Comparison of Outcomes of Dialectical Behavior Therapy (DBT) Alone versus DBT Combined with Second-Generation Antipsychotic in the Treatment of Borderline Personality Disorder
DOI:
https://doi.org/10.70749/ijbr.v3i5.1030Keywords:
Borderline Personality Disorder, Dialectical Behavior Therapy, Second-Generation Antipsychotics, Olanzapin, Impulsivity, Self-Harm, Psychiatric Treatment, Emotional DysregulationAbstract
Background: Borderline Personality Disorder (BPD) is a complex psychiatric condition characterized by emotional instability, impulsivity, self-harming behaviors, and difficulties in interpersonal relationships. While Dialectical Behavior Therapy (DBT) is widely recognized as the most effective treatment for BPD, some individuals continue to struggle with severe mood disturbances and impulsive behaviors, necessitating additional therapeutic interventions. This study aimed to compare the outcomes of DBT alone versus DBT combined with second-generation antipsychotic medication (olanzapine) in the treatment of BPD. Methodology: A randomized controlled trial was conducted at Gulab Devi Hospital, Lahore, where 102 participants diagnosed with BPD, as per DSM-5 criteria, were recruited and assigned to one of two treatment groups. Group A received DBT alone, while Group B received DBT along with olanzapine (5-20 mg/day). Treatment effectiveness was assessed using standardized clinical scales, including the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HARS), and Barratt Impulsiveness Scale (BIS-11). Additionally, self-harm attempts and emergency unit visits were recorded over a 12-week period. Result: The results indicated that both groups showed significant symptom reduction; however, the DBT + Olanzapine group demonstrated greater improvements across all measured outcomes. Participants in the combination therapy group exhibited significantly lower post-treatment scores for depression, anxiety, and impulsivity compared to the DBT-alone group (p < 0.05). Moreover, there was a notable reduction in self-harm attempts and emergency visits in the DBT + Olanzapine group, suggesting enhanced emotional stabilization and crisis prevention. Conclusion: These findings support the potential benefits of combining DBT with pharmacological intervention in the management of BPD, particularly for individuals with severe emotional dysregulation and high-risk behaviors. However, given the side effect profile of olanzapine, individualized treatment plans should be considered. Further research with long-term follow-up is needed to assess the sustainability of treatment effects and medication adherence.
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Wu, T., Hu, J., Davydow, D., Huang, H., Spottswood, M., & Huang, H. (2022). Demystifying borderline personality disorder in primary care. Frontiers in Medicine, 9. https://doi.org/10.3389/fmed.2022.1024022
Tramontano, H., Fetter, J., & ElSayed, M. W. (2025). Intranasal esketamine for treating inpatients with borderline personality disorder and comorbid treatment-resistant depression – a retrospective chart review study. https://doi.org/10.20944/preprints202501.0316.v1
American Psychiatric Association. (2024). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder. https://doi.org/10.1176/appi.books.9780890428009
Yang, J. H., Yoo, J., Kang, D. H., Park, C. H., Rhee, S. J., Kim, M. J., Lee, S. Y., Shim, S., Moon, J., Cho, S., Kim, S. G., Kim, M., Lee, J., Kang, W. S., Lee, W., & Ahn, Y. M. (2024). Development of a clinical guideline for suicide prevention in psychiatric patients based on the ADAPTE methodology. Psychiatry Investigation, 21(10), 1149-1166. https://doi.org/10.30773/pi.2024.0195
Voytenko, V. L., & Huprich, S. K. (2025). Treatment-resistant depression and personality disorders: An update on conceptualization, assessment, and evidence-based psychodynamic approaches. Psychoanalytic Psychology, 42(1), 1-8. https://doi.org/10.1037/pap0000521
Baumann, P., & Herpertz, S. C. (2022). Pharmacotherapy of personality disorders. NeuroPsychopharmacotherapy, 4153-4170. https://doi.org/10.1007/978-3-030-62059-2_252
Magni, L., Ferrari, C., Barlati, S., Ridolfi, M., Prunetti, E., Vanni, G., Bateni, M., Diaferia, G., Macis, A., Meloni, S., Perna, G., Occhialini, G., Vita, A., Rossi, G., & Rossi, R. (2021). Psychopharmacological treatment in borderline personality disorder: A pilot observational study in a real-world setting. Psychiatry Research, 295, 113556. https://doi.org/10.1016/j.psychres.2020.113556
Bellino, S., Bosia, M., Montemagni, C., Rocca, P., & Bozzatello, P. (2022). Risk factors of early onset of borderline personality disorder: A conceptual model. Psychosis and Personality Disorders, 107-124. https://doi.org/10.1007/978-3-031-09058-5_6
de Oliveira, B. G. M. (2021). The Effects of Second-Generation Antipsychotics in Borderline Personality Disorder-A Systematic Review. PQDT-Global.
