The role of existential concerns in borderline personality disorder and their responsiveness to dialectical behaviour therapy

Abstract

ABSTRACT Objectives Existential concerns (i.e. death anxiety, isolation, identity, meaninglessness, and guilt) have increasingly been linked to various mental health conditions. Two studies were conducted to examine whether these are relevant to borderline personality disorder (BPD) and whether they are ameliorated through dialectical behaviour therapy (DBT). Methods In Study 1, 175 people reporting a BPD diagnosis were administered measures of existential concerns and mental health difficulties. Correlational analyses were conducted to examine relationships between existential concerns and measures of mental health. In Study 2, these measures were completed at baseline and post-treatment by 22 outpatients undertaking a standalone 16-week DBT skills training (DBT-ST) group program. The percentage of participants who made a clinically reliable change on each existential concern was then calculated. Results Study 1 indicated that all five existential concerns were above community norms, and were significantly correlated with mental health outcomes in BPD (i.e. depression, anxiety, stress, emotion regulation difficulties). In Study 2, only 33.3% (4/12) of participants made a clinically reliable improvement in their overall existential concerns following a 16-week DBT-ST group intervention. Conclusions These findings suggest that existential issues are pronounced in BPD, but show low responsiveness to the DBT-ST group intervention examined in the current study. Further research should examine whether existentially-informed treatments may be more efficacious.