Front Matter
Copyright
About the Author
Acknowledgments
Preface
Contents
Introduction
The Purpose of this Book
How this Book is Organized
Part I: Definitions
Chapter 1: Making the Diagnosis
A Brief History of the BPD Diagnosis
BPD in the DSM System
BPD in DSM-III and DSM-IV
DSM-5's Section II Definition of BPD
Trait Domains Underlying BPD and their Implications
Emotional Dysregulation (Affective lnstability)
lmpulsivity
Interpersonal Sensitivity
Cognitive Dysfunction
How Traits Interact to Produce Disorders
Diagnostic Measures
Case Example 1: Wilma (Typical BPD)
Case Example 2: Samantha (Typical BPD)
Case Example 3: Sarah (Typical BPD)
Case Example 4: Melissa (BPD According to DSM but not to DIB-R)
Case Example 5: Nathalie (Lifetime but Not Current BPD)
Case Example 6: Maureen (Personality Disorder but Not BPD)
BPD in Practice and in the Community
Case Example 7: Steven
Why Making a BPD Diagnosis is Important
Sources of Resistance to Diagnosing BPD
Clinical Implications
Chapter 2: Dimensional Models
BPD in DSM-5's Section III
The ICD-11 Model of Personality Disorders
Dimensions Versus Categories in BPD
Dimensional Diagnosis for all Mental Disorders?
Some Conclusions About Dimensional Models
Clinical Implications
Chapter 3: Boundaries with Other Mental Disorders
Why BPD Remains Controversial
Comorbidity and Co-Occurrence
BPD and Psychosis
Case Example 1 : Bill
Case Example 2: Wendy
Case Example 3: ]une
Case Example 4
BPD and Depression
Case Example 5: Susan
BPD and the Bipolar Spectrum
Case Example 6: Lisa
Case Example 7: Mona
Case Example 8: Helen
BPD and PTSD
Case Example 9: Lily
Case Example 10: Meredith
BPD and ADHD
BPD and Other Personality Disorders
Case Example 11: David
Case Example 12: George
When Comorbidity is Clinically Important
Case Example 13: Caroline
Case Example 14: Betty
Clinical Implications
Part II: Causes
Chapter 4: BPD across the Life Cycle
Childhood Precursors of BPD
Internalizing and Externalizing Features
Borderline Pathology of Childhood
Case Example 1: Rory
Why Adolescence is Crucial for Psychopathology
Misconceptions About BPD in Adolescence
Adolescent and Adult Symptoms of BPD
Case Example 2: Dora
Treating BPD in Adolescence
Late-Onset BPD
Case Example 3: Joan
Case Example 4: Lalith
Clinical Implications
Chapter 5: Risk Factors
Lessons from Behavioral Genetics
The Nature of Genetic Influence in BPD
Neurobiological Correlates of BPD
Neurotransmitters
Brain lmaging
Neuropsychological Testing
Neural Connectivity
Psychological Theories of BPD
Retrospective Studies
Prospective Studies
High-Risk Studies
Parenting, Emotional Neglect, and BPD
Child Abuse and Trauma
The Ubiquity of Resilience
Social Factors
BPD: A Socially Sensitive Disorder
Clinical Implications
Chapter 6: A General Model
The Biological-Psychological Interface
The Biological-Social Interface
The Psychological-Social Interface
A Multidimensional View of BPD
Implications of the Model for Treatment
Clinical Implications
Part III: Treatment
Chapter 7: Outcome
Early Studies
Outcome Studies from the 1980's
Predictors of Outcome
Long-Term Outcome and Suicide
Prospective Studies of BPD Outcome
Mechanism of Recovery
Treatment and Recovery
Clinical Implications
Chapter 8: Psychopharmacology
Are Drugs Always Necessary in the Treatment of BPD?
Antipsychotics
Selective Serotonin Reuptake lnhibitors
Mood Stabilizers
Other Options
Polypharmacy
Clinical Implications
Chapter 9: Psychotherapy
Dialectical Behavior Therapy
Other Forms of Cognitive Therapy and CBT
Mentalization-Based Therapy
Psychodynamic Therapies
General Psychiatric Management
Other Therapies
Psychotherapy for Adolescents with BPD
Group Therapy and Psychoeducation
Integrative Psychotherapy and Common Factors in the Therapy of BPD
Clinical Implications
Chapter 10: Brief Treatment and Stepped Care
Access to Treatment and Public Health
Brief and Long-Term Psychotherapies
Costing Psychotherapy
How Psychotherapy Became Lengthy
Stepped Care in Medicine and Psychiatry
Stepped Care in BPD
Origins of a Stepped-Care Program
Results of the Stepped-Care Program
Clinical Implications
Chapter 11: Guidelines for Management
Psychotherapy: What to Do and What Not to Do
"Getting a Life"
Work and Relationships
Easy Cases
Case Example 1: Brenda
Case Example 2: Cathy
Case Example 3: Fiona
Middling Cases
Case Example 4: Chloe
Case Example 5: Oriana
Case Example 6: Laura
Hard Cases
Case Example 7: Rachel
Case Example 8: Mary
Case Example 9: Norma
Case Example 10: Doris
Brief Interventions and Extended Care
Case Example 11: Paula
Clinical Implications
Chapter 12: Stigma and Families
Stigma and BPD
Psychoeducation for Patients with BPD
Psychoeducation for the Families of Patients with BPD
Clinical Implications
Chapter 13: Therapeutic Interventions
The General and the Specific
How to Talk to a Patient with BPD
Building an Alliance
Case Example 1: Marilyn
Case Example 2: Nora
Targeting the Core Dimensions of BPD
Case Example 3: Patricia
Case Example 4: Rachel
Case Example 5: Soraya
Case Example 6: Vanessa
Case Example 7: Chloe
Work and Relationships
Case Example 8: Zara
Case Example 9: Rita
Case Example 10: Abigail
Case Example 11 : Barbara
Group and Individual Therapy
Case Example 12: Tania
Clinical Implications
Chapter 14: Problems in Therapy
Frequency of Sessions
Case Example 1: Frances
Attendance
Telephone Calls
Case Example 2: Cora
Therapist-Patient Boundaries
Case Example 3: Ellen
Sharing the BPD Diagnosis with Patients
Case Example 4: Gloria
Involving the Family
Case Example 5: Leila
Case Example 6: Olivia
Split Treatments
Case Example 7: Tara
Length of Therapy
Intermittent Therapy for BPD
Case Example 8: Greta
Termination Issues
Case Example 9: Melanie
Case Example 10: Kate
Case Example 11: Anne
Clinical Implications
Chapter 15: Suicidality and Hospitalization
Suicidal Thoughts
Case Example 1: Tania
Self-Harm
Case Example 2: Helen
Suicide Attempts
Case Example 3: Brigitte
Case Example 4: Elaine
Death by Suicide
Case Example 5: Florence
Case Example 6: Harold
Chronic Suicidality
Case Example 7: Moira
Managing Chronic Suicidality
"Will I Be Sued?"
Hospitalization
Case Example 8: Yael
Clinical Implications
Chapter 16: Research Directions
Resolving Issues of Diagnosis and Boundaries
Etiology
Treatment
References
Index