Gartlehner, G., Crotty, K., Edlund, M. J., & Viswanathan, M. (2021). Authors’ reply to pereira Ribeiro et al.: Comment on “Pharmacological treatments for borderline personality disorder: A systematic review and Meta Analysis”. CNS Drugs, 35(12), 1335-1336. https://doi.org/10.1007/s40263-021-00873-2
Bozzatello, P., Rocca, P., De Rosa, M. L., & Bellino, S. (2019). Current and emerging medications for borderline personality disorder: Is pharmacotherapy alone enough? Expert Opinion on Pharmacotherapy, 21(1), 47-61. https://doi.org/10.1080/14656566.2019.1686482
Pascual, J. C., Arias, L., & Soler, J. (2023). Pharmacological management of borderline personality disorder and common comorbidities. CNS Drugs, 37(6), 489-497. https://doi.org/10.1007/s40263-023-01015-6
Casellas‐Pujol, E., Soler, J., Schmidt, C., Soriano, J., & Pascual, J. C. (2024). Long‐lasting symptoms in borderline personality disorder: Defining an emergent population with differential clinical and therapeutic features. Personality and Mental Health, 18(3), 248-258. https://doi.org/10.1002/pmh.1614
Kujovic, M., Bahr, C., Riesbeck, M., Benz, D., Wingerter, L., Deiß, M., Margittai, Z., Reinermann, D., Plewnia, C., & Meisenzahl, E. (2024). Effects of intermittent theta burst stimulation add-on to dialectical behavioral therapy in borderline personality disorder: Results of a randomized, sham-controlled pilot trial. European Archives of Psychiatry and Clinical Neuroscience. https://doi.org/10.1007/s00406-024-01901-0
Kujovic, M., Bahr, C., Riesbeck, M., Benz, D., Deiß, M., Margittai, Z., Henges, S., Reinermann, D., Plewnia, C., & Meisenzahl, E. (2025). Effects on impulsivity and delay discounting of intermittent theta burst stimulation add-on to dialectical behavioral therapy in borderline personality disorder: A randomized, sham-controlled pilot trial. Borderline Personality Disorder and Emotion Dysregulation, 12(1). https://doi.org/10.1186/s40479-025-00278-3
Huntjens, A., Van den Bosch, L. M., Sizoo, B., Kerkhof, A., Smit, F., & Van der Gaag, M. (2024). The effectiveness and safety of dialectical behavior therapy for suicidal ideation and behavior in autistic adults: A pragmatic randomized controlled trial. Psychological Medicine, 54(10), 2707-2718. https://doi.org/10.1017/s0033291724000825
Bourvis, N., Cohen, D., & Benarous, X. (2023). Therapeutic and preventive interventions in adolescents with borderline personality disorder: Recent findings, current challenges, and future directions. Journal of Clinical Medicine, 12(20), 6668. https://doi.org/10.3390/jcm12206668
Del Casale, A., Bonanni, L., Bargagna, P., Novelli, F., Fiaschè, F., Paolini, M., Forcina, F., Anibaldi, G., Cortese, F. N., Iannuccelli, A., Adriani, B., Brugnoli, R., Girardi, P., Paris, J., & Pompili, M. (2021). Current clinical psychopharmacology in borderline personality disorder. Current Neuropharmacology, 19(10), 1760-1779. https://doi.org/10.2174/1570159x19666210610092958
Choi-Kain, L. W., Sahin, Z., & Traynor, J. (2022). Borderline personality disorder: Updates in a Postpandemic world. Focus, 20(4), 337-352. https://doi.org/10.1176/appi.focus.20220057
Azzam, S., Almari, R., Khattab, K., Badr, A., Balawi, A. R., Haddad, R., Almasri, R., & Varrassi, G. (2024). Borderline personality disorder: A comprehensive review of current diagnostic practices, treatment modalities, and key controversies. Cureus. https://doi.org/10.7759/cureus.75893
Sciriha Camilleri, R. (2024). Emotionally unstable personality disorder: an in-depth analysis in clinical practice. https://www.um.edu.mt/library/oar/handle/123456789/125857
Hansen, B., Inch, K. M., & Kaschor, B. A. (2022). The use of buprenorphine/naloxone to treat borderline personality disorder: A case report. Borderline Personality Disorder and Emotion Dysregulation, 9(1). https://doi.org/10.1186/s40479-022-00181-1
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