Download PDF Cognitive Behavioral Treatment of Borderline Personality Disorder by Marsha M Linehan

Sinopsis

In recent years, interest in borderline personality disorder (BPD) has exploded. This interest is related to at least two factors. First, individuals meeting criteria for BPD are flooding mental health centers and practitioners' offices. Eleven percent of all psychiatric outpatients and 19 % of psychiatric inpatients are estimated to meet criteria for BPD; of patients' with some form of a personality disorder, 33 % of outpatients and 63 % of inpatients appear to meet B P D criteria (see Widiger & Frances, 1989, for a review). Second, available treatment modalities appear to be woefully inadequate. Follow-up studies suggest that the initial dysfunction of these patients m a y be extreme; that significant clinical improvement is slow, taking many years; and that improvement is marginal for many years after initial assessment (Carpenter, Gunderson, & Strauss, 1977; Pope, Jonas, Hudson, Cohen, & Gunderson, 1983; McGlashan, 1986a, 1986b, 1987). Borderline patients are so numerous that most practitioners must treat at least one. They present with severe problems and intense misery. They are difficult to treat successfully. It is no wonder that many mental health clinicians are feeling overwhelmed and inadequate, and are in search of a treatment that promises some relief.

Interestingly, the behavior pattern most frequently associated with the B P D diagnosis a pattern of intentional self-damaging acts and suicide attempts has been comparatively ignored as a target of treatment efforts. Gunderson (1984) has suggested that this behavior may come closest to representing the "behavioral specialty" of the borderline patient. The empirical data bear him out: From 70 % to 75 % of borderline patients have a history of a least one self-injurious act (Clarkin, Widiger, Frances, Hurt, & Gilmore, 1983; Cowdry, Pickar, & Davis; 1985). These acts can vary in in tensity from ones requiring no medical treatment (e.g., slight scratches, head banging, and cigarette burns) to ones requiring care on an intensive care unit (e.g., overdoses, self-stabbings, and asphyxiations). Nor is the suicidal behavior of borderline patients always nonfatal. Estimates of suicide rates among BPD patients vary, but tend to be about 9 % (Stone, 1989; Paris, Brown, & NowHs, 1987; KroU, Carey, & Sines, 1985). In a series of B P D inpatients followed from 10 to 23 years after discharge (Stone, 1989), patients exhibiting all eight DSM-III criteria for BPD at the index admission had a suicide rate of 3(>°/o, compared to a rate of 7 % for individuals w h o met five to seven criteria. In the same study, individuals with BPD and a history of previous parasuicide had suicide rates that were double the rates of individuals without previous parasuicide. Although there are substantial literatures both on suicidal and self-injurious behavior and on BPD, there is virtually no communication between the two areas of study

Content

1. Borderline Personality Disorder: Concepts, Controversies, and Definitions
2. Dialectical and Biosocial Underpinnings of Treatment 
3. Behavioral Patterns: Dialectical Dilemmas in the Treatment of Borderline Patients
4. Overview of Treatment: Targets, Strategies, and Assumptions in a Nutshell
5. Behavioral Targets In Treatment: Behaviors to Increase a n d Decrease
6. Structuring Treatment Around Target Behaviors: Who Treats What and When
7. Dialectical Treatment Strategies
8. Core Strategies: Part 1. Validation
9. Core Strategies: Part II. Problem Solving
10. Change Procedures: Part I. Contingency Procedures (Managing Contingencies and Observing Limits)
11. Change Procedures: Part II. Skills Training, Exposure, Cognitive Modification
12. Stylistic Strategies: Balancing Communication
13. Case Management Strategies: Interacting with the Community
14. Structural Strategies
15. Special Treatment Strategies

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