Applying Dialectical Behavior Therapy as a transdiagnostic treatment in
a case of borderline personality disorder and eating disorder.
Abstract
This article presents a case study of a 31-year-old woman with a dual
diagnosis of Borderline Personality Disorder (BPD) and Eating Disorder
Not Otherwise Specified (EDNOS). Paula received a 12-month Dialectical
Behavior Therapy (DBT) outpatient treatment. DBT is considered a
transdiagnostic treatment approach to address emotion dysregulation,
which shifts the therapy focus traditionally placed only on behavioral
change towards including also validation and acceptance and dialectical
strategies. DBT addresses eating symptomatology as a dysfunctional form
of emotional regulation and has shown promising results regarding its
efficacy for the treatment of BPD and EDNOS comorbidity. Given the
growing evidence, a standard DBT treatment plan was developed for this
case. Specifically, pre-treatment and phase 1 of the DBT program are
described. During pre-treatment and phase 1, individual therapy aims to
improve and maintain client’s motivation to change and engage in
treatment, as well as to establish and prioritize treatment goals. As
for group therapy, the main goal of the skills training in DBT is to
enhance individual’s capability by increasing skillful behavior
(mindfulness, emotion regulation, distress tolerance and interpersonal
effectiveness skills). Paula received 24 weekly skills training sessions
over a year. The results after a 12-month standard DBT treatment showed
that Paula no longer met criteria for BPD, she had a significant
decrease in difficulties in emotional regulation and impulsiveness and
in EDNOS symptomatology. This case study may enhance learning about how
to apply a transdiagnostic treatment to address BPD and EDNOS together
in clinical practice.