Treating Veterans With PTSD and Borderline Personality Symptoms in a 12‐Week Intensive Outpatient Setting: Findings From a Pilot Program

Rates of comorbidity between borderline personality disorder and posttraumatic stress disorder (PTSD) are high in veteran populations, and clinicians are hesitant to treat PTSD given high rates of suicidality. Given promising early work integrating dialectical behavior therapy (DBT) and prolonged exposure (PE) therapy, we created a 12-week intensive outpatient program combining these two treatments. PE and DBT were provided concurrently to 33 veterans with PTSD symptoms and BPD symptoms at a large, midwestern Veteran Affairs medical center. Approximately half of the participants were male, with the majority identifying as Caucasian. Participants' ages ranged from 23 to 58 years, with a mean age of 43.21 years. The full-model of DBT was provided; PE was provided twice weekly for approximately 6 weeks of the program. Of participants, 22 veterans successfully completed the program with no dropout during PE. Large pre- to posttreatment effect sizes were found for decreases in PTSD symptoms (d = 1.61) and dysfunctional coping styles (d = 1.55), and an increase in the use of DBT skills (d = 1.02). A moderate effect size was found in the decrease of suicidal ideation (d = 0.64). The results of this pilot program suggest that PTSD can be safely and effectively treated among veterans with comorbid symptoms of borderline personality disorder through the combination of concurrent intensive DBT and PE.