This is a masterly contemporary clinical, empirical and theoretical overview of borderline personality disorder (BPD). The author was considerably involved in the differentiation and professional recognition of the condition more than 20 years ago.
Whatever your branch of adult or adolescent psychiatry, a significant percentage of your out— and in-patients will suffer from an underlying BPD. You will find ample information in this book to aid you in recognising the coexistence of a BPD in Axis I patients as well as those presenting with such problems as somatic complaints, eating disorders, depression, overdoses, substance misuse, trauma and self-mutilating behaviour.
The classification can be misused and this is well discussed. (Misuse can include under— and overdiagnosis.) Making an accurate diagnosis is really important because these patients suffer over a very long time, as do those professionals and family members who encounter them. Most importantly, there is increasing evidence (which is well-marshalled in this book) that, when an appropriate range of therapies are well coordinated and structured by specialist teams, a considerable reduction in disturbance can be achieved. Longerterm treatment with appropriately trained professionals leads to an increasing capacity to contain impulses, feelings and affects, with consequent improvement in social functioning. Without coordinated and skilled therapies the likelihood is that there will be a continuation of costly destructive and self-destructive behaviour and impoverished lives. Although the author is American, he is clearly well acquainted with important recent British contributions to understanding and treating BPD and groundbreaking research into the clinical effectiveness of such treatments.
This is a very readable book. It is scholarly, up to date and full of clinical wisdom (and vignettes). It is written from a broad empirical basis and therefore the place of medication, partial hospitalisation, family, group, cognitive and psychodynamic approaches are well covered and integrated. I would therefore recommend it to clinicians of all disciplines. A particularly useful section lists other relevant books, films, videos, newsletters and websites.
Familiarity with the book could be of considerable assistance in developing clinical governance recommendations and for audit projects and personal development plans. I hope that it might come to the attention of commissioning agencies who may be able to play an important part in guaranteeing that adult mental health services are appropriately organised to provide adequate services and skills to meet the treatment needs of patients with BPD.
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