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
- Borderline Personality Disorder: Concepts, Controversies, and Definitions
- Dialectical and Biosocial Underpinnings of Treatment
- Behavioral Patterns: Dialectical Dilemmas in the Treatment of Borderline Patients
- Overview of Treatment: Targets, Strategies, and Assumptions in a Nutshell
- Behavioral Targets In Treatment: Behaviors to Increase a n d Decrease
- Structuring Treatment Around Target Behaviors: Who Treats What and When
- Dialectical Treatment Strategies
- Core Strategies: Part 1. Validation
- Core Strategies: Part II. Problem Solving
- Change Procedures: Part I. Contingency Procedures (Managing Contingencies and Observing Limits)
- Change Procedures: Part II. Skills Training, Exposure, Cognitive Modification
- Stylistic Strategies: Balancing Communication
- Case Management Strategies: Interacting with the Community
- Structural Strategies
- Special Treatment Strategies
Download PDF Borderline Personality Disorder FOR DUMMIES by Charles H. Elliott
Sinopsis
Sometimes we watch a news show that features a daily commentary called “Worst Person in the World.” During this segment, the reporter chooses a few people who’ve said or done something that he thinks deserves his haughty contempt. Not so long ago, many mental health professionals may have labeled people with borderline personality disorder (BPD) as “Worst Patients in the World.”
Until recently, no one knew which treatments really help people with BPD. Furthermore, people with BPD are incredibly scary to treat because they tend to have a lot of rage directed at themselves, the people they care about, the world, and even their doctors and therapists. Borderline rage can occur anywhere and anytime. Mental health professionals want to protect and help their clients, but people with BPD are hard to keep safe and frequently block therapists’ best efforts. In fact, about 75 percent of people who have BPD hurt themselves in some way, and one out of ten succeeds in suicide. On the other hand, if you’re lucky enough to treat, know, or care about someone with BPD, you may want to consider that person one of the “Best People in the World.” People with BPD can be highly intelligent, enthusiastic, and kind. Some therapists find that persistent effort over time results in a surprisingly gratifying metamorphosis in their patients with BPD.
Content
- Mapping the Boundaries of Borderline Personality Disorder
- Exploring Borderline Personality Disorder
- Defining Personality to Understand BPD
- Describing BPD
- Who Gets BPD and Why?
- Taking Note of the Major BPD Symptoms
- Sensation Seeking and Self-Harm: The Impulsivity of BPD
- Explosive Feelings and Moods
- Missing Persons: Identity Problems and BPD
- Perceiving, Understanding, and Relating to Others
- BPD and Extreme Thinking
- Slipping Away from Reality
- Making the Choice to Change
- Preparing to Conquer BPD
- Breaking Through Barriers to Change
- Explaining BPD to Others
- Taking Care of Yourself
- Treatments for BPD
- Inhibiting Impulsivity
- Calming the Storms Within
- Creating an Identity
- Putting Yourself in Other People’s Shoes
- Finding Shades of Gray: Changing Problematic Core Beliefs
- Considering Medication for BPD
- Advice for People Who Care
- What to Do When Your Partner Has BPD
- Befriending People with BPD
- Parenting Children at Risk for BPD
- Advice for Adult Children of BPD Parents
- Advice for Therapists of People with BPD
- Ten Quick Ways to Settle Down
- Ten Ways to Say You’re Sorry
- Ten Things You Shouldn’t Do
Download PDF Borderline Personality Disorder A practical guide to treatment by Roy Krawitz
Sinopsis
Gina, a community mental health nurse, is allocated to see Anne, a client, at a routine referral meeting. Gina planned to maintain regular contact with Anne and ‘‘keep an eye on her’’ whilst Anne was on the waiting list to see one of the people ascribed skill in treating people such as Anne. Anne had been previously diagnosed as meeting diagnostic criteria for borderline personality disorder. She had been attending psychiatric services for eight years which included 20 admissions to acute psychiatric units and a similar number of visits to emergency departments as a result of self-harm. Anne self-harmed most weeks, sometimes in a manner which was like ‘‘playing Russian roulette’’.
Gina did not see herself as being especially skilful in the treatment of people meeting diagnostic criteria for borderline personality disorder but she knew she had attained professional maturity in her practice as a psychiatric nurse. She was compassionate and believed that people meeting diagnostic criteria for borderline personality disorder were deserving of treatment and could get better. Unlike many of her colleagues, she had maintained optimism and enthusiasm for her work and her clients.
Gina met Anne and together over a period of storms, crises, emergency service and acute inpatient admissions, they collaboratively developed a clinical plan including acute admission and crisis plans. Michael and Dorothy worked on the crisis and acute inpatient teams and did not see themselves as having specific expertise in this area but, like Gina, did have considerable general mental health skills. There were discussions between Gina, Michael, Dorothy and Anne with significant conflicts of views. Over the months however, they developed a coherent plan they could agree to, for the most part.
Content
- Background to treatment
- Treatment issues and clinical pathways
- Stigma, language, clinician feelings, and resourcing
- The legal environment
- Maintaining enthusiasm
Download PDF Borderline Personality Disorder by Mary C. Zanarini
Sinopsis
Borderline personality disorder (BPD) enjoys the dual distinction of being one of the most written about and talked about conditions in contemporary psychiatry, and of being the only condition among the nearly 400 in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) (1) whose label provides no hint, no semantic handle, as to what sort of condition it is. One might argue that the seven eponymous syndromes of the DSM (Alzheimer’s, Asperger’s, Creutzfeld–Jakob’s, Huntington’s, Pick’s, Rett’s, and Gilles de la Tourette’s) require a bit of study before their nature is clarified, but all the others either stem from common English roots (gambling, binge-eating, sleep disorder) or are decipherable from their Greek or Latin origins (trichotillomania: pathological pulling of hair; insomnia: absence of sleep, etc.). Borderline, when used adjectivally, suggests something that is in close proximity to something else. Indeed, in its first uses in psychiatry, borderline designated either (a) a condition that approximated another, already well-established disorder, or (b) a condition that occupied a region in between two rather indistinctly boundaried levels of mental functioning. As we shall see, the borderline of our current BPD is derived from both these usages.
Content
- Borderline Personality Disorder: History of the Concept
- The Subsyndromal Phenomenology of Borderline Personality Disorder
- Environmental Factors in the Etiology of Borderline Personality Disorder
- A Temperament Model of Borderline Personality Disorder
- Neurobiology of Impulsive Aggression
- Biochemical Endophenotypes in Borderline Personality Disorder
- Genetics of Borderline Personality Disorder
- Comorbidity and Borderline Personality Disorder
- Psychosocial Functioning in BPD
- The Symptomatic Course of Borderline Personality Disorder
- Suicidality in Borderline Personality Disorder
- Psychodynamic Psychotherapy of Borderline Personality Disorder
- Dialectical Behavior Therapy for Borderline Personality Disorder
- Pharmacotherapy of Borderline Personality Disorder
- Family Interventions for Borderline Personality Disorder
- Day Hospital Treatment of Borderline Personality Disorder
- Structural and Functional Imaging of Patients with Borderline Personality Disorder
- Risk Factors for Suicidal Behavior in Borderline Personality Disorder: A Review and Update
Download PDF Get Me Out of Here My Recovery from Borderline Personality Disorder by RACHEL REILAND
Sinopsis
Rachel Reiland's courageous struggle with borderline personality disorder
(BPD) is a tale that is both harrowing and reassuring, disturbing but
sustaining. Her battle is typical yet unique. These paradoxes are like the
illness itself. BPD is a disorder characterized by contradictions. Its cure is
derived by navigating through the straits of emotional extremes into the
tranquil waters of compromise and consolidation.
Get Me Out of Here details Reiland's recovery. Her
triumph results from the collaboration with her talented and unconditionally
accepting psychiatrist. In the doctor, she found compromise between her
desperate childhood fears of abandonment and her adult-derived defenses of
self-destructiveness, attacking rage, and nihilism. From the remnants of her
frightened, vulnerable childhood (which she labeled “Vulno”) and her “Tough
Chick” personae, Reiland fashioned her individual humanity.
Some of this story is typical: early family conflicts, abusive
relationships, feelings of insecurity contributing to destructive behaviors such
as rage attacks, promiscuity, and anorexia. The extreme behaviors of BPD
constitute the high drama in the stories of those who endure its ravages. But
Reiland does not focus only on the flamboyance of the symptoms. She also
describes the small, intimate nicks and cuts that bleed slowly and painfully,
day to day.
Reiland's recovery is, in many ways, atypical. It is attained
through an intensive, four-year course of traditional, psychoanalytically
oriented psychotherapy, punctuated by several hospitalizations, some lasting for
several weeks. Unfortunately, such a treatment program would be unavailable to
most patients today. Most hospital psychiatric units are not geared for extended
stays of more than a few days, and most insurance will not support this
intensive treatment regimen.
Fortunately, Reiland possessed financial support to pay for her
care. She also maintained a supportive, loving relationship with her husband and
children. And she developed a trusting relationship with an experienced,
knowledgeable psychiatrist. Although many sufferers may not share all of these
blessings, they can, nevertheless, still achieve the victories she accomplished
through the same persistence and courage she demonstrated.
BPD is the monstrous, metastatic malignancy of psychiatry. Most
professionals shun patients with this diagnosis, convinced that they are
exhausting, hopeless, and often terminal. The sickest, most severely psychotic
schizophrenic patient is preferred over one with BPD, because at least there is
some feeling of control over the treatment process. Hospitalization and
medication can easily and quickly subdue the schizophrenia monster. But BPD
symptoms can rage unpredictably, are difficult to control, require months or
years to detect improvement, and can overwhelm the vulnerable therapist.
Until recently, a diagnosis of BPD was a label of hopelessness
for both the patient and the doctor. With a suicide rate of almost 10 percent
and no consistent treatment approaches offered, the prognosis was considered to
be poor. However, with developments over the last ten years, such pessimism is
no longer warranted.
Refined treatment approaches, such as dialectical behavioral
therapy and adapted psychoanalytic techniques, have demonstrated significant
effectiveness. Long-term follow-up studies, just now becoming available,
illustrate that individuals with BPD can survive and thrive. Recent studies
confirm that many borderline symptoms resolve over the years.
Although continuous treatment significantly augments the
recovery rate, many patients achieve remission even without therapy. Over time
spans ranging from six to fifteen years, as many as three-fourths of all
patients with BPD will have resolved symptoms such that they no longer qualify
for the BPD diagnosis. These patients would then, within the medical lexicon, be
considered cured. Few other chronic medical conditions (e.g., diabetes,
emphysema, hypertension, and schizophrenia) can achieve this ultimate level.
Download PDF Psychotherapy for borderline personality disorder Mentalization-based treatment Anthony W. Bateman
Sinopsis
The term personality remains one of the most confused and
abstract ideas within psychiatry and psychology and there are frequent attempts
to discard the concept altogether. Yet each generation of academics and
practitioners seem to have to rediscover its significance in clinical practice
(Livesley 2001) and over the last decade there has been increasing interest in
the notion of personality disorder both in its own right (Rutter 1987; Clarkin
and Lenzenweger 1996) and as a problem that interferes with treatment of other
mental health problems. The result has been the development of multifaceted
treatments which have led to a guarded optimism (Higgitt and Fonagy 1992 b; Pilkonis et al. 1997) that
personality is changeable and treatable.
This manual has been developed within this positive climate.
Yet, despite the present zeitgeist, considerable problems remain in writing a
manual for the treatment of borderline personality disorder. The aim of a manual
is to help practitioners organize their thinking about a specific group of
patients and to advise them what they need to do to treat them effectively. But
even in short-term treatments lasting 12–16 sessions, no manual can cover all
the clinical events that may occur during treatment. This is all the more so
with this manual which is about a long-term treatment for patients with
personality disorder.
Manuals addressing long-term treatment are rare and cannot
provide adequate detail about every clinical situation. This manual is no
exception and you, the practitioner, will have to use discretion and ingenuity.
Content
- Epidemiological and etiological research on borderline personality disorder
- Therapy research and outcome
- Mentalization-based understanding of borderline personality disorder
- Current models of treatment for borderline personality disorder
- Treatment organization
- Transferable features of the MBT model
- Strategies of treatment
- Techniques of treatment
- Implementation pathway
Download PDF Overcoming Borderline Personality Disorder A Family Guide for Healing and Change by VALERIE PORR
Sinopsis
Borderline personality disorder is a scientific enigma that
pathbreaking neuroscientists are trying to decipher. Thus far, research on BPD
has revealed problems or irregularities in several important areas of
functioning, such as impulse control and mood regulation. However, understanding
the cause or etiology of BPD at the present time is like working on a complex
jigsaw puzzle that has pieces missing when you have never seen a picture of the
completed puzzle. Various scientific communities are engaged in research on
different areas of the brain, on chemicals in the brain called neurotransmitters, on the anatomical architecture of the
brain, and on how specific parts of the brain function and interact with each
other. Current research is exploring specific behaviors as well as the functions
and reactions of distinct areas of the brain. Researchers are piecing together
what seem to be snippets of data, finding some answers in research from other
disciplines such as neurology and addiction. As of now, we do not know precisely
how all these new findings fit together to explain this disorder, nor do we know
what destabilizes the person, what actually triggers the emotional dysregulation
that characterizes or actually drives BPD symptoms, what starts the cascade that
leads to the emotional outbursts or suicide attempts. What we are missing is a
clear overview, a theory to integrate all these diverse observations. How does
information about specific structures of the brain, functional abnormalities, or
neurotransmitter increases or decreases add up to explanations that can account
for BPD behaviors? How do we connect the dots to see how research in one area of
neuroscience fits into research in other areas? The scientific findings brought
together here will help you reframe BPD as a mental disorder with real, tangible
biological underpinnings rather than a “character flaw” or a matter of “bad”
personality.
Imagine a doctor who is trying to treat a person with a
“fever” in the year 1200. He would see a patient who was hot to the touch,
shaking with chills, possibly red in the face, sweating profusely, or very pale
with parched lips, perhaps afflicted with hives, spots, or pustules. The doctor
would diagnose the person as having a fever. Today we would describe the person
with much more refined terminology, as having an infection caused by strep,
staph, or other bacteria or viral in origin. The patient would then receive a
specific treatment.
BPD research is still in the Middle Ages, so to speak. If a
group of blindfolded scientists were on various ladders around an elephant and
were asked to describe only what they feel and smell directly in front of them,
each one would be sure that the part he is describing is the whole. Research on
BPD is in a similar place. It has been looking at facets of the disorder—such as
mood dysregulation, impulsivity, or addictive behaviors—rather than the disorder
as a whole. As a result, BPD is generally described by its symptoms in a
dimensional way. We do not know for sure how to effectively decrease or prevent
the situations that trigger the behaviors nor do we have a panacea drug to cure
BPD, as penicillin cures infection or chicken soup “cures” the common cold. What
we do have is burgeoning neurobiological research that is giving us new areas to
study, vital clues about the disorder, and new directions as to how to treat
it.
Changing the Brain Changes Behavior
Phineas Gage was a railroad worker who lived from 1823 to
1860. Gage was a responsible, reliable, well-liked, nondrinking, and considerate
family man. He was not aggressive, nor did he get into arguments or barroom
brawls. He was in charge of a work crew that blasted rocks to clear a path for
railroad tracks. They drilled holes in the rocks, pushed gunpowder and a fuse
into the hole, added sand, then pushed it all down with an iron tamping rod. One
day, Gage was somehow distracted and a terrible accident occurred. The fuse was
ignited while the tamping rod was still in place. The resulting explosion blew
the tamping rod out of the hole and into Gage’s skull, entering under his eye
socket and coming out through the area at the top of his skull above his eye—the
region called the prefrontal cortex (PFC).
Miraculously, Gage survived his injury. The hole in his head
managed to heal, yet he seemed to turn into a completely different person. His
personality changed so drastically that he became irresponsible, made very bad
decisions, could not get along with his crew or his family, was aggressive and
careless, fought with everyone, drank heavily, and eventually abandoned his
family. He died destitute and homeless.
Antonio Damasio, in his book Descartes’
Error, described the actual area where Phineas Gage’s skull was injured;
his prefrontal cortex had suffered devastating damage. This is of particular
interest to neuroscientists today because it documents a radical change in a
person’s personality and behavior that corresponds with damage to a specific
part of the brain, the prefrontal cortex. Long before we had functional magnetic
resonance imaging (fMRI) machines with which to observe how the brain functions,
Gage’s injury demonstrated the interconnection between the architecture, or neuroanatomy, of the brain, and actual behavior. Dr. Damasio
studies people with brain injuries and tumors, relating how the exact location
of a brain injury, tumor, or lesion affects a person’s behavior. It seems that
Phineas Gage developed many symptoms of BPD after his prefrontal cortex was
damaged; certainly he became impulsive and exhibited poor judgment.
Behavioral Aspects of BPD
You have no doubt seen a juggler in a circus or magic act
tossing five or six colored balls into the air in different combinations and
rhythms that constantly vary. Sometimes all the balls
are moving in a circle, sometimes two may be up in the air from the juggler’s
right hand while the others remain low in his left hand. Or, two are up and
three down, four up and one down. There does not seem to be a logical plan as to
how the juggler tosses these balls. You are always anticipating what he will do
next, ready for a surprise.
Now, imagine that each one of the colored balls the juggler
tosses into the air is a behavioral aspect of BPD caused by a neurobiological
system in dysregulation. Keep the image of the juggler in your mind as we
discuss how different neurobiological systems work, how they affect behavior,
and how they can help to explain BPD. This metaphor will help you understand the
mercurial behavior of people with BPD and how the nine symptoms of BPD in the
DSM-IV-TR can combine or morph into so many different variations, yet still meet
criteria for a single disorder.
Latest research findings on various neurobiological systems
explain some of the apparently irrational BPD behaviors from a neurobiological
and genetic point of view, minus guilt or blame. Have you ever noticed the
cacophony when an orchestra is tuning up before a performance? Like the
juggler’s balls, each section of the orchestra can be thought of as a
neurobiological system in dysregulation. When the orchestra is in tune you will
not hear an individual flute or an out-of-tune violin. When tuned up, each
section is in harmony with the others and you hear beautiful music. When the
brain is in tune, when moods are regulated, and sleep is not troubled, a person
will be in harmony and will function well in most situations. His behavior will
tend to be predictable and generally stable.
People with BPD have been found to have neurobiological
vulnerabilities that are likely genetic in origin yet are probably exasperated
or mitigated by environmental influences. Study your family members and try to
create your own family tree. You will probably find an impulsive uncle, an aunt
who suffered from depression, someone else who was painfully shy, a brother who
suffered with addictions, a distant cousin who was emotionally volatile and
another who was extremely sensitive. People who develop BPD seem to have lost at
the genetic lottery. They have inherited a combination of dysregulations that
have reached a critical mass of system dysregulations that seems to add up to
the disorder. If one were to inherit these traits separately, they could be
considered as assets—such as a very sensitive person who becomes an artist, an
impulsive person who is fun to be around, or a highly
successful business person who enjoys taking risks. But the combination of these
elements, the pileup, so to speak, in one person, can result in BPD. Sometimes
BPD affects more than one child in a family or both a parent and child in
family. BPD can be found in both biological and adopted children. In one family,
a mother may have BPD, as well as four out of five of her daughters. Studies
with twins have shown that BPD runs in families, and that 69% of the variance in
the likelihood of someone having BPD can be explained by inherited genetic
factors.
Content
- Loving Someone with Borderline Personality Disorder: The Family Experience
- The Science of Borderline Personality Disorder
- The Principles of Behavior Change
- Understanding Dialectical Behavior Therapy
- Understanding and Applying Validation
- Mindfulness
- Grieving and Radical Acceptance
- Dialectical Behavior Therapy Skills for Behavior Change: Interpersonal Relationships, Emotion Regulation, and Distress Tolerance
- Mentalization: Understanding Misunderstanding
Download PDF BORDERLINE PERSONALITY DISORDER A Clinical Guide SECOND EDITION by John G. Gunderson
Sinopsis
THE BORDERLINE PERSONALITY DISORDER (BPD) diagnosis entered the American Psychiatric Association’s DSM-III in 1980 (American Psychiatric Association 1980) and 12 years later, in 1992, was adapted for the World Health Organization’s ICD-10 (World Health Organization 1992). The growth in the recognition and use of this diagnosis during the period from 1975 to 1990 has been remarkable. It is easily the most widely and commonly used diagnosis for personality disorders in modern clinical practice (Loranger 1990; Loranger et a1. 1997). Individuals with BPD constitute about 2%–3% of the general population (Swartz et al. 1990; Zimmerman and Coryell 1989), about 25% of all inpatients, and about 15% of all outpatients (Koenigsberg et al. 1985; Widiger and Weissman 1991).
The origins of the borderline diagnosis, illustrated in Figure 1–1, are usually traced to the clinical observations of Adolph Stern (1938), a psychoanalyst in office practice, who recognized that a subgroup of his patients disregarded the usual boundaries of psychotherapy and did not fit into the existing classification system, a system concerned primarily with dividing psychoses from neuroses. A scholarly review of the work preceding Stern’s can be found in Mack (1975). The patient group became somewhat more widely recognized in the early 1950s as a result of several influential papers by Robert Knight (1953, 1954). He expanded the descriptor borderline from relating to only the border with neurosis to being equally relevant to the border with psychosis. Like Stern, he began by decrying the “wastebasket” diagnostic status for such patients. However, he added that failure to identify the unique needs of these patients was responsible for the troubling disagreements between staff members on inpatient units; he further stated that this failure led clinicians to ignore providing the structure such Use of the term borderline for atypical, clinically troubling cases staggered along in the periphery of psychiatric thinking without notable progress until developments in the late 1960s. At this point, the confluence of three independent investigations forced the questions about a borderline consciousness.
The first of these investigations came from Otto Kernberg (1967). Even as a relatively young man, Kernberg authoritatively added to the psychoanalytic perspective of the borderline construct. He defined borderline personality organization as one of three forms of personality organization, to be differentiated from sicker patients, who had psychotic personality organization, and healthier patients, who had neurotic personality organization (Figure 1–2). Borderline personality organization was characterized by failed or weak identity formation, primitive defenses (namely, splitting and projective identification), and reality testing that transiently lapsed under stress. Kernberg’s scheme was a conceptual advance within the psychoanalytic community by virtue of integrating object relations with ego psychology and the instincts and by virtue of giving a rationale and organization to a basic classification system. However, the effect of his scheme within the larger mental health community derived more from the optimistic therapeutic mandates that he gained from his way of understanding these patients than from the concept itself (see Kernberg 1968, 1975).
Content
- The Borderline Diagnosis
- Differential Diagnosis: Overlaps, Subtleties, and Treatment Implications
- Overview of Treatment
- Case Management: The Primary Clinician
- Levels of Care: Indications, Structure, Staffing
- Pharmacotherapy: Clinical Practices
- Pharmacotherapy: Selection of Medications
- Family Interventions and Therapies
- Group Therapy
- Individual Psychotherapies: Getting Started
- Cognitive-Behavioral Therapies: Dialectical Behavior Therapy and Cognitive Therapies
- Psychodynamic Psychotherapies
- Future Considerations
Download PDF Dialectical Behavior Therapy in Clinical Practice APPLICATIONS ACROSS DISORDERS AND SETTINGS by Linda A. Dimeff
Sinopsis
DBT is a cognitive-behavioral treatment originally developed by Marsha M. Linehan, PhD, as a treatment for chronically suicidal individuals, and first validated with suicidal women who met criteria for borderline personality disorder (BPD). Those with BPD represent 14–20% of inpatients (Widiger & Frances, 1989; Widiger & Weissman, 1991), include 8–11% of outpatients (Widiger & Frances, 1989; Kroll, Sines, & Martin, 1981; Modestin, Abrecht, Tschaggelar, & Hoffman, 1997), and consume a disproportionate amount of mental health resources, often up to 40%. Adequately addressing the needs of individuals with BPD poses several challenges. Individuals with BPD typically require therapy for multiple, complex, and severe Axis I problems, often in the context of unrelenting crises and management of high-risk suicidal behavior. With many of these clients, the sheer number of serious (at times life-threatening) problems that therapy must address makes it difficult to establish and maintain a treatment focus. Following the concern most pressing to the client can result in a different crisis management focus each week. Therapy can feel like a car veering out of control, barely averting disaster, with a sense of forward motion but no meaningful progress.
Treatment decisions are made yet more complicated because clients with chronic suicidal behavior and extreme emotional sensitivity often act in ways that distress their therapists. Suicide attempts, threats of suicide attempts, and anger directed at the therapistcan be very stressful. Regardless of their training and experience, therapists can struggle with their own emotional reactions when a client is recurrently suicidal and both rejects the help that the therapist offers and demands help that therapist cannot give. Even when the therapist is on the right track, progress can be slow and sporadic. All these factors increase the chance of therapeutic errors, including making premature changes to the treatment plan, and may contribute to the fact that those with BPD have high rates of treatment failure (Perry & Cooper, 1985; Tucker, Bauer, Wagner, Harlam, & Sher, 1987). Intense distress, treatment failure, and repeated suicidal behavior, in turn, contribute to the high use of psychiatric services by this population. Individuals who meet criteria for BPD typically have sought help repeatedly and from multiple sources; in one study, 97% of those seeking treatment had received prior outpatient treatment from a mean of 6.1 previous therapists and 72% had had at least one psychiatric hospitalization (Skodol, Buckley, & Charles, 1983; Perry, Herman, Vander Kolk, & Hoke, 1990; Bender et al., 2001). Legal and ethical concerns about suicide make it difficult to limit hospital use, even when “revolving door” use of involuntary inpatient facilities may itself inadvertently cause harm (i.e., be iatrogenic). The experience for individuals who meet criteria for BPD and their treatment providers has historically been a discouraging path of recurrent treatment failures despite their best efforts.
It was within this context that DBT evolved. As Linehan began to use standard clinical behavior therapy (Goldfried & Davison, 1976), she was led by the nature of her clients’ problems to balance and complement behavior therapy’s change orientation with other therapeutic strategies. Linehan’s careful observation of successes and failures resulted in treatment manuals (1993a, 1993b) that organize strategies into protocols and that structure therapy and clinical decision making so that therapists can respond flexibly to an ever-changing clinical picture. Although DBT shares elements with the psychodynamic, client-centered, gestalt, paradoxical, and strategic approaches to therapy (cf. Heard & Linehan, 1994), it is the application of behavioral science, mindfulness, and dialectical philosophy that are its defining features.
DBT has evolved into a sophisticated treatment, yet most of its concepts are quite straightforward. For example, DBT emphasizes an organized, systematic approach in which members of the treatment team share fundamental assumptions about therapy and clients. DBT considers suicidal behavior to be a form of maladaptive problem solving and uses well-researched cognitive-behavioral therapy (CBT) techniques to help clients solve life problems in more adaptive ways. DBT therapists take every opportunity to strengthen
clients’ valid responses, which alone and in combination with CBT interventions facilitate change (e.g., Linehan et al., 2002). Because difficult clinical problems naturally provoke strong differing opinions among treatment providers, and because DBT clients’ problems themselves include dichotomous, rigid thinking and behavioral and emotional extremes, dialectical philosophy and strategies offer a means of reconciling differences so that conflicts in therapy are met with movement rather than with impasse. Below we discuss each of these in turn as a way to lay out DBT in a nutshell.
Content
- Overview of Dialectical Behavior Therapy
- Adopt or Adapt?: Fidelity Matters
- Implementing Standard Dialectical Behavior Therapy in an Outpatient Setting
- Dialectical Behavior Therapy on Inpatient Units
- Implementing Dialectical Behavior Therapy in Residential Forensic Settings with Adults and Juveniles
- Dialectical Behavior Therapy for Individuals with Borderline Personality Disorder and Substance Dependence
- Dialectical Behavior Therapy and Eating Disorders
- Dialectical Behavior Therapy with Families
- Dialectical Behavior Therapy for Adolescents
- Dialectical Behavior Therapy for Depression with Comorbid Personality Disorder: An Extension of Standard Dialectical Behavior Therapy with a Special Emphasis on the Treatment of Older Adults
- Dialectical Behavior Therapy for Assertive Community Treatment Teams
- Evaluating Your Dialectical Behavior Therapy Program
Download PDF THE ESSENTIAL FAMILY GUIDE TO Borderline Personality Disorder New Tools and Techniques to Stop Walking on Eggshells by Randi Kreger
Sinopsis
Borderline personality disorder is a serious mental illness
that causes those who have it to see people and situations as all good or all
bad; to feel empty and without an identity; and to have extreme, blink-of-an-eye
mood swings. People with BPD act impulsively; their self-loathing and extreme
fear of abandonment can cause them to lash out at others with baseless criticism
and blame. Some practice self-harm or see no other option than suicide as a way
to end their pain.
People with borderline personality disorder experience the
world much differently than most people. For reasons we don’t entirely
understand, the disorder distorts critical thought processes, resulting in
emotions and actions that are out of the norm.
If we could look inside the heads of people with BPD to see
the way they think, we’d find out they live in a world
of extremes. To them, people and situations are all good or all bad, with
nothing in between. They don’t just admire or respect someone—they elevate that
person to an impossible standard and then knock him down when he inevitably
disappoints them. They see themselves this way, too, so that one small misstep
leads them to think, I am a worthless person.
If you could snap your fingers and, by magic, experience what
a BP feels, you would be overwhelmed by self-loathing, an intense fear of being
abandoned, and a relentless sense of emptiness. Irritability and depression
would be there, too, a steady drumbeat blocking out feelings of joy and even
simple satisfaction. “BPD is a cancer that eats away at my body, mind, and
soul,” says one woman with the illness.
It’s easy enough to observe how BPs act. Actions, unlike
thoughts and feelings, are obvious. They’re what make people with BPD so hard to
live with. BPs behave impulsively, not thinking things through. Some
deliberately hurt themselves—they make themselves bleed or they attempt suicide.
They may spend too much money, engage in dangerous sex, abuse drugs or alcohol,
drive recklessly, shoplift, or eat in a disordered way.
People with BPD repeatedly pull people toward them—often
desperately—and then brusquely shove them away through bitter criticism,
unappeasable rages, and fits of irrational blaming. They elevate people onto a
lofty pedestal and then push them off. Some BPs put people into no-win
situations and make absurd accusations.
Content
- Chapter 1: Welcome to Oz
- Chapter 2: Understanding Borderline Personality Disorder
- Chapter 3: Making Sense of Your Relationship
- Chapter 4: Risk Factors of BPD
- Chapter 5: Treating BPD
- Chapter 6: Finding Professional Help
- Chapter 7: Power Tool 1: Take Good Care of Yourself
- Chapter 8: Power Tool 2: Uncover What Keeps You Feeling Stuck
- Chapter 9: Power Tool 3: Communicate to Be Heard
- Chapter 10: Power Tool 4: Set Limits with Love
- Chapter 11: Power Tool 5: Reinforce the Right Behavior
Download PDF The Borderline Personality Disorder Survival Guide by Alexander L. Chapman
Sinopsis
People with borderline personality
disorder (BPD) struggle with their emotions, their behaviors, and their sense of
identity, as well as their relationships with other people. Because they are in
such emotional turmoil, they often resort to coping strategies that seem to work
in the moment but actually make their problems worse (such as suicide attempts,
self-harm, or drug use). Indeed, people with BPD sometimes careen through life
as if they’re driving a 350-horsepower car with no brakes. They often act on the
spur of the moment without thinking things through carefully. As a result, their
relationships and responsibilities may suffer. Emotionally, people with BPD are
like burn victims (Linehan 1993a), extremely sensitive to even the slightest
hint of an emotion and yet so afraid of their emotions that they seek to do
anything and everything they can to avoid them.
BPD has received an explosion of interest
lately, both from researchers and the popular media. Researchers are examining
what causes BPD, when and how people recover from BPD, the brain areas involved
in BPD, and the treatments that help people with BPD lead fulfilling and
satisfying lives. In the past couple of years alone, articles in both the New
York Times and O, the Oprah Magazine featured Dr. Marsha Linehan’s
groundbreaking work on dialectical behavior therapy for BPD (Linehan 1993a).
What’s more, popular movies, such as Girl, Interrupted, have featured characters
with BPD, and television shows, such as Beverly Hills 90210 and 7th Heaven, have
featured characters who injure themselves, a symptom that sometimes occurs in
BPD.
You might be asking yourself, “Why is BPD
such a hot topic now?” A better question is “What took so long?” People with BPD
experience intense emotional pain. They struggle with unrelenting chaos in their
relationships with other people; feelings of emptiness, aloneness, and
desperation; and a confused sense of who they are and where they are going in
life. Indeed, up to 10 percent of people with BPD commit suicide, a rate that is
over fifty times that of the general population (Skodol et al. 2002). Yet,
despite all of this, many people with BPD do not receive the support they
need.
BPD also influences the lives of family
members, friends, and caregivers. If a chemist were to concoct a potion that
would create stress, concern, and heartbreak among loved ones, this potion would
probably look a lot like BPD. It is heartbreaking and scary when someone you
love talks about or attempts suicide. Trying to help someone with BPD overcome
emotional turmoil is like being dropped into a fighter jet going full speed and
not knowing how or where to land it.
The powerful emotions and sensitivity of
people with BPD can be exciting and intense. People with BPD can be dramatic and
charismatic, and they are often quite caring and understanding. Nevertheless,
caring for someone with BPD is like trying to hold onto the sun: the emotional
intensity of a person with BPD can singe and char relationships. Further, people
with BPD often become swallowed by grief or sadness, leaving the caregiver or
family member in the dark about what to do.
Many people with BPD and their loved ones
do not know how to understand the difficulties they struggle with on a daily
basis, or where to turn for help. Although there is a smattering of information
available online, the Internet can be a confusing and treacherous place for
someone who is suffering, with misinformation and websites offering dangerous
advice (such as those that promote self-harm and eating-disordered behaviors)
lurking around every corner.
Where else can someone with BPD go to get
useful information? Two sources that contain a lot of information are treatment
manuals and research papers. However, these sources can be very difficult to use
and understand if you are not a therapist or a researcher, and especially if you
don’t have a therapist or someone with expertise to help you.
Download PDF Stop Walking On Eggshells Secon Edition by Paul T. Mason
Sinopsis
More than 400,000 copies—that’s how many
Stop Walking on Eggshells copies have been purchased
since it was published in 1998. At the rate it’s selling, the benchmark of half
a million copies is well within sight. Not only that, this book has been
translated into so many languages, I have trouble remembering which they
are.
When Paul Mason and I were writing this
book, we had to struggle to find information of use to family members. A few
people were talking about borderline personality disorder (BPD) on AOL and a
personality newsgroup. We found just two books for laypeople. Now, the Internet
is teeming with information, and you’d need an entire bookshelf to hold the
mainstream books about BPD—not to mention all the self-published books and
e-books by people who have struggled with this disorder from the inside or the
outside.
So what happened? Many things.
Researchers started to have the ability to scan the brain and actually see the
differences between the normal brain and the brains of people with BPD. New
medications followed, and research continues to reveal data that explain why
people with BPD think, feel, and act the way they do. Forward-thinking
clinicians developed novel approaches that started showing results. Advocates
started their own organizations and began pressuring for more visibility and
research dollars.
But that’s not all. Stop Walking on Eggshells, along with my website and my
Welcome to Oz online community, was a potent force in increasing awareness of
BPD. Readers went online and started to talk to each other on the Internet;
people with BPD and their families started websites and formed communities
because they had something to say and they didn’t feel heard in other arenas.
Formerly isolated, people started reaching out to each other. Between 1995 and
2008, my online Welcome to Oz family group grew from twelve members to sixteen
thousand.
The success of Stop
Walking on Eggshells (and later, the Stop Walking on
Eggshells Workbook) also showed publishers that books about BPD could succeed, hence the proliferation of titles. The
foreign editions started information flowing in other countries. In 2008, I
(Randi Kreger) gave a series of presentations to BPD family members in Tokyo on
the invitation of the Japanese publisher of Stop Walking on
Eggshells.
But not everything is rosy. Most
clinicians still lack essential knowledge—especially about how to assess and
treat children and adolescents with symptoms of BPD. Another problem is the
fundamental lack of understanding that borderline behavior can be expressed in a
multitude of ways that don’t necessarily get noticed by, or detected as, signs
of BPD by clinicians in the mental health system.
On a more personal level, just as the
world has moved on, so have my coauthor and I. A few years after this book was
first published, I wrote The Stop Walking on Eggshells
Workbook: Practical Strategies for Living with Someone Who Has Borderline
Personality Disorder. The workbook format allows for lots of examples and
description, and the interactive elements help readers understand themselves and
apply the information to their own lives.
In 2008, I came out with another major
book, The Essential Family Guide to Borderline Personality
Disorder: New Tools and Techniques to Stop Walking on Eggshells. It
contains a clear-cut system with five skill sets to help family members move
beyond blame and use concrete solutions to feel better, get unstuck, be heard,
and set limits with confidence. As you’ll see, I’ve sprinkled some items from
the book in this new edition; both books complement each other and offer
different perspectives. Family members need all the help they can
get!
Paul Mason, my coauthor, took a
different path. He is now the vice-president of clinical services at Wheaton
Franciscan Healthcare–All Saints in Racine, Wisconsin. In his role, Paul has
executive and administrative oversight of the Mental Health and Addiction Care
service line, which includes three inpatient programs and six outpatient clinics
serving the needs of adults, children, and families in southeast
Wisconsin.
His three children, who were just
entering grade school when this book first appeared in bookstores, are now ages
thirteen, seventeen, and eighteen. He continues to be happily married to Monica,
who, when not taking care of all of the family needs, maintains a small therapy
practice serving adults and couples in Racine.
We hope you’ll enjoy this new
edition.
Download PDF Sometimes I Act Crazy Living with Borderline Personality Disorder by Jerold J. Kreisman
Sinopsis
Borderline Personality Disorder (BPD), the most common personality disorder seen in clinical settings, is excruciatingly painful to live with both for the sufferer and those closest to him. Yet despite the prevalence of BPD, it may be the most misunderstood and underdiagnosed mental illness. This chapter provides a broad discussion of the disorder from biological, genetic, and environmental causes, to the most current DSM diagnostic criteria, to the various forms of psychotherapeutic and medical treatments. The obstacles to properly diagnosing BPD, such as its stigma within the mental health profession and the vagaries of insurance
coverage, also are examined. A “BPD Checklist” gives the reader a chance to detect BPD’s early warning signs in himself and others.
Content
- Borderline Basics
- Fears of Abandonment
- Unstable Interpersonal Relationships
- Identity Disturbance
- Destructive Impulsivity
- Suicidal Behaviors and Self-Mutilation
- Mood Instability
- Emptiness
- Anger
- Reality Distortions: Paranoia and Dissociation
- Treatment Strategies and Communication Techniques
- Prognosis and Directions of Future Research
Download PDF Understanding Your Borderline Personality Disorder A Workbook by Chris Healy
Sinopsis
Sufferers approach mental health workers for information regarding their diagnosis and psychiatrists ask mental health workers to educate clients about their diagnosis. But how does a busy mental health worker achieve this?
There is much information on the Internet, in books and leaflets, but it takes time to bring together and organise this information. Most mental health workers will admit to struggling with collating up-to-date information and structuring sessions for their clients.
They may have printed off some information from the Internet, educated clients from their experience of nursing those with mental illness or read academic literature on the subject and summarised their findings. As a result, most clients receive different levels of education regarding the understanding of their illness.
This was the problem that I encountered during my nursing career, whereby I was in need of a format regarding basic information for my clients, and also a framework to provide structured sessions which would aid me in educating sufferers regarding their illness. So a few years ago I put together Understanding Your Schizophrenia Illness: A Workbook and this was published by Wiley-Blackwell in 2007. I have found that information in a workbook format allows sufferers to be more involved in learning about their illness and by writing down their thoughts and feelings their understanding is enhanced. After I completed this first workbook I felt that there was a real need for sufferers of Borderline Personality tounderstandmore about their illness as this isamuchmisunderstoodcondition. Sufferers of Borderline Personality Disorder have difficulties in managing their emotions and behaviour which causes devastating results for those who have to try and live this condition and also those who care about them.
Over the past few years there has been increased awareness and research regarding this disorder which is helping to improve the treatment and understanding of Borderline Personality Disorder but at the same time it remains a controversial condition. Regrettably, some health professionals have a negative concept regarding this diagnosis due to the difficulties of managing the care of sufferers with this disorder; also many health professionals would admit to having limited knowledge regarding this disorder due to it being a complex condition; but if sufferers of Borderline Personality Disorder can be motivated to change life long behaviours and learn how to tolerate uncomfortable feelings during treatment there is hope for a better quality of life for them and their loved ones. Sufferers of Borderline Personality Disorder, their loved ones and health professionals need to believe that sufferers can make progress over time and lead happy peaceful lives; this workbook hopes to help towards achieving this.
Content
- What does personality mean?
- What is a personality disorder?
- What have people said about Borderline Personality Disorder?
- What is it like to suffer from Borderline Personality Disorder?
- Can you inherit Borderline Personality Disorder?
- Is it something to do with the brain?
- Does the environment in which you grew up cause you to develop Borderline Personality Disorder?
- What famous people suffer from Borderline Personality Disorder?
- What are the symptoms of Borderline Personality Disorder?
- What famous people have self harmed?
- What are talking therapies?
- What are creative arts therapies?
- What are the roles of professionals who treat me?
- What difficulties might I anticipate regarding a working relationship with my therapist?
- How can medication help with the symptoms of Borderline Personality Disorder?
- How can you work with your GP regarding your prescribed medication?
- What is the most commonly prescribed medication?
- Wheel of mood swings
- Wheel of psychosis
- Wheel of impulsive behaviours
- Wheel of emptiness and boredom
- Wheel of suicidal ideas
- Wheel of abandonment
- Wheel of relationships
- Wheel of self harming
- Wheel of anger
- Wheel of self identity
Download PDF Understanding and Treating Borderline Personality Disorder A Guide for Professionals and Families by John G. Gunderson
Sinopsis
Borderline personality disorder (BPD) is a complex and serious mental disorder. It is estimated to occur in 1%–2% of the general population (Torgersen et al. 2001) and is the most common personality disorder for which people receive treatment. Ten percent of all psychiatric outpatients and 15%–20% of inpatients are estimated to have BPD (Widiger and Frances 1989). BPD is characterized by severe impairment in functioning (Skodol et al. 2002a), extensive use of psychiatric treatments (Bender et al. 2001), and a mortality rate by suicide of almost 10%—50 times higher than the rate in the general population (Work Group on Borderline Personality Disorder 2001). Nevertheless, effective treatments for BPD exist, and the prognosis—even over as short an interval as 1–2 years—may be better than expected (Gunderson et al. 2003; Shea et al. 2002).
From the perspectives of both the public and the mental health professional, BPD can also be a confusing and poorly understood disorder. In this chapter I describe the historical evolution of the concept of borderline personality to its current status as a personality disorder on Axis II of the assessment system that is outlined in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) (American Psychiatric Association 2000). I also review the current diagnostic criteria for BPD, as well as other manifestations that many believe are characteristic of the “borderline” patient. The chapter concludes with a discussion of several of the controversies that have surrounded the diagnosis of borderline personality over the years and that persist to this day.
The borderline concept dates back more than 60 years. Borderline patients were first described by Stern (1938) and later by Knight (1953). Kernberg (1967) referred to the intrapsychic features of these patients as “borderline personality organization,” an intermediate level of internal personality organization more disturbed than that seen in a neurotic disorder but less disturbed than in a psychotic disorder. The notion that the disorder lay between the neurotic disorders and the psychotic disorders gave rise to the designation “borderline” in the first place. Borderline personality organization was characterized by an unstable sense of self (identity diffusion); use of primitive, immature defense mechanisms (categorizing others as “all good” or “all bad,” denial, projection, acting out); and temporary lapses in the ability to distinguish the real from the imagined (defective reality testing). The Kernberg concept of borderline personality includes a number of other severe personality disorders as defined in DSM-IV-TR—for example, the narcissistic, antisocial, and schizoid types—in addition to BPD, a fact that has contributed to some of the confusion about the term.
Content
- The Borderline Diagnosis: Concepts, Criteria, and Controversie
- Psychotherapies for Borderline Personality Disorder
- Suicidal and Self-Injurious Behavior in Borderline Personality Disorder: A Self-Regulation Model
- Pharmacotherapy in Borderline Personality Disorder
- The Longitudinal Course of Borderline Personality Disorder
- Living With Borderline Personality Disorder : Two Firsthand Accounts
- Family Perspectives on Borderline Personality Disorder
- From Family Trauma to Family Support System
- Family Involvement in Treatment
Download PDF Treatment Of Borderline Personality Disorder A Guide To Evidence Based Practice by Joel Paris
Sinopsis
A historical perspective helps in understanding the problems
of diagnosing BPD. Adolf Stern (1938), the psychoanalyst who first
described borderline personality, observed that these patients
became worse, not better, in therapy. He suggested this group was
unsuitable for analytic treatment because their pathology lay on a
“borderline” between neurosis and psychosis. Stern documented their
clinical features (“psychic bleeding,” inordinate hypersensitivity,
difficulties in both reality testing and relationships), and his description
is as relevant today as it was 70 years ago.
However, following Stern’s article, there was only sporadic
interest in borderline pathology over the next 30 years. Robert
Knight (1953) published a study that added little to what Stern had
said and had little impact beyond the psychoanalytic community. Three psychiatrists were responsible for reviving and
popularizing the concept of BPD. The first was Otto Kernberg (1970), a
psychoana- lyst who first worked at the Menninger Clinic and then at
Cornell University. Kernberg proposed that character pathology (or
what we now call personality disorder) has three levels: one milder
(close to “neurosis”), one moderate, and one severe (i.e., borderline).
However, there were two problems with his concept of “borderline
personality organization” (BPO). First, it was entirely psychoanalytical
in that it was defined on the basis of theories about mental mechanisms
rather than on observable behaviors. Second, BPO defined a very
broad group of patients with personality disorder as “borderline.”
The second pioneer was Roy Grinker (Grinker, Werble, &
Dyre, 1968), working at Michael Reese Hospital in Chicago. Grinker
pub- lished the first empirical study of borderline patients, which
gave more weight to clinical observation than to psychodynamic
speculation and subgrouped patients based on observable symptoms.
Grinker’s group also conducted the first systematic follow-up studies of
pa- tients with BPD (see Chapter 6). The third, and most influential, pioneer was John Gunderson
of McLean Hospital and Harvard Medical School. Gunderson and Making the Diagnosis 5 Singer’s (1975) article in the American
Journal of Psychiatry was a turning point for the acceptance of BPD. It showed that this
form of pathology could be operationalized with behavioral criteria
and that a semistructured interview yielded a reliable diagnosis. I have vivid memories of reading this report. Up to that
point, under the influence of my teachers, I had rejected the
validity of BPD. The concept seemed all too vague and wooly, and I actually
refused to let residents make the diagnosis. However, Gunderson and
Singer convinced me, and many others, that the construct was valid. The work of these pioneers influenced the definition of
BPD adopted by the Diagnostic and Statistical
Manual of Mental Disorders (third edition [DSM-III]; American
Psychiatric Association, 1980) 5 years later. The BPD diagnosis was included in DSM,
and personality disorders as a whole were given a separate axis.
As a re- sult, research took off. In 1987, the International Society
for the Study of Personality Disorders (ISSPD) was founded and has met
every 2 years ever since. (ISSPD also publishes the Journal of Personal- ity Disorders, now 20 years old.)
Because BPD is the most important clinical problem described on Axis II, most personality
disorder re- search has focused on this category.
However, there continues to be controversy about the best
way to classify the pathology that BPD describes. I discuss three
ways to do so. The first is the DSM system (American Psychiatric
Associa- tion, 1980, 1987, 1994, 2000), which lists nine criteria, of
which five must be present to make a diagnosis. The second is based on
four do- mains of pathology, each of which can be scored on a scale.
The third is a dimensional approach, in which BPD (as well as all other
personality disorders) are described by scores on measures of their
underlying traits.
Content
- Making the Diagnosis
- The Boundaries of BPD
- Personality and Development
- Risk Factors
- A General Model
- Outcome
- Pharmacotherapy
- Psychotherapy
- Guidelines for Management
- Therapeutic Interventions
- Problems in Therapy
- Suicidality and Hospitalization
- Research Directions
Download PDF Borderline Personality Disorder by Mary C. Zanarini
Sinopsis
Borderline personality disorder (BPD) enjoys the dual distinction of being one of the most written about and talked about conditions in contemporary psychiatry, and of being the only condition among the nearly 400 in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) (1) whose label provides no hint, no semantic handle, as to what sort of condition it is. One might argue that the seven eponymous syndromes of the DSM (Alzheimer’s, Asperger’s, Creutzfeld–Jakob’s, Huntington’s, Pick’s, Rett’s, and Gilles de la Tourette’s) require a bit of study before their nature is clarified, but all the others either stem from common English roots (gambling, binge-eating, sleep disorder) or are decipherable from their Greek or Latin origins (trichotillomania: pathological pulling of hair; insomnia: absence of sleep, etc.). Borderline, when used adjectivally, suggests something that is in close proximity to something else. Indeed, in its first uses in psychiatry, borderline designated either (a) a condition that approximated another, already well-established disorder, or (b) a condition that occupied a region in between two rather indistinctly boundaried levels of mental functioning. As we shall see, the borderline of our current BPD is derived from both these usages.
Content
- Borderline Personality Disorder: History of the Concept
- The Subsyndromal Phenomenology of Borderline Personality Disorder
- Environmental Factors in the Etiology of Borderline Personality Disorder
- A Temperament Model of Borderline Personality Disorder
- Neurobiology of Impulsive Aggression
- Biochemical Endophenotypes in Borderline Personality Disorder
- Genetics of Borderline Personality Disorder
- Comorbidity and Borderline Personality Disorder
- Psychosocial Functioning in BPD
- The Symptomatic Course of Borderline Personality Disorder
- Suicidality in Borderline Personality Disorder
- Psychodynamic Psychotherapy of Borderline Personality Disorder
- Dialectical Behavior Therapy for Borderline Personality Disorder
- Pharmacotherapy of Borderline Personality Disorder
- Family Interventions for Borderline Personality Disorder
- Day Hospital Treatment of Borderline Personality Disorder
- Structural and Functional Imaging of Patients with Borderline Personality Disorder
- Risk Factors for Suicidal Behavior in Borderline Personality Disorder: A Review and Update
Download PDF PSYCHIATRY THIRD EDITION Vol 1 by Alan Tasman
Sinopsis
It was Freud who raised the technique of psychiatric examination—listening—to an expert level unexplored in earlier eras. Binswanger (1963) said of the period prior to Freud: “psychiatric ‘auscultation’ and ‘percussion’ was performed as if through the patient’s shirt with so much of his essence remaining covered or muffl ed that layers of meaning remained unpeeled away or unexamined.” This metaphor and parallel to the cardiac examination is worth considering as we ask if listening will remain a central part of psychiatric examination. The explosion of biomedical knowledge has radically altered our evolving view and practice of the doctor–patient relationship. Physicians of an earlier generation were taught that the diagnosis is made at the bedside; that is, the history and physical examination are paramount. Laboratory and imaging examinations were seen as confi rmatory exercises. As our technologies have blossomed, the bedside and/or consultation room examinations have evolved into the method whereby the physician determines what tests to run, and the tests are often viewed as making the diagnosis. A cardiologist colleague expresses the opinion that, given the growing availability of noninvasive tests—echocardiograms, for example—he is not sure that this is a bad thing (Hillis 2001, personal communication). This alteration of the core doctor–patient relationship has been exacerbated by the advent of the electronic medical record. It is not unusual for the patient to carry on a conversation with his/her physician as the doctor scans a computer screen.
Content
- Listening to the Patient
- Physician–Patient Relationship
- The Psychiatric Interview: Settings and Techniques
- The Cultural Context of Clinical Assessment
- Professional Ethics and Boundaries
- Legal Issues in Psychiatric Practice
- A Psychiatric Perspective on Human Development
- Infant Development: The First 3 Years of Life
- Preschool Development
- School-Age Development
- Adolescent Development
- Adult Development
- Late Life
- A Brief History of Psychiatry
- Are there Biological Commonalities among Different Psychiatric Disorders ?
- Genetic Epidemiology and Molecular Genetics of Psychiatric Disorders
- Modeling Psychiatric Disorders in Experimental Animals
