A 26-year-old woman has a history of unstable relationships, fear of abandonment, identity disturbance, self-cutting, and brief psychotic episodes under stress. She is started on dialectical behaviour therapy (DBT). Which primary mechanism does DBT target in Borderline Personality Disorder?

• A Correcting faulty automatic thoughts through Socratic questioning (cognitive restructuring)
• B Emotional dysregulation through a biosocial model combining acceptance-based and change-based strategies ✓
• C Desensitisation to abandonment fears through graduated exposure
• D Reinforcing healthy attachment through transference interpretation

Explanation

DBT, developed by Marsha Linehan, is based on the biosocial theory that BPD arises from biological emotional vulnerability combined with an invalidating environment. DBT combines acceptance strategies (mindfulness, validation) with change strategies (cognitive restructuring, skills training). Its four skill modules — distress tolerance, emotion regulation, interpersonal effectiveness, and mindfulness — directly target emotional dysregulation, which is the core deficit in BPD according to this model. DBT is the only psychotherapy with robust RCT evidence showing reduction in self-harm, suicidality, and hospitalisation in BPD.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.