Beyond Boundaries
Revising Diagnostics and Improving Treatment for Patients with Posttraumatic Stress Disorder and Borderline Personality Disorder
Dr. Aishah Snoek’s research enhances treatment outcomes for patients with posttraumatic stress disorder (PTSD) and comorbid personality disorders, with a specific focus on borderline personality disorder (BPD).
Key findings from her research:
- First, a network-based approach to mapping comorbid PTSD and personality disorders can help clinicians identify central symptoms for targeted treatment, potentially accelerating symptom improvement. Second, meta-analysis challenges the belief that comorbid personality disorders exacerbate PTSD or increase dropout rates. Instead, trauma-focused treatments were found to be effective and safe for these patients.
- Findings from RCTs demonstrate that brief trauma-focused therapy is as effective as combined trauma-focused and personality disorder treatment. However, these results apply specifically to patients with a primary PTSD diagnosis and secondary personality disorder symptoms. Patients with primary personality disorders may still benefit from personality disorder treatment, but for most patients with a primary PTSD diagnosis, adding personality disorder therapy provides no additional benefit.
- Improving treatment adherence requires psychoeducation, strong therapeutic alliances, social support, and clear communication about the demands of combined treatments.
- Finally, a one-size-fits-all approach falls short in adequately addressing the diverse needs of patients with PTSD and comorbid BPD. Treatment outcomes can be optimized by integrating a network-based approach alongside the DSM model, reassessing traditional contraindications, initiating treatment with brief trauma-focused therapy, and considering factors that influence treatment adherence.
Optimal care integrates scientific evidence, clinician expertise, and patient preferences, adhering to the principles of evidence-based practice.
