Borderline Personality Disorder: A Practical Guide to Treatment

✍ Scribed by Roy Krawitz, Christine Watson

• Year: 2003
• Tongue: English
• Leaves: 218
• Edition: 1
• Category: Library

✦ Synopsis

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

Contents......Page 8
Terminology......Page 12
Abbreviations......Page 13
‘‘Molly’’......Page 14
Introduction......Page 16
Part 1 Background to treatment......Page 18
Origins of the label ‘‘borderline personality disorder’’......Page 20
Epidemiology......Page 21
Diagnosis......Page 23
Comorbidity......Page 26
Clinical boundaries......Page 28
Aetiology......Page 30
Prognosis......Page 32
Mortality......Page 35
Health resource usage......Page 36
Health resource use after effective treatment......Page 37
Psychodynamic and psychoanalytically informed psychotherapy......Page 38
Self psychology......Page 40
Cognitive analytical therapy (CAT)......Page 41
Cognitive-behavioural therapies......Page 43
Commonalities between different models......Page 46
Multimodel approach......Page 47
An organizing clinical framework for mental health clinicians......Page 48
Psychosocial treatments......Page 51
Pharmacological treatments......Page 57
Serotonergic agents......Page 58
Older agents (tricyclic antidepressants, older MAOIs)......Page 59
Other agents......Page 60
In summary......Page 61
Part 2 Treatment issues and clinical pathways......Page 64
Assessment......Page 66
Risk assessment......Page 71
Team/system culture......Page 75
Clinical plan......Page 76
Prioritizing interventions......Page 86
Empathy and validation......Page 88
Containment/holding......Page 89
Transitional people and items......Page 90
Self-harm......Page 91
Contracts......Page 97
Crisis work......Page 98
Regression at times of crisis......Page 100
Some anti-suicide interventions......Page 101
Acute inpatient services......Page 102
Client-controlled brief acute admissions......Page 108
Pragmatic conceptual frameworks guiding treatment......Page 111
Cognitive behavioural strategies......Page 118
Behaviour chain and solution analysis......Page 124
Team structure......Page 129
Investing value and status in the key clinician role......Page 131
Specialist teams......Page 132
Responsiveness of the organization to clinician needs......Page 133
Staff differences......Page 135
Residential treatment......Page 140
Relatives and friends......Page 142
Principles of effective treatment......Page 144
In summary......Page 155
Part 3 Stigma, language, clinician feelings, and resourcing......Page 148
Stigma and discrimination......Page 150
Language – negative terminology......Page 151
Clinician values and feelings......Page 152
Resourcing......Page 154
Part 4 The legal environment......Page 156
Medicolegal framework......Page 158
Duty of care and institutional responsibilities......Page 159
Professionally indicated risk-taking......Page 162
Clinical appropriateness of the use of mental health legislation......Page 175
In summary......Page 176
Part 5 Maintaining enthusiasm......Page 178
Limit-setting......Page 180
Preventing clinician burn-out......Page 182
Supervision......Page 187
Words of hope from clients......Page 188
In summary......Page 190
Guided reading......Page 192
References......Page 200
C......Page 214
F......Page 215
O......Page 216
S......Page 217
Y......Page 218