Borderline Personality Disorder

The diagnostic features of BPD are outlined in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) also known as DSM-IV. According to DSM-IV the essential feature of BPD is a pattern of difficulty in maintaining interpersonal relationships, self-concept and affects, and marked impulsivity. Norcross (1995) describes BPD as "the most angst-producing and recalcitrant of personality disorders," one that produces "feelings of bewilderment, inadequacy, and downright fear in practicing psychologists" (p. 428, p. 426). Arntz (1994) cites Beck et al.'s identification of three characteristic assumptions of borderline patients: fear and mistrust of others, feelings of powerlessness and vulnerability, and negative self-image (p. 421). Norcross (1995) cites Layden et al.'s hypothesis of three subtypes of BPD: "borderline-avoidant/dependent; borderline-histrionic/narcissistic; and borderline-antisocial/paranoid" (p. 428).

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e first year of treatment and include instruction in: "core mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance skills" (Norcross, 1995, p. 427). The difficulty in treating BPD patients has been known to create enormous stress in therapists, thus any comprehensive treatment program must acknowledge the needs of the therapist as well as the patient. Linehan's approach is to provide case consultation for therapists: "DBT providers are required to attend case consultation meetings held weekly with an experienced supervisor or (Linehan's preference) with a group of therapists" (Norcross, 1995, p. 426). Dublin (1992) relates her experience in the treatment of a severe borderline patient using the application of concepts from theories of self psychology and intersubjectivity. The case study involved a patient who had experienced an emotionally deprived childhood and whose current financial situation precluded care in the private sector: "She was typical of the highly challenging patients who are seen in community mental health clinics, where scarce resources dictate that they will be seen at most once a week" (Dublin, 1992, p. 289). Dublin (1992) found that a breakthrough in treatment did no
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Approximate Word count = 2471
Approximate Pages = 10 (250 words per page)

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