Borderline Personality Disorder A Practical Guide to Treatment

by Krawitz, Roy; Watson, Christine

• ISBN13: 9780198520672
• ISBN10: 0198520670
• Format: Paperback
• Copyright: 2003-10-16
• Publisher: Oxford University Press

Summary

Borderline personality disorder is a multidimensional disorder best considered as severe personality dysfunction. Around 2% of the population are thought to meet the criteria for the disorder, with approximately 1 in 10,000 people experiencing the most severe difficulties. This group places a disproportionate burden on mental health services. Once seen as 'untreatable,' patients with borderline personality disorder are all too often mistreated and misdiagnosed, resulting in prolonged and unhelpful relationships with support services, and taxing patients and clinicians alike. Borderline Personality Disorder: Foundations of Treatment draws on the latest research and clinical experience to provide an accessible and practical summary of the options for clinical management and treatment. It provides hope and evidence that sufferers can be treated effectively and successfully. The book presents a pragmatic approach to care and should be read by all members of the mental health team including psychiatrists, clinical psychologists, counsellors, mental health nurses and social workers.

Table of Contents

Terminology	p. xi
Abbreviations	p. xii
Molly	p. xiii
Introduction	p. xv
Background to treatment
Origins of the label "borderline personality disorder"	p. 3
History of treatment	p. 4
Epidemiology	p. 4
Diagnosis	p. 6
Comorbidity	p. 9
Clinical boundaries	p. 11
Aetiology	p. 13
Prognosis	p. 15
Morbidity and mortality	p. 18
Morbidity	p. 18
Mortality	p. 18
Health resource usage	p. 19
Health resource use after effective treatment	p. 20
Different treatment models	p. 21
Psychodynamic and psychoanalytically informed psychotherapy	p. 21
Self psychology	p. 23
Relationship management	p. 24
Cognitive analytical therapy (CAT)	p. 24
Cognitive-behavioural therapies	p. 26
Dialectical behavior therapy (DBT)	p. 26
Commonalities between different models	p. 29
Multimodel approach	p. 30
An organizing clinical framework for mental health clinicians	p. 31
Outcome studies	p. 34
Psychosocial treatments	p. 34
Pharmacological treatments	p. 40
Serotonergic agents	p. 41
Neuroleptic agents	p. 42
Anticonvulsants	p. 42
Older agents (tricyclic antidepressants, older MAOIs)	p. 42
Other agents	p. 43
Prescribing in the acute situation	p. 44
In summary	p. 44
Treatment issues and clinical pathways
Introduction	p. 49
Assessment	p. 49
Risk assessment	p. 54
Differentiating acute and chronic suicidal and self-harm patterns	p. 54
Crisis assessment	p. 56
Interventions	p. 58
Client-clinician relationship	p. 58
Team/system culture	p. 58
Clinical plan	p. 59
Duration of treatment	p. 69
Prioritizing interventions	p. 69
Empathy and validation	p. 71
Containment/holding	p. 72
Transitional people and items	p. 73
Self-harm	p. 74
Contracts	p. 80
Crisis work	p. 81
Regression at times of crisis	p. 83
Some anti-suicide interventions	p. 84
Acute inpatient services	p. 85
Client-controlled brief acute admissions	p. 91
Pragmatic conceptual frameworks guiding treatment	p. 94
Cognitive behavioural strategies	p. 101
Behaviour chain and solution analysis	p. 107
Teams	p. 112
Team structure	p. 112
Investing value and status in the key clinician role	p. 114
Specialist teams	p. 115
Systems	p. 116
Responsiveness of the organization to clinician needs	p. 116
Staff differences	p. 118
Residential treatment	p. 123
Relatives and friends	p. 125
Principles of effective treatment	p. 127
In summary	p. 128
Stigma, language, clinician feelings, and resourcing
Stigma and discrimination	p. 133
Language--negative terminology	p. 134
Clinician values and feelings	p. 135
Resourcing	p. 137
In summary	p. 138
The legal environment
Medicolegal framework	p. 141
Duty of care and institutional responsibilities	p. 142
Professionally indicated risk-taking	p. 145
Clinical appropriateness of the use of mental health legislation	p. 158
In summary	p. 159
Maintaining enthusiasm
Limit-setting	p. 163
Preventing clinician burn-out	p. 165
Supervision	p. 170
Words of hope from clients	p. 171
In summary	p. 173
References
Guided reading	p. 175
References	p. 183
Index	p. 197
Table of Contents provided by Ingram. All Rights Reserved.