Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial with a 15-month follow-up Christoph Kröger a, * , Ulrich Schweiger b,1 , Valerija Sipos b,1 , Sören Kliem a , Ruediger Arnold b,1 , Tanja Schunert b,1 , Hans Reinecker c, 2 a Technical University of Braunschweig, Department of Psychology, Humboldtstraße 33, 38106 Braunschweig, Germany b Department of Psychiatry and Psychotherapy, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany c Department of Psychology, University of Bamberg, Markusplatz 3, 96045 Bamberg, Germany article info Article history: Received 30 July 2008 Received in revised form 8 April 2010 Accepted 8 April 2010 Keywords: Eating disorders Borderline personality disorder Dialectical behavior therapy abstract There is evidence from case studies suggesting that adapted dialectical behavior therapy (DBT) for borderline personality disorder (BPD) and eating disorders (ED) might improve disorder related complaints. Twenty-four women with BPD (9 with comorbid anorexia nervosa [AN] and 15 with bulimia nervosa [BN]), who already had failed to respond to previous eating-disorder related inpatient treat- ments were consecutively admitted to an adapted inpatient DBT program. Assessment points were at pre-treatment, post-treatment, and 15-month follow-up. At follow-up, the remission rate was 54% for BN, and 33% for AN. Yet 44% of women with AN crossed over to BN and one woman additionally met the criteria of AN. For women with AN, the mean weight was not significantly increased at post-treatment, but had improved at follow-up. For women with BN, the frequency of binge-eating episodes was reduced at post-treatment as well as at follow-up. Self-rated eating-related complaints and general psychopa- thology, as well as ratings on global psychosocial functioning, were significantly improved at post- treatment and at follow-up. Although these findings support the assumption that the adapted DBT inpatient program is a potentially efficacious treatment for those who failed to respond to previous eating-disorder related inpatient treatments, remission rates and maintained eating-related psychopa- thology also suggest that this treatment needs further improvement. Ó 2010 Elsevier Ltd. All rights reserved. 1. Introduction According to the “Practice guideline for the treatment of patients with eating disorders” of the American Psychiatric Association (2006), both women and men with eating disorders (ED) should be routinely assessed for personality disorders (PD). Previous studies have reported comorbidity rates for ED and borderline personality disorder (BPD) of around 3% for anorexia nervosa, restricting type, 21% for bulimia nervosa (BN), and 9% for binge-eating disorder (BED), when the disorders were assessed by diagnostic interviews (Cassin & von Ranson, 2005). Considering the potentially confounding effect of malnutrition at intake, personality pathology might be more difficult to detect in samples with AN. However, women who recovered from anorexia nervosa, restricting type (AN-R) or binge-purging type (ANBP) showed a low and similar rate of Cluster B disorders (5% and 11%, respectively; Wagner et al., 2006). The comorbidity with BPD may have significant implications for the course and outcome of treatment for ED. For individuals with BN, the presence of BPD seems to be associated with a history of more frequent hospitalizations, a higher severity of psychopa- thology, lower levels of global psychosocial functioning, and more interpersonal problems (Johnson, Tobin, & Enright, 1989; Steiger, Thibaudeau, Leung, Houle, & Ghadirian, 1994; Wonderlich & Swift, 1990). In cluster-analytic approaches, the most impaired of three subgroups with BN were individuals classified as emotionally * Corresponding author. Tel.: þ49 531 391 2865; fax: þ49 531 391 8195. E-mail addresses: c.kroeger@tu-bs.de (C. Kröger), ulrich.schweiger@psychiatrie.uk- sh.de (U. Schweiger), sipos.v@psychiatry.uni-luebeck.de (V. Sipos), soerenkliem@web. de (S. Kliem), arnold.r@psychiatrie.uk-sh.de (R. Arnold), tanjaschirrmacher@yahoo. com (T. Schunert), hans.reinecker@ppp.uni-bamberg.de (H. Reinecker). 1 Tel.: þ49 451 500 2454. 2 Tel.: þ49 451 863 1884. Contents lists available at ScienceDirect Journal of Behavior Therapy and Experimental Psychiatry journal homepage: www.elsevier.com/locate/jbtep 0005-7916/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.jbtep.2010.04.001 J. Behav. Ther. & Exp. Psychiat. 41 (2010) 381e388