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Dialectical Behavior Therapy for Men With Borderline Personality Disorder and Antisocial Behavior: A Clinical Trial

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In addition to suicidal behaviors, men with borderline personality disorder (BPD) often display antisocial behavior that could impair contacts with mental health services. While research has established effective treatments for women with BPD, this is not yet the case for men. The authors evaluated 12 months of dialectical behavior therapy (DBT) for 30 men with BPD and antisocial behavior, using a within-group design with repeated measurements. The authors found moderate to strong, statistically significant pre-to posttreatment reductions of several dysfunctional behaviors, including self-harm, verbal and physical aggression, and criminal offending (rate ratios 0.17–0.39). Symptoms of BPD and depression were also substantially decreased. The dropout rate was 30%, and completing participants reported high satisfaction with treatment and maintained their improvements at 1-year follow-up. The authors conclude that DBT could be an effective treatment alternative for men with BPD and antisocial behavior, and it merits future studies with more rigorous design.


  • Achenbach T., , & Rescorla L. (2003). Manual for the ASEBA adult forms & profiles. Burlington, VT: University of Vermont. Google Scholar
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. CrossrefGoogle Scholar
  • Bateman A., , O'Connell J., , Lorenzini N., , Gardner T., , & Fonagy P. (2016). A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder. BMC Psychiatry, 16, 304. Crossref MedlineGoogle Scholar
  • Andersson E., , Forslund K., , Gustafsson P., , & Åsberg M. (2003). Symptoms in Borderline Personality Disorder: A new self-rating scale. Unpublished manuscript, Centre of Psychiatry, Karolinska, Karolinska University Hospital, Stockholm. Google Scholar
  • Beck A. T., , Brown G., , Epstein N., , & Steer R. A. (1988). An inventory for measuring clinical anxiety—Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897. Crossref MedlineGoogle Scholar
  • Beck A. T., , Steer R.A ., , & Brown G. T. (2006). Beck Depression Inventory–Second edition. Manual. Svensk version (Swedish version). Stockholm, Sweden: Psykologiförlaget AB. Google Scholar
  • Becker D., , & Lamb S. (1994). Sex bias in the diagnosis of borderline personality disorder and posttraumatic stress disorder. Professional Psychology: Research and Practice, 25, 55–61. CrossrefGoogle Scholar
  • Bergman H., , & Källmén H. (1994). The Alcohol Use Disorders Identification Test (AUDIT): Manual. Stockholm, Sweden: Karolinska Institutet, Magnus Huss Klinik. Google Scholar
  • Bergman H., , & Källmén H. (2002). Alcohol use among Swedes and a psychometric evaluation of the Alcohol Use Disorders Identification Test. Alcohol and Alcoholism, 37, 245–251. Crossref MedlineGoogle Scholar
  • Berman A. H., , Bergman H., , Palmstierna T., , & Schlyter F. (2005). Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample. European Addiction Research, 11(1), 22–31. Crossref MedlineGoogle Scholar
  • Berman A. H., , Bergman H., , Palmstierna T., , & Schlyter F. (2007). DUDIT-E. The Drug Use Disorders Identification Test–E. Manual. Stockholm, Sweden: Karolinska Institutet. Google Scholar
  • Black D. W., , Simsek-Duran F., , Blum N., , McCormick B., , & Allen J. (2016). Do people with borderline personality disorder complicated by antisocial personality disorder benefit from the STEPPS treatment program? Personality and Mental Health, 10, 205–215. Crossref MedlineGoogle Scholar
  • Bolger N., , & Laurenceau J.-P. (2013). Intensive longitudinal methods: An introduction to diary and experience sampling research. New York, NY: Guilford Press. Google Scholar
  • Carey M. P., , Carey K. B., , Maisto S. A., , Gordon C. M., , & Weinhardt L. S. (2001). Assessing sexual risk behaviour with the Timeline Followback (TLFB) approach: Continued development and psychometric evaluation with psychiatric outpatients. International Journal of STD and AIDS, 12, 365–375. Crossref MedlineGoogle Scholar
  • Duggan C. (2009). A treatment guideline for people with antisocial personality disorder: Overcoming attitudinal barriers and evidential limitations. Criminal Behaviour and Mental Health, 19, 219–223. Crossref MedlineGoogle Scholar
  • Evershed S., , Tennant A., , Boomer D., , Rees A., , Barkham M., , & Watsons A. (2003). Practice-based outcomes of dialectical behaviour therapy (DBT) targeting anger and violence, with male forensic patients: A pragmatic and non-contemporaneous comparison. Criminal Behaviour and Mental Health, 13, 198–213. Crossref MedlineGoogle Scholar
  • Fals-Stewart W., , Birchler G. R., , & Kelley M. L. (2003). The timeline followback spousal violence interview to assess physical aggression between intimate partners: Reliability and validity. Journal of Family Violence, 18, 131–142. CrossrefGoogle Scholar
  • First M. B., , Gibbon M., , Spitzer R. L., , & Benjamin L. S. (1997). User's guide for the Structured Clinical Interview for DSM-IV Axis II personality disorders: SCID-II. Washington, DC: American Psychiatric Publishing. Google Scholar
  • Freestone M., , Howard R., , Coid J. W., , & Ullrich S. (2013). Adult antisocial syndrome co-morbid with borderline personality disorder is associated with severe conduct disorder, substance dependence and violent antisociality. Personality and Mental Health, 7(1), 11–21. Crossref MedlineGoogle Scholar
