dialectical Behavior Therapy manual.