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

1. The Borderline Diagnosis
2. Differential Diagnosis: Overlaps, Subtleties, and Treatment Implications
3. Overview of Treatment
4. Case Management: The Primary Clinician
5. Levels of Care: Indications, Structure, Staffing
6. Pharmacotherapy: Clinical Practices
7. Pharmacotherapy: Selection of Medications
8. Family Interventions and Therapies
9. Group Therapy
10. Individual Psychotherapies: Getting Started
11. Cognitive-Behavioral Therapies: Dialectical Behavior Therapy and Cognitive Therapies
12. Psychodynamic Psychotherapies
13. Future Considerations

Click here to download