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Zahra Tanvir
Masooma Zainab Bokhari
Rutaab Kareem
Dr. Mirrat Gul Butt



Objectives: The goal of this study was to assess the effectiveness of dialectical behavioral therapy (DBT) in treating post-traumatic stress disorder (PTSD) symptoms in patients with borderline personality disorder (BPD) compared to other interventions.

Background: PTSD and BPD are often comorbid, and effective treatment options are limited. DBT has shown promise in treating BPD, but its efficacy in treating PTSD symptoms in this population is unclear. This research aimed to deal with this gap in the literature.

Methods: The PRISMA guidelines were followed in conducting this systematic review. For this systematic review, papers published in Cochrane, Science Direct, PubMed, Google Scholar, and gray literature were considered without any exclusions based on country, setting, and date of publication. However, these studies were restricted to English and clinical trials involving human participants. Randomized controlled trials comparing DBT to other interventions in patients with PTSD and BPD were included.

Results: Four trials were included in this review. The findings showed a significant improvement in PTSD and BPD symptoms in those who received DBT intervention compared to those who received other interventions. However, one study showed that the DBT prolonged exposure protocol yielded better results than the regular DBT protocol. Notably, one study showed that NET was slightly more effective than DBT therapy after 12 months.

Conclusion: This study provides evidence that DBT can be used to treat PTSD symptoms in individuals with BPD. It suggests that the use of a prolonged exposure protocol may lead to better outcomes than the standard DBT approach. Practitioners should consider these findings when deciding on options for treating patients with both PTSD and BPD diagnosis. Further research is needed to determine if other interventions beyond DBT, are effective in this population over an extended period.

