Borderline Personality Disorder

This page is dedicated to understanding and treating the borderline patient… and to help myself and my coworkers in working with the borderline. The page, borderline, is more detailed treatment and realizes some of the ambitions stated below

My background includes (1) a number of years of work in an environment that includes moderate to severe cases of the disorder, (2) some study of the nature of the borderline, of the difficulties of treatment, of treatments, and (3) an interest in improving my work environment, and (4) an interest in well being and in mind – see the Journey In Being™ website

CONTENTS

Initial Approach. 1

Goals. 1

Some resources. 1

Summary. 2

Initial Approach

Instead of doing a huge amount of research (the literature is extensive, the need is immediate) before publishing, I thought I would begin small; we will learn as we go along. Initially, I will:

§ State what seems to me to be ‘the’ problem in simple terms

§ Publish some few resources

§ Invite comment; contact me at the email link above

Goals

The long range goals are therapeutic and management of resources

The therapeutic concern is obvious; however, treatment of the borderline is difficult. A first reason for the difficulty is the therapy defeating nature of the disorder. A second reason is the difficulty faced by the therapeutic community or milieu; these difficulties include the problems of empathy and reaction (too much or too little,) splitting, burn-out, and the especial need in the case of the borderline for careful treatment planning and general and micro resource management

The resource management concern is that the borderline tends to consume a disproportionate amount of resources – on a small scale in terms of the amount of attention required and in the long term in terms of the enormously disproportionate resources required by the borderline. The question of resources highlights one of the problems of the institutional context of treatment: the gap between the decision makers (including the community) and the executors (the institution)

Some resources

At a recent HCMH seminar on ‘best practices’ (treatments) the speaker discussed ‘Dialectical Behavior Therapy’ (DBT – a form of cognitive behavioral therapy) associated with Marsha Linehan (University of Washington.) This therapeutic modality is currently one of the most publicized treatments with a fair degree of proven success; Sharon Crockett has incorporated some elements of DBT in setting up our treatment of bpd clients. A key aspect of DBT is its dual (dialectical) focus on acceptance (with which the bpd client has great difficulty) and change. A useful aspect of DBT is that it addresses the difficulties of patient and staff –client and therapist– in the treatment of bpd patients

Here is a link to Marsha Linehan’s site and some further resources (consider usual comments about reliability of Internet information to have been made)

§ Marsha M. Linehan’s UW site: http://faculty.washington.edu/linehan/

§ For DBT based consultation and training see: Behavioral Tech, LLC

§ Borderline Personality Disorder: Pathways to Effective Service Delivery and Clinical Treatment Options, Roy Krawitz with Christine Watson. Discusses integrated in / outpatient options. Has good argument to the effect that the best outcome results from community placement with brief hospitalization when absolutely necessary due to suicidal behavior. Assesses risk of suicide, clinical need to take risk; addresses litigation concerns and safeguards

§ BPD World: http://www.bpdworld.org/bpd.php (discusses medication; therapies – psychodynamic, cognitive behavioral, cognitive analytic, DBT, schema; electroconvulsive therapy; many alternative therapies)

§ Research on Psychoanalytic Treatment

§ DSM V conference on Dimensional Models of Personality Disorders: Etiology, Pathology, Phenomenology, and Treatment

§ NIMH site on the borderline personality disorder

§ Search Google or other Sites for ‘Borderline Personality Disorder’ and related searches

§ Borderline (by me)

Summary

This is a beginning; I’ve been thinking of doing this for some time but was motivated to do something by our recent trials with borderlines. I will add to the resources soon but even the extremely short list shows that there are many options to consider. I will continue to reflect on the topic in a more detailed treatment