Dialectic behavioural therapy has an impact on self‐concept clarity and facets of self‐esteem in women with borderline personality disorder

Abstract

Identity disturbance and an unstable sense of self are core criteria of borderline personality disorder (BPD) and significantly contribute to the suffering of the patient. These impairments are hypothesized to be reflected in low self-esteem and low self-concept clarity. The objective of this study was to evaluate the impact of an inpatient dialectic behavioral therapy (DBT) programme on self-esteem and self-concept clarity. Forty women with BPD were included in the study. Twenty patients were treated with DBT for 12 weeks in an inpatient setting and 20 patients from the waiting list served as controls. Psychometric scales were used to measure different aspects of self-esteem, self-concept clarity and general psychopathology. Patients in the treatment group showed significant enhancement in self-concept clarity compared with those on the waiting list. Further, the scales of global self-esteem and, more specifically, the facets of self-esteem self-regard, social skills and social confidence were enhanced significantly in the intervention group. Additionally, the treatment had a significant impact on basic self-esteem in this group. On the other hand, the scale of earning self-esteem was not significantly abased in patients with BPD and did not show significant changes in the intervention group. Our data provide preliminary evidence that DBT has an impact on several facets of self-esteem and self-concept clarity, and thus on identity disturbance, in women with BPD.

Self-concept structure and borderline personality disorder: Evidence for negative compartmentalization

“…Moreover, BPD patients have self-concepts that contain a higher proportion of negative attributes than both control groups. This finding is consistent with several studies providing evidence that patients with BPD tend to generate extremely negative evaluations of themselves and others (Arntz & ten Haaf, 2012;Barnow et al, 2009;Klein et al, 2001;Roepke et al, 2011;Rüsch et al, 2007). Concluding from our results, BPD patients rate the majority of their self-aspects as being mostly negative, while few self-aspects are rated as being mostly positive.…”

“…However, Sieswerda, Arntz, and Wolfis (2005) demonstrated that patients with BPD tended to produce extremely negative, but not split or dichotomous evaluations of themselves on 20 trait visual analogue scales. Consistent with this result, several studies have found that BPD patients possess a more negative selfconcept than non-clinical individuals (Klein, Wonderlich, & Crosby, 2001;Roepke et al, 2011;Rüsch et al, 2007).…”

“…Using an adapted version of the repertory grid test, a study by De Bonis et al (1995) showed that BPD patients describe themselves more in terms of opposites than in terms of salient attributes. Roepke et al (2011) showed that patients with BPD report lower self-concept clarity than non-clinical controls and that self-concept clarity increases with therapy.…”

“…One study exclusively relied on ratings of clinicians (e.g., Wilkinson-Ryan & Westen, 2000). Other studies relied on self-report questionnaires yielding one sum score only (e.g., Roepke et al, 2011), thereby, operationalizing selfconcept as a unitary, one-dimensional construct. Several authors argued, however, that self-concept should be viewed as a multifaceted phenomenon that encompasses a diverse set of images, schemas or concepts (Markus & Wurf, 1987;Marsh & Shavelson, 1985;Shavelson, Hubner, & Stanton, 1976).…”

Dialectical Behavior Therapy: A Portuguese Pilot Program

“…Those results are aligned with previous ones from other studies that pointed out an significant enhancement in self-concept clarity of the patients that completed the treatment (DBT) compared with those on the waiting list, especially in what concerns to some facets of the self-concept like self-esteem self-regard, social skills and social confidence (Roepke, 2011).…”