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1. Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533.
2. Harned MS, Rizvi SL, Linehan MM. Impact of co-occurring posttraumatic stress disorder on suicidal women with borderline personality disorder. Am J Psychiatry. 2010;167(10):1210–7.
3. Pagura J, Stein MB, Bolton JM, Cox BJ, Grant B, Sareen J. Comorbidity of borderline personality disorder and posttraumatic stress disorder in the US population. J Psychiatr Res. 2010;44(16):1190–8.
4. Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Am J Psychiatry. 2004;161(11):2108–14.
5. Compean E, Hamner M. Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges. Prog Neuro-Psychopharmacology Biol Psychiatry. 2019;88:265–75.
6. Kulacaoglu F, Kose S. Borderline personality disorder (BPD): in the midst of vulnerability, chaos, and awe. Brain Sci. 2018;8(11):201.
7. Harned MS, Korslund KE, Linehan MM. A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behav Res Ther. 2014;55(1):7–17.
8. O'connell B, Dowling M. Dialectical behaviour therapy (DBT) in the treatment of borderline personality disorder. J Psychiatr Ment Health Nurs. 2014;21(6):518–25.
9. Stoffers-Winterling JM, Storebø OJ, Kongerslev MT, Faltinsen E, Todorovac A, Jørgensen MS, et al. Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis. Br J Psychiatry. 2022;
10. Fassbinder E, Assmann N, Schaich A, Heinecke K, Wagner T, Sipos V, et al. PRO*BPD: effectiveness of outpatient treatment programs for borderline personality disorder: a comparison of Schema therapy and dialectical behavior therapy: study protocol for a randomized trial. BMC Psychiatry. 2018 Oct;18(1):341.
11. Wynn GH. Complementary and alternative medicine approaches in the treatment of PTSD. Curr Psychiatry Rep. 2015;17:1–7.
12. Boyd JE, Lanius RA, McKinnon MC. Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence. J Psychiatry Neurosci. 2018;43(1):7–25.
13. Harned MS, Gallop RJ, Valenstein-Mah HR. What changes when? The course of improvement during a stage-based treatment for suicidal and self-injuring women with borderline personality disorder and PTSD. Psychother Res. 2018 Sep 3;28(5):761–75.
14. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906.
15. Reiswig J. Mendeley. J Med Libr Assoc JMLA. 2010;98(2):193.
16. Bohus M, Dyer AS, Priebe K, Krüger A, Kleindienst N, Schmahl C, et al. Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: A randomised controlled trial. Psychother Psychosom. 2013;82(4):221–33.
17. Kleindienst N, Steil R, Priebe K, Müller-Engelmann M, Biermann M, Fydrich T, et al. Treating Adults With a Dual Diagnosis of Borderline Personality Disorder and Posttraumatic Stress Disorder Related to Childhood Abuse:Results From a Randomized Clinical Trial. J Consult Clin Psychol. 2021;89(11):925–36.
18. Steuwe C BMBT, Driessen M. Narrative Exposure Therapy in Patients With Posttraumatic Stress Disorder and Borderline Personality Disorder in a Naturalistic Residential Setting: a Randomized Controlled Trial. Front psychiatry. 2021;12.
19. Bohus M, Kleindienst N, Hahn C, Müller-Engelmann M, Ludäscher P, Steil R, et al. Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared with Cognitive Processing Therapy (CPT) in Complex Presentations of PTSD in Women Survivors of Childhood Abuse: A Randomized Clinical Trial. JAMA Psychiatry. 2020 Dec;77(12):1235–45.
20. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. bmj. 2019;366.
21. Jones BDM, Umer M, Kittur ME, Finkelstein O, Xue S, Dimick MK, et al. A systematic review on the effectiveness of dialectical behavior therapy for improving mood symptoms in bipolar disorders. Int J Bipolar Disord. 2023;11(1):1–11.
22. Zeifman RJ, Landy MSH, Liebman RE, Fitzpatrick S, Monson CM. Optimizing treatment for comorbid borderline personality disorder and posttraumatic stress disorder: A systematic review of psychotherapeutic approaches and treatment efficacy. Clin Psychol Rev. 2021;86:102030.
23. Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT. What works in the treatment of borderline personality disorder. Curr Behav Neurosci reports. 2017;4:21–30.
24. Kleindienst N SRPKM-EMBMFTSC, Bohus M. Treating adults with a dual diagnosis of borderline personality disorder and posttraumatic stress disorder related to childhood abuse: results from a randomized clinical trial. J Consult Clin Psychol. 2021;89(11):925‐936.
25. Gratz KL, Berghoff CR, Richmond JR, Vidaña AG, Dixon‐Gordon KL. Examining posttraumatic stress disorder as a predictor of treatment response to dialectical behavior therapy. J Clin Psychol. 2020;76(9):1563–74.
26. Fitzpatrick S, Bailey K, Rizvi SL. Changes in Emotions Over the Course of Dialectical Behavior Therapy and the Moderating Role of Depression, Anxiety, and Posttraumatic Stress Disorder. Behav Ther. 2020 Nov 1;51(6):946–57.
27. Tan MYL, McConnell B, Barlas J. Application of Dialectical Behaviour Therapy in treating common psychiatric disorders: study protocol for a scoping review. BMJ Open. 2022;12(9):e058565.
28. Paul HA. The Handbook of Dialectical Behavior Therapy: Theory, Research and Evaluation. Child Fam Behav Ther. 2021 Oct 2;43(4):293–9.
29. CTRI/2021/01/030688. Application of dialectical behavior therapy for patients with opium addiction. [Internet]. 2021; Available from:
30. Mehlum L. Mechanisms of change in dialectical behaviour therapy for people with borderline personality disorder. Curr Opin Psychol. 2021;37:89–93.
31. O'Toole SK, Diddy E, Kent M. Mindfulness and emotional well-being in women with borderline personality disorder. Mindfulness (N Y). 2012;3:117–23.
32. Perroud N, Nicastro R, Jermann F, Huguelet P. Mindfulness skills in borderline personality disorder patients during dialectical behavior therapy: Preliminary results. Int J Psychiatry Clin Pract. 2012;16(3):189–96.
33. Mochrie KD, Lothes J, Quickel EJW, St John J, Carter C. From the hospital to the clinic: The impact of mindfulness on symptom reduction in a DBT partial hospital program. J Clin Psychol. 2019;75(7):1169–78.
34. Krantz LH, McMain S, Kuo JR. The unique contribution of acceptance without judgment in predicting nonsuicidal self-injury after 20-weeks of dialectical behaviour therapy group skills training. Behav Res Ther. 2018;104:44–50.
35. Reddy MS, Vijay MS. Empirical reality of dialectical behavioral therapy in borderline personality. Vol. 39, Indian Journal of Psychological Medicine. SAGE Publications Sage India: New Delhi, India; 2017. p. 105–8.
36. Murphy A, Bourke J, Flynn D, Kells M, Joyce M. A cost-effectiveness analysis of dialectical behaviour therapy for treating individuals with borderline personality disorder in the community. Irish J Med Sci. 2020;189:415–23.
37. Carmel A, Rose ML, Fruzzetti AE. Barriers and solutions to implementing dialectical behavior therapy in a public behavioral health system. Adm Policy Ment Heal Ment Heal Serv Res. 2014;41:608–14.
38. Flynn D, Joyce M, Gillespie C, Kells M, Swales M, Spillane A, et al. Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: a mixed methods approach. BMC Psychiatry. 2020;20:1–13.
39. Flynn D, Kells M, Joyce M, Corcoran P, Hurley J, Gillespie C, et al. Multisite implementation and evaluation of 12-month standard Dialectical Behavior Therapy in a public community setting. J Pers Disord. 2020;34(3):377–93.