The most common personality disorder here and abroad, borderline personality disorder is often misdiagnosed or underdiagnosed. Left untreated, it causes marked distress and impairment in social, occupational, and role functioning, with high rates of self-destructive behavior (attempted and completed suicide). Its pervasive pattern of impulsivity and instability of interpersonal relationships, affects, and self-image begins in early adulthood and presents in a variety of contexts. Developed primarily by psychiatrists in active clinical practice, the revised edition of this popular work offers an updated synthesis of current scientific knowledge and rational clinical practice for patients with borderline personality disorder -- with the important caveat that clinicians should consider, but not limit themselves to, the treatments recommended here. The summary of treatment recommendations is keyed according to the level of confidence with which each recommendation is made and coded to show the nature of its supporting evidence. Highly informative and easy to use, this eminently practical volume is organized into three major parts: Part A contains treatment recommendations (Section I, treatment summaries; Section II, treatment plans; Section III, special clinical considerations; and Section IV, risk management issues during treatment), Part B presents the evidence underlying these treatment recommendations (Section V, an overview of DSM-IV-TR criteria, prevalence rates, and natural history and course; and Section VI, a review of existing treatment literature), and Part C summarizes those areas in which better research data are needed. Remarkably concise and comprehensive, this practice guideline continues to be an indispensable reference for every clinician who treats patients with this heterogeneous and complex disorder.
Guide to using this Practice Guideline. Introduction. Development process. Part A: Treatment Recommendations for Patients with Borderline Personality Disorder. Executive Summary of Recommendations. Coding systems. General considerations. Summary of recommendations. Formulation and Implementation of a Treatment Plan. The initial assessment. Principles of psychiatric management. Principles of treatment selection. Specific treatment strategies for the clinical features of borderline personality disorder. Special Features Influencing Treatment. Comorbidity. Problematic substance use. Violent behavior and antisocial traits. Chronic self-destructive behavior. Childhood trauma and PTSD. Dissociative features. Psychosocial stressors. Gender. Cultural factors. Age. Risk Management Issues. General considerations. Suicide. Anger, impulsivity, and violence. Boundary violations. Part B: Background Information and Review of Available Evidence. Disease Definition, Epidemiology, and Natural History. Definition and core clinical features. Assessment. Differential diagnosis. Epidemiology. Natural history and course. Review and Synthesis of Available Evidence. Issues in interpreting the literature. Review of psychotherapy and other psychosocial treatments. Review of pharmacotherapy and other somatic treatments. Part C: Future Research Needs. Psychotherapy. Pharmacotherapy and other somatic treatments. Appendixes: Psychopharmacological treatment algorithms. Individuals and organizations that submitted comments. References.
