Journal of psychosomatic research · 2025
Persistent somatic symptom severity in patients with borderline personality disorder: Trauma-related symptoms as mechanism for improvement during inpatient dialectical behavior therapy.
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Hüsing Paul, Löwe Bernd, Biedermann Sarah V
Аннотация
BACKGROUND: Patients with borderline personality disorder (BPD) frequently report high levels of somatic symptoms. BPD and persistent somatic symptoms (PSS) share risk factors such as depression, trauma history and posttraumatic stress disorder (PTSD), as well as dissociation. This study examined predictors of PSS improvement in BPD patients during inpatient dialectical behavior therapy (DBT).
METHOD: Data from BPD inpatients (79.5 % female, mean age = 29.54 years, SD = 9.24) were analyzed at baseline (N = 180), four weeks (n = 117), and discharge (n = 92). Baseline PSS severity (PHQ-15) was predicted using depressive symptoms (PHQ-9), BPD symptoms (BSL-23), childhood trauma (CTQ), PTSD symptoms (PCL-5) and dissociation (FDS-20) via multiple linear regression. Symptom changes were analyzed using repeated measures ANOVA. Hierarchical Linear Modeling (HLM) was conducted to examine the relationship between PTSD, depression, dissociation, and borderline symptoms with PSS severity across time.
RESULTS: Baseline PSS severity was significantly associated with depressive symptoms (t = 5.613, p < .001), PTSD symptoms (t = 4.02, p < .001), and dissociation (t = 3.406, p < .001; R2 = 0.57). Significant improvements during treatment were observed in PSS (η2 = 0.35), depression (η2 = 0.55), dissociation (η2 = 0.27), BPD symptoms (η2 = 0.42), and PTSD (d = 0.96). Only changes in PTSD symptoms were associated with changes in PSS severity (F (1, 152.719) = 4.356, p = .039).
DISCUSSION: While multiple factors contribute to baseline PSS severity in BPD patients, improvements in PTSD symptoms appear to play a key role in the reduction of somatic complaints during inpatient DBT. This highlights the importance of addressing PTSD-related distress in treatment to achieve broader symptom relief. Future research should explore the mechanisms underlying this relationship and assess whether targeted interventions for PTSD within DBT could enhance outcomes for patients experiencing PSS.
METHOD: Data from BPD inpatients (79.5 % female, mean age = 29.54 years, SD = 9.24) were analyzed at baseline (N = 180), four weeks (n = 117), and discharge (n = 92). Baseline PSS severity (PHQ-15) was predicted using depressive symptoms (PHQ-9), BPD symptoms (BSL-23), childhood trauma (CTQ), PTSD symptoms (PCL-5) and dissociation (FDS-20) via multiple linear regression. Symptom changes were analyzed using repeated measures ANOVA. Hierarchical Linear Modeling (HLM) was conducted to examine the relationship between PTSD, depression, dissociation, and borderline symptoms with PSS severity across time.
RESULTS: Baseline PSS severity was significantly associated with depressive symptoms (t = 5.613, p < .001), PTSD symptoms (t = 4.02, p < .001), and dissociation (t = 3.406, p < .001; R2 = 0.57). Significant improvements during treatment were observed in PSS (η2 = 0.35), depression (η2 = 0.55), dissociation (η2 = 0.27), BPD symptoms (η2 = 0.42), and PTSD (d = 0.96). Only changes in PTSD symptoms were associated with changes in PSS severity (F (1, 152.719) = 4.356, p = .039).
DISCUSSION: While multiple factors contribute to baseline PSS severity in BPD patients, improvements in PTSD symptoms appear to play a key role in the reduction of somatic complaints during inpatient DBT. This highlights the importance of addressing PTSD-related distress in treatment to achieve broader symptom relief. Future research should explore the mechanisms underlying this relationship and assess whether targeted interventions for PTSD within DBT could enhance outcomes for patients experiencing PSS.