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Olanzapine Plus Dialectical Behavior Therapy for Women With High Irritability Who Meet Criteria for Borderline Personality Disorder: A Double-Blind, Placebo-Controlled Pilot Study

Marsha M. Linehan, Ph.D.; Joshua D. McDavid, M.D., M.P.H.; Milton Z. Brown, Ph.D.; Jennifer H. R. Sayrs, Ph.D.; and Robert J. Gallop, Ph.D.

Objective: This double-blind study examined whether olanzapine augments the efficacy of dialectical behavior therapy (DBT) in reducing anger and hostility in borderline personality disorder patients.

Method: Twenty-four women with borderline personality disorder (DSM-IV criteria) and high levels of irritability and anger received 6 months of DBT. Subjects were randomly assigned to receive either low-dose olanzapine or placebo and were assessed with standardized measures in a double-blind manner. The study was conducted from September 2000 to December 2002.

Results: Intent-to-treat analyses indicated that both treatment conditions resulted in significant improvement in irritability, aggression, depression, and self-inflicted injury (p < .01 for each). Irritability and aggression scores tended (p < .10) to decrease more quickly for the olanzapine group than for the placebo group. Self-inflicted injury tended (p < .10) to decrease more for the placebo group than for the olanzapine group.

Conclusions: Olanzapine may promote more rapid reduction of irritability and aggression than placebo for highly irritable women with borderline personality disorder. Effect sizes were moderate to large, with the small sample size likely limiting the ability to detect significant results. Overall, there were large and consistent reductions in irritability, aggression, depression, and self-injury for both groups of subjects receiving DBT.


(J Clin Psychiatry 2008;69:999-1005. Online Ahead of Print May 6, 2008.)

Received Feb. 22, 2007; accepted Oct. 1, 2007. From the Department of Psychology, University of Washington, Seattle (Drs. Linehan and McDavid); the Department of Psychology, Alliant University, San Diego, Calif. (Dr. Brown); Evidence Based Treatment Centers of Seattle and the Department of Psychology, University of Washington, Seattle (Dr. Sayrs); and the Department of Mathematics, West Chester University, West Chester, Pa. (Dr. Gallop).

This research was supported by a grant from Eli Lilly and Co., Protocol F1D-US-X173, to Dr. Linehan; by Remind Rx Medication Compliance Systems; and by a contribution of electronic pill bottles from IBV Technologies, Seattle, Wash.

The authors thank Katherine Comtois, Ph.D.; Angela Murray, M.A., M.S.W.; Susan Bland, M.S.W.; and Katherine Gechter, M.P.H., Department of Psychology, University of Washington, for their contribution to this project. None of the acknowledged individuals have financial affiliations or other relationships relevant to the subject of this article.

Dr. Linehan is a consultant for, has received grant/research support and honoraria from, and is a member of the speakers/advisory board for Eli Lilly. Drs. McDavid, Brown, Sayrs, and Gallop report no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: Marsha M. Linehan, Ph.D., Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Seattle, WA 98195-1525 (e-mail: