Borderline Personality Disorder: A Challenge for Mental Health Services

Abstract

The study firmly supported BPD as a valid diagnosis. Its treatment within the state mental health system was generally haphazard and ineffective. Post-discharge plