Trait dissociation in borderline personality disorder: influence on immediate therapy outcomes, follow-up assessments, and self-harm patterns

Background: Dissociative symptoms are suggested to compete with the effectiveness of psychotherapeutic treatment and frequently co-occur with early life trauma and self-harm patterns, including self-injury, suicidal ideation, and suicide attempts, which are characteristic for borderline personality disorder (BPD).Objective: We explore the connections between dissociation and other BPD features like self-harm and childhood traumatization and examine the impact of trait dissociation on both immediate and follow-up psychotherapy outcomes.Method: In this naturalistic prospective evaluation study, we investigated psychopathology including general psychological distress (SCL-90), depression (BDI-II), and borderline-specific pathology (BSL) in 131 patients with BPD pre and post of a certified 8-week inpatient Dialectical Behaviour Therapy (DBT), as well as 3- and 6-month post inpatient treatment. Prior to therapy, we evaluated trait dissociation (Dissociative Experience Scale), early life trauma (Childhood Trauma Questionnaire), and self-harm patterns (clinical interview). We performed a network analysis to explore the interplay between dissociation, self-harm, and childhood traumatization. To analyse the influence of dissociation on treatment outcomes, we employed linear mixed models.Results: Psychopathology (SCL-90, BDI-II and BSL) exhibited significant reductions at post-treatment and follow-up assessments when compared to baseline measurements. Higher levels of trait dissociation were consistently related to higher psychopathology but did not suggest poorer symptom reduction during DBT. However, trait dissociation predicted reduced 6-month follow-up benefits from DBT, regardless of the baseline symptom burden. The network analysis revealed a close association between self-injury and derealization/depersonalization, while the frequency of suicide attempts was more closely connected to childhood emotional abuse, which was identified as a central node of the network.Conclusions: Dissociation was not related to poorer outcomes regarding inpatient DBT. However, trait dissociation predicted reduced follow-up benefits, highlighting the need to address dissociation during psychotherapeutic interventions. Based on the estimated network structure, treating dissociative symptoms could potentially mitigate self-injury while especially childhood emotional abuse was linked with suicide attempts. Antecedentes: Se ha sugerido que los s & iacute;ntomas disociativos compiten con la eficacia del tratamiento psicoterap & eacute;utico y con frecuencia coocurren con traumas de la vida temprana y patrones de autolesi & oacute;n, incluyendo autolesiones, ideaci & oacute;n suicida e intentos de suicidio, que son caracter & iacute;sticos del trastorno l & iacute;mite de la personalidad (TLP).Objetivo: Exploramos las conexiones entre la disociaci & oacute;n y otros rasgos del TLP como la autolesi & oacute;n y la traumatizaci & oacute;n infantil y examinamos el impacto del rasgo disociaci & oacute;n en los resultados de la psicoterapia inmediata y de seguimiento.M & eacute;todo: En este estudio natural & iacute;stico de evaluaci & oacute;n prospectiva, investigamos la psicopatolog & iacute;a incluyendo el malestar psicol & oacute;gico general (SCL-90), la depresi & oacute;n (BDI-II), y la patolog & iacute;a borderline espec & iacute;fica (BSL) en 131 pacientes con TLP antes y despu & eacute;s de una Terapia Dial & eacute;ctica Conductual (DBT por sus siglas en ingl & eacute;s) certificada de ocho semanas en r & eacute;gimen de hospitalizaci & oacute;n, as & iacute; como tres y seis meses despu & eacute;s del tratamiento en r & eacute;gimen de hospitalizaci & oacute;n. Antes de la terapia, evaluamos la disociaci & oacute;n de rasgos (Escala de Experiencia Disociativa), el trauma de las primeras etapas de la vida (Cuestionario de Trauma Infantil) y los patrones de autolesi & oacute;n (entrevista cl & iacute;nica). Para analizar la influencia de la disociaci & oacute;n en los resultados del tratamiento, empleamos modelos lineales mixtos.Resultados: La psicopatolog & iacute;a (SCL-90, BDI-II y BSL) mostr & oacute; reducciones significativas en las evaluaciones post-tratamiento y de seguimiento en comparaci & oacute;n con las mediciones basales. Los niveles m & aacute;s altos de rasgo de disociaci & oacute;n se relacionaron consistentemente con una psicopatolog & iacute;a m & aacute;s alta, pero no sugirieron una menor reducci & oacute;n de los s & iacute;ntomas durante la DBT. Sin embargo, el rasgo de disociaci & oacute;n predijo una reducci & oacute;n de los beneficios de la DBT durante los 6 meses de seguimiento, independientemente de la carga sintom & aacute;tica basal. El an & aacute;lisis de la red revel & oacute; una estrecha asociaci & oacute;n entre la autolesi & oacute;n y la desrealizaci & oacute;n/despersonalizaci & oacute;n, mientras que la frecuencia de intentos de suicidio estaba m & aacute;s estrechamente relacionada con el abuso emocional en la infancia, que fue identificado como un nodo central de la red. Conclusiones: La disociaci & oacute;n no se relacion & oacute; con peores resultados en relaci & oacute;n con la DBT hospitalaria. Sin embargo, el rasgo de disociaci & oacute;n predijo menores beneficios en el seguimiento, destacando la necesidad de abordar la disociaci & oacute;n durante las intervenciones psicoterap & eacute;uticas. Sobre la base de la estructura de red estimada, el tratamiento de los s & iacute;ntomas disociativos podr & iacute;a mitigar potencialmente las autolesiones, mientras que el abuso emocional infantil en particular se relacion & oacute; con los intentos de suicidio.