Effectiveness of dialectical behavior therapy on neurocognitive characteristics in adolescents with borderline personality disorder receiving care at Peru's National Institute of Mental Health
DOI:
https://doi.org/10.20453/rnp.v89i2.7282Keywords:
borderline personality disorder, adolescents, dialectical behavior therapy, memory, attention, mentalizingAbstract
Borderline personality disorder (BPD) in adolescents is associated with a significant decline in quality of life, an increased risk of suicidal and self-harming behaviors, school dropout, difficulties in social functioning, and high psychiatric comorbidity, leading to significant overall dysfunction. Objective: To evaluate the effectiveness of dialectical behavior therapy for adolescents (DBT-A), compared to usual care, on attention, memory, mentalization, and general functioning in adolescents with BPD, at the end of the intervention and 2 months post-intervention. Materials and methods: Observational, quasi-experimental, longitudinal study conducted with 24 adolescents with BPD, divided into an intervention group that received DBT-A and a control group that received usual care psychotherapy. Assessments were performed before the intervention, at the end of the 6-month treatment period, and at the 2-month follow-up. The d2-R and the Processing Speed Index (PSI) of the Wechsler scales were used to assess attention; For memory, the Neuropsi Memory subscale and the Working Memory Index (WMI) of the Wechsler scales were used; for mentalization, the Reading Mind Through Gaze Test (RMET) and the Cambridge Behavior Scales; and for general functioning, the Borderline Personality Disorder Symptom List (BSL-23) and the Children and Adolescents Global Assessment Scale (C-GAS). Results: At the end of the intervention and at 2 months post-intervention, adolescents who received DBT-A showed a significant improvement in general functioning compared to those who received usual psychotherapy. The adjusted linear regression model showed a significant association between DBT-A and C-GAS scores at the end of the intervention (p = 0.001) and at 2 months post-intervention (p = 0.039). Conclusions: DBT-A showed significant effectiveness in the studied sample, evidenced by an improvement in overall functioning at the end of the intervention and at 2 months post-intervention, as well as in attention and memory at 2 months post-intervention.
Downloads
References
Linehan MM. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: The Guilford Press; 1993.
Putnam KM, Silk KR. Emotion dysregulation and the development of borderline personality disorder. Dev Psychopathol. 2005;17(4):899-925. doi:10.1017/S0954579405050431
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Arlington: American Psychiatric Association Publishing; 2013. doi:10.1176/appi.books.9780890425596
Albarrán S, Alva P, Correa M, et al. El límite de Marsha: terapia dialéctica conductual para el trastorno límite de personalidad. J Neurosci Public Health. 2021;1(1):5-11. doi:10.46363/jnph.v1i1.1
Gratz KL, Dixon LJ, Kiel EJ, et al. Emotion regulation: theoretical models, associated outcomes and recent advances. En: Zeigler-Hill V, Shackelford TK, editores. The SAGE Handbook of Personality and Individual Differences: Volume III: Applications of Personality and Individual Differences. SAGE Publications; 2018. Cap. 3. doi: 10.4135/9781526470300.n3
Klinkby IM, Hastrup LH, Bo S, et al. Prevalence and incidence of personality disorders among children and adolescents in Danish mental health services: a nationwide register study. Eur Child Adolesc Psychiatry. 2023;33(6):1731-40. doi:10.1007/s00787-023-02274-w
Haglund A, Lysell H, Larsson H, et al. Suicide immediately after discharge from psychiatric inpatient care: a cohort study of nearly 2.9 million discharges. J Clin Psychiatry. 2019;80(2):18m12172. doi:10.4088/JCP.18m12172
Goodman M, Mascitelli K, Triebwasser J. The neurobiological basis of adolescent-onset borderline personality disorder. J Can Acad Child Adolesc Psychiatry. 2013;22(3):212-9. PMCID:PMC3749895
Drews E, Fertuck EA, Koenig J, et al. Hypothalamic-pituitary-adrenal axis functioning in borderline personality disorder: a meta-analysis. Neurosci Biobehav Rev. 2019;96:316-34. doi:10.1016/j.neubiorev.2018.11.008
Asarnow JR, Berk MS, Bedics J, et al. Dialectical behavior therapy for suicidal self-harming youth: emotion regulation, mechanisms, and mediators. J Am Acad Child Adolesc Psychiatry. 2021;60(9):1105-15.e4. doi:10.1016/j.jaac.2021.01.016
López-Villatoro JM, Diaz-Marsá M, Rico-Perez A, et al. Neurocognitive profile associated with borderline personality disorder: building specific indices of executive function. Actas Esp Psiquiatr [Internet]. 2023;51(5):220-8. Disponible en: https://actaspsiquiatria.es/index.php/actas/article/view/58
Gabriel ET, Oberger R, Schmoeger M, et al. Cognitive and affective Theory of Mind in adolescence: developmental aspects and associated neuropsychological variables. Psychol Res. 2021;85(2):533-53. doi:10.1007/s00426-019-01263-6
Bozzatello P, Blua C, Brasso C, et al. The role of cognitive deficits in borderline personality disorder with early traumas: a mediation analysis. J Clin Med. 2023;12(3):787. doi:10.3390/jcm12030787
Palomares N, García-Andrade R, Arza R, et al. Perfil neuropsicológico en primeros episodios de esquizofrenia y trastorno límite de la personalidad: un estudio comparativo. Actas Esp Psiquiatr [Internet]. 2019;47(1):7-15. Disponible en: https://actaspsiquiatria.es/index.php/actas/article/view/171
Arabadzhiev Z, Paunova R. Complexity of mentalization. Front Psychol. 2024;15:1353804. doi:10.3389/fpsyg.2024.1353804
Bermúdez F. Neurobiología de los trastornos de personalidad: Estudio de los trastornos límite y antisocial de la personalidad. Rev Cúpula [Internet]. 2023;37(2):59-73. Disponible en: https://www.binasss.sa.cr/bibliotecas/bhp/cupula/v37n2/art04.pdf
Fonagy P, Bateman A. The development of borderline personality disorder a mentalizing model. J Pers Disord. 2008; 22(1):4-21. doi:10.1521/pedi.2008.22.1.4
Pérez P. Revisión de los factores de riesgo que influyen en el trastorno límite de la personalidad [trabajo de fin de grado en Internet]. Valencia: Universidad Católica de Valencia San Vicente Mártir; 2021. Disponible en: http://hdl.handle.net/20.500.12466/1879
Guilé JM, Boissel L, Alaux-Cantin S, et al. Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies. Adolesc Health Med Ther. 2018;9:199-210. doi:10.2147/AHMT.S156565
Keng SL, Lee CS, Eisenlohr-Moul TA. Effects of brief daily mindfulness practice on affective outcomes and correlates in a high BPD trait sample. Psychiatry Res. 2019;280:112485. doi:10.1016/j.psychres.2019.112485
Hutsebaut J, Clarke SL, Chanen AM. The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence. Front Psychiatry. 2023;14:1130417. doi:10.3389/fpsyt.2023.1130417
Gurahua KJ. Características clínicas y sociodemográficas del trastorno límite de personalidad en escolares de la institución educativa peruano suizo del distrito de Comas [tesis de título profesional en Internet]. Lima: Universidad Privada San Juan Bautista; 2021. Disponible en: https://hdl.handle.net/20.500.14308/3054
Zanarini MC, Frankenburg FR, Hennen J, et al. The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. Am J Psychiatry. 2003;160(2):274-83. doi:10.1176/appi.ajp.160.2.274
Zanarini MC, Frankenburg FR, Reich DB, et al. The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study. Am J Psychiatry. 2007;164(6):929-35. doi:10.1176/ajp.2007.164.6.929
Miller AL, Rathus JH, DuBose AP, et al. Dialectical behavior therapy for adolescents. En: Dimeff LA, Koerner K, editores. Dialectical Behavior Therapy in Clinical Practice: Applications across disorders and settings. New York: The Guilford Press; 2007. pp. 245-63.
Navarro MV, Mozota P, García A. Revisión de revisiones sobre la eficacia de los tratamientos psicológicos para adolescentes con trastorno de la personalidad límite. Rev Psicol Clín Niños Adolesc. 2023;10(1):91-8. doi:10.21134/rpcna.2023.10.1.8
Flynn D, Kells M, Joyce M. Dialectical behaviour therapy: implementation of an evidence-based intervention for borderline personality disorder in public health systems. Curr Opin Psychol. 2021;37:152-7. doi:10.1016/j.copsyc.2021.01.002
Brickenkamp R, Schmidt-Atzert L, Liepmann D. d2-R. Test de Atención - Revisado. Madrid: Hogrefe; 2022.
Amador JA, Forns i Santacana M. Escala de inteligencia de Wechsler para niños, quinta edición (WISC-V) [documento de trabajo en Internet]. Barcelona: Universitat de Barcelona; 2019. Disponible en: https://diposit.ub.edu/bitstreams/40b5c115-581f-4612-964f-8f7d704bf412/download
Magallanes A. Perfil neuropsicológico del síndrome KGB [presentación oral]. En: Primer Congreso Iberoamericano sobre Avances en el Diagnóstico y Tratamiento del Espectro Autista: un enfoque multidisciplinario. Ponce Health Sciences University, National Academy of Neuropsychology, Centro Integral de Reahabilitación Física y Aprendizaje; 2025, 26-27 de abril.
Rosas R, Tenorio M, Pizarro M, et al. Estandarización de la Escala Wechsler de Inteligencia para Adultos-cuarta edición en Chile. Psykhe. 2014;23(1). doi:10.7764/psykhe.23.1.529
Zegarra-Valdivia JA, Chino BN, Doval S, et al. Test de Lectura de la Mente a través de la Mirada: primera aproximación a las propiedades psicométricas en población peruana. Rev Ecuat Neurol [Internet]. 2022;31(1):66-75. doi:10.46997/revecuatneurol31100066
Ezpeleta L, Granero R, De la Osa N. Evaluación del deterioro en niños y adolescentes a través de la Children’s Global Assessment Scale (CGAS). Rev Psiquiatr Infanto-Juv [Internet]. 1999;(1):18-26. Disponible en: https://aepnya.eu/index.php/revistaaepnya/article/view/480
Soler J, Vega D, Feliu-Soler A, et al. Validation of the Spanish version of the Borderline Symptom List, short form (BSL-23). BMC Psychiatry. 2013;13(1):1317. doi:10.1186/1471-244X-13-139
Rathus JH, Miller AL. Dialectical Behavior Therapy adapted for suicidal adolescents. Suicide Life Threat Behav. 2002;32(2):146-57. doi:10.1521/suli.32.2.146.24399
Sawilowsky SS. New effect size rules of thumb. J Mod Appl Stat Methods. 2009;8(2):597-9. doi:10.22237/jmasm/1257035100
Kothgassner OD, Goreis A, Robinson K, et al. Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis. Psychol Med. 2021;51(7):1057-67. doi:10.1017/S0033291721001355
Vijayapriya CV, Tamarana R. Effectiveness of dialectical behavior therapy as a transdiagnostic treatment for improving cognitive functions: a systematic review. Res Psychother Psychopathol Process Outcome. 2023;26(2):662. doi:10.4081/ripppo.2023.662
Smith A, Freeman K, Montgomery S, et al. Executive functioning outcomes among adolescents receiving dialectical behavior therapy. Child Adolesc Social Work J. 2019;36(5):495-506. doi:10.1007/s10560-018-0578-9
Górska D, Marszał M. [Mentalization and theory of mind in borderline personality organization: exploring the differences between affective and cognitive aspects of social cognition in emotional pathology]. Psychiatr Pol. 2014;48(3):503-13. PMID:25204096. Polish.
Clarkin JF, Levy KN, Lenzenweger MF, et al. Evaluating three treatments for borderline personality disorder: a multiwave study. Am J Psychiatry. 2007;164(6):922-8. doi:10.1176/ajp.2007.164.6.922
Poznyak E, Morosan L, Perroud N, et al. Roles of age, gender and psychological difficulties in adolescent mentalizing. J Adolesc. 2019;74(1):120-9. doi: 10.1016/j.adolescence.2019.06.007
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Cindy Amaro Hurtado, Susan Escobar Benites, Ximena Alarcón Guzmán, Natali Rubina Camargo
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
RNP is distributed under a 