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

1. The Borderline Diagnosis: Concepts, Criteria, and Controversie
2. Psychotherapies for Borderline Personality Disorder
3. Suicidal and Self-Injurious Behavior in Borderline Personality Disorder: A Self-Regulation Model
4. Pharmacotherapy in Borderline Personality Disorder
5. The Longitudinal Course of Borderline Personality Disorder
6. Living With Borderline Personality Disorder : Two Firsthand Accounts
7. Family Perspectives on Borderline Personality Disorder
8. From Family Trauma to Family Support System
9. Family Involvement in Treatment

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