  • Fruzzetti A. E. (2010). DBT therapist rating and feedback form. Retrieved from Google Scholar
  • Fruzzetti A. E., , & Levensky E. R. (2000). Dialectical behavior therapy for domestic violence: Rationale and procedures. Cognitive and Behavioral Practice, 7, 435–447. CrossrefGoogle Scholar
  • Gibbon S., , Duggan C., , Stoffers J., , Huband N., , Völlm B. A., , Ferriter M., , & Lieb K. (2010). Psychological interventions for antisocial personality disorder. Cochrane Database of Systematic Reviews, 2010(6). doi:101002/14651858.CD007668.pub2 Google Scholar
  • Goodman M., , Patil U., , Steffel L., , Avedon J., , Sasso S., , Triebwasser J., , & Stanley B. (2010). Treatment utilization by gender in patients with borderline personality disorder. Journal of Psychiatric Practice, 16, 155–163. Crossref MedlineGoogle Scholar
  • Grant B. F., , Chou S. P., , Goldstein R. B., , Huang B., , Stinson F. S., , Saha T. D., , & Ruan W. J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry y, 69, 533–545. Crossref MedlineGoogle Scholar
  • Hedeker D., , & Gibbons R. D. (1997). Application of random-effects pattern-mixture models for missing data in longitudinal studies. Psychological Methods, 2(1), 64–78. CrossrefGoogle Scholar
  • Howard R., , McCarthy L., , Huband N., , & Duggan C. (2013). Re-offending in forensic patients released from secure care: The role of antisocial/borderline personality disorder co-morbidity, substance dependence and severe childhood conduct disorder. Criminal Behaviour and Mental Health, 23, 191–202. Crossref MedlineGoogle Scholar
  • Jacobson N. S., , & Truax P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. Crossref MedlineGoogle Scholar
  • Kliem S., , Kroger C., , & Kosfelder J. (2010). Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78, 936–951. Crossref MedlineGoogle Scholar
  • Leichsenring F., , Leibing E., , Kruse J., , New A. S., , & Leweke F. (2011). Borderline personality disorder. Lancet, 377(9759), 74–84. Crossref MedlineGoogle Scholar
  • Linehan M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press. Google Scholar
  • Linehan M. (2015). DBT skills training manual. New York, NY: Guilford Press. Google Scholar
  • Linehan M. M., , Armstrong H. E., , Suarez A., , Allmon D., , & Heard H. L. (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060–1064. Crossref MedlineGoogle Scholar
  • McCormick B., , Blum N., , Hansel R., , Franklin J. A., , St. John D., , Pfohl B., , & Black D. W. (2007). Relationship of sex to symptom severity, psychiatric comorbidity, and health care utilization in 163 subjects with borderline personality disorder. Comprehensive Psychiatry, 48, 406–412. Crossref MedlineGoogle Scholar
  • McGirr A., , Paris J., , Lesage A., , Renaud J., , & Turecki G. (2007). Risk factors for suicide completion in borderline personality disorder: A case-control study of cluster B comorbidity and impulsive aggression. Journal of Clinical Psychiatry, 68, 721–729. Crossref MedlineGoogle Scholar
  • Newhill C. E., , Eack S. M., , & Mulvey E. P. (2009). Violent behavior in borderline personality. Journal of Personality Disorders, 23, 541–554. LinkGoogle Scholar
  • Olver M. E., , Stockdale K. C., , & Wormith J. S. (2011). A meta-analysis of predictors of offender treatment attrition and its relationship to recidivism. Journal of Consulting and Clinical Psychology, 79, 6–21. Crossref MedlineGoogle Scholar
  • Rathus J., , & Miller A. (1995). DBT Skills Rating Scale for Adolescents. Unpublished manuscript, Montefiore Medical Center, Bronx, NY. Google Scholar
  • Sansone R. A., , Lam C., , & Wiederman M. W. (2010). Self-harm behaviors in borderline personality: An analysis by gender. Journal of Nervous and Mental Disorders, 198, 914–915. Crossref MedlineGoogle Scholar
  • Sansone R. A., , & Sansone L. A. (2011). Gender patterns in borderline personality disorder. Innovative Clinical Neuroscience, 8(5), 16–20. MedlineGoogle Scholar
  • Schwartz D., , & Lellouch J. (2009). Explanatory and pragmatic attitudes in therapeutical trials. Journal of Clinical Epidemiology, 62, 499–505. Crossref MedlineGoogle Scholar
  • Sheehan D. V., , Lecrubier Y., , Sheehan K. H., , Amorim P., , Janavs J., , Weiller E., , & Dunbar G. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33. MedlineGoogle Scholar
  • Sobell L. C., , & Sobell M. B. (1996). Timeline Followback user's guide: A calendar method for assessing alcohol and drug use. Toronto, ON: Addiction Research Foundation. Google Scholar
  • Stoffers J. M., , Völlm B. A., , Rücker G., , Timmer A., , Huband N., , & Lieb K. (2012). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 2012(8). doi: 10.1002/14651858.CD005652.pub2 Google Scholar
  • Tadic A., , Wagner S., , Hoch J., , Baskaya O., , von Cube R., , Skaletz C., , & Dahmen N. (2009). Gender differences in Axis I and Axis II comorbidity in patients with borderline personality disorder. Psychopathology, 42, 257–263. Crossref MedlineGoogle Scholar
  • Taylor A. (2014). Standardised effect size in a mixed/multilevel model. Retrieved from Google Scholar
  • Verheul R., , Van den Bosch L. M. C., , Koeter M. W. J., , De Ridder M. A. J., , Stijnen T., , & Van den Brink W. (2003). Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands. British Journal of Psychiatry, 182, 135–140. Crossref MedlineGoogle Scholar
  • Wetterborg D., , Langstrom N., , Andersson G., , & Enebrink P. (2015). Borderline personality disorder: Prevalence and psychiatric comorbidity among male offenders on probation in Sweden. Comprehensive Psychiatry, 62, 63–70. Crossref MedlineGoogle Scholar