DBT to Treat Women with BPD, Emotion Dysregulation, and Substance Use Disorder

Emotional woman

Disordered Emotion Regulation  

Individuals diagnosed with Borderline Personality Disorder (BPD) struggle with the capacity to regulate emotions, which is integral to an individual’s ability to function in interpersonal relationships and professionally and further complicates identity formation and acceptance. Impulsivity is also a common characteristic in individuals with BPD and is likely adopted as a maladaptive attempt at coping with negative emotions. Disordered emotion regulation is also associated with substance abuse, contributing to a population of patients with co-morbid BPD and substance use disorders (SUD).


Components of DBT   

Dialectical Behavior Therapy (DBT) is the preferred treatment for BPD and has been adapted for those with co-morbid SUDs. This treatment targets suicidal and non-suicidal self-harming behaviors first and foremost; attention is then directed to substance use related behaviors that interfere with quality of life. DBT programs are typically a year in duration and consist of weekly individual therapy sessions, weekly group skills-based sessions, telephone consultations as necessary, and weekly clinician team meetings to address treatment obstacles. Improved emotion regulation is a primary target of DBT, with the belief that improvement in this arena will directly impact maladaptive behaviors in addition to mood and global functioning.


Impact of DBT on Emotion Regulation  

To better understand the correlation between DBT treatment in individuals with dual diagnoses of BPD and SUD and improved emotion regulation, a group of researchers designed a 20-week experimental study (Axelrod, Perepletchikova, Holtzman, & Sinha, 2011). The subjects consisted of 27 women admitted to a primary substance use clinic in Connecticut and who met diagnostic criteria for BPD. Results of the study indicated that DBT, in fact, made a significant impact on participants’ emotion regulation, measured before and after treatment with the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004). By the end of treatment, patients reported increased confidence in their ability to “attend to, identify, and understand their emotions, and to remain in control when experiencing negative emotions” (Axelrod et al., 2011, p. 6).


Limitations of Studies on Treating BPD  

An obstacle that was indicated in this investigation and that applies to treatment of BPD in general is the often-reported low rate of treatment retention. At the end of the study, only 55.6% of participants had completed treatment (Axelrod et al., 2011, p. 6). The researchers noted it is difficult to ascertain the specific reasons for treatment termination as most patients fell out of contact. Engaging lost patients and retaining patients in treatment are major barriers in DBT and in any treatment of BPD. Another limitation of the study is the abbreviated amount of time for treatment as compared to the typical year-long DBT program. Yet, the promising results warrant further examination and additional research in the hopes of refining and improving treatment for this high-risk population.






Axelrod, S., Perepletchikova, F., Holtzman, K., & Sinha, R. (2011). Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy. American Journal of Drug and Alcohol Abuse, 37, 37-42.


Gratz, K., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathological Behavior Assessment, 26, 41-54.