The Use of Dialectical Behavior Therapy and Prolonged Exposure to Treat Comorbid Dissociation and Self-Harm: The Case of a Client With Borderline Personality Disorder and Posttraumatic Stress Disorder.

There is a high rate of comorbidity between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD; Pagura et al., 2010). Preliminary studies have evaluated the treatment of PTSD in a BPD population and found positive outcomes for the integration of dialectical behavior therapy (DBT) and prolonged exposure (PE). This case study illustrates the implementation of a PE protocol into standard DBT treatment, specifically focusing on the management of self-harm and severe dissociation for a client with co-occurring PTSD and BPD. The client entered into treatment with severe and persistent dissociation and a recent history of self-harm, and the case includes consideration of two separate pauses in PTSD treatment related to elevated dissociation and self-harm behaviors. The client successfully completed the DBT PE protocol and results indicate significant improvements in PTSD symptoms as well as outcomes related to self-harm and dissociation. These findings demonstrate the efficacy of combining DBT with PE for clients with comorbid BPD and PTSD and exemplify how complex clients with BPD who present with severe dissociation and self-harm behavior can safely and successfully receive treatment for PTSD.

The relation of insecure attachment states of mind and romantic attachment styles to adolescent aggression in romantic relationships.

The relation of attachment states of mind and self reported attachment relationship styles to romantic partner aggression was examined in a community sample of 93 adolescents. Higher levels of insecure-preoccupied and insecure-dismissing states of mind, as assessed by the Adolescent Attachment Interview at age 14, were predictive, respectively, of perpetration and victimization of psychological aggression in romantic relationships four years later. Partners' romantic attachment anxiety was linked to both psychological and physical aggression perpetration in romantic relationships. Results are interpreted as suggesting the value of assessing aggression in adolescent romantic relationships in the context of broader patterns of regulation of affect and behavior via the attachment system.

Attachment in adolescence: A move to the level of emotion regulation.

The early adolescent's state of mind in the Adult Attachment Interview (AAI) is more closely linked to social interactions with peers, who are unlikely to serve as attachment figures, than it is to (i) qualities of the adolescent's interactions with parents, (ii) the AAI of the adolescent's mother, or (iii) the adolescent's prior Strange Situation behavior. This unexpected finding suggests the value of reconceptualizing AAI autonomy/security as a marker of the adolescent's capacity for emotion regulation in social interactions. Supporting this, we note that the AAI was originally validated not as a marker of attachment experiences or expectations with one's caregivers, but as a predictor of caregiving capacity sufficient to produce secure offspring. As such, the AAI may be fruitfully viewed as primarily assessing social emotion regulation capacities that support both strong caregiving skills and strong skills relating with peers.

Fighting fair: Adaptive Marital Conflict Strategies as Predictors of Future Adolescent Peer and Romantic Relationship Quality.

This study examined the associations between reasoning during interparental conflict and autonomous adolescent conflict negotiation with peers over time. Participants included 133 adolescents and their parents, peers, and romantic partners in a multi-method, multiple reporter, longitudinal study. Interparental reasoning at adolescent age 13 predicted greater autonomy and relatedness in observed adolescent-peer conflict one year later and lower levels of autonomy undermining during observed romantic partner conflict five years later. Interparental reasoning also predicted greater satisfaction and affection in adolescent romantic relationships seven years later. Findings suggest that autonomy promoting behaviors exhibited in the interparental context may influence adolescents' own more autonomous approaches to subsequent peer and romantic conflict. Possible explanatory models are discussed, including social learning theory and attachment theory.

Intergenerational transmission of aggression in romantic relationships: the moderating role of attachment security.

This prospective study used longitudinal, multi-reporter data to examine the influence of parents' marital relationship functioning on subsequent adolescent romantic relationships. Consistent with Bryant and Conger's (2002) model for the Development of Early Adult Romantic Relationships (DEARR), we found that interactional styles, more specifically paternal aggression and satisfaction, exhibited in parents' marital relationship when their adolescents were age 13 were predictive of qualities of the adolescent's romantic relationships 5 years later. Continuities were domain specific: paternal satisfaction predicted adolescent satisfaction and paternal aggression predicted adolescent aggression. Attachment security moderated the link between paternal aggression and subsequent adolescent aggression, with continuities between negative conflictual styles across relationships reduced for secure adolescents. Results are interpreted as suggesting that attachment may help attenuated the transmission of destructive conflict strategies across generations.