Journal of Personality Disorders, 34(1), 22-39, 2020
© 2020 The Guilford Press
22
From Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm,
Sweden (D. W., P. D., P. E.); Department of Public Health Sciences, Epidemiology of Mental Health Divi-
sion, Karolinska Institutet (P. D.); Department of Neuroscience, Uppsala University, Uppsala, Sweden (N.
L.); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet (N. L.); Department
of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden (G. A.); Department of
Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet (G. A.); and McLean Hospi-
tal and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (A. E. F.).
We would like to thank all participants and therapists who contributed to this study. The study was partly
funded by the Swedish Prison and Probation Services, PRIMA barn och vuxenpsykiatri AB, and the L.
J. Boëthius Foundation.
Address correspondence to Dan Wetterborg, Division of Psychology, Karolinska Institutet, Nobels väg 9,
Solna, Stockholm 171 77, Sweden. E-mail: dan.wetterborg@ki.se
DBT FOR MEN WITH BPD AND ANTISOCIAL BEHAVIOR
WETTERBORG ET AL.
DIALECTICAL BEHAVIOR THERAPY FOR MEN
WITH BORDERLINE PERSONALITY DISORDER
AND ANTISOCIAL BEHAVIOR: A CLINICAL TRIAL
Dan Wetterborg, PhD, Peter Dehlbom, MSc, Niklas Långström, MD,
Gerhard Andersson, PhD, Alan E. Fruzzetti, PhD,
and Pia Enebrink, PhD
In addition to suicidal behaviors, men with borderline personality disorder
(BPD) often display antisocial behavior that could impair contacts with
mental health services. While research has established effective treatments
for women with BPD, this is not yet the case for men. The authors evalu-
ated 12 months of dialectical behavior therapy (DBT) for 30 men with BPD
and antisocial behavior, using a within-group design with repeated measure-
ments. The authors found moderate to strong, statistically significant pre-
to posttreatment reductions of several dysfunctional behaviors, including
self-harm, verbal and physical aggression, and criminal offending (rate
ratios 0.17–0.39). Symptoms of BPD and depression were also substantially
decreased. The dropout rate was 30%, and completing participants re-
ported high satisfaction with treatment and maintained their improvements
at 1-year follow-up. The authors conclude that DBT could be an effective
treatment alternative for men with BPD and antisocial behavior, and it mer-
its future studies with more rigorous design.
Keywords: dialectical behavior therapy, borderline personality disorder,
antisocial personality disorder, self-harm, criminality, offending, male,
antisocial behavior
Men with severe and chronic emotional instability, who display both self-
harming and suicidal behaviors as well as criminality and violence, constitute
a challenge to both the mental health and criminal justice systems. Border-
line personality disorder (BPD) is a complex mental disorder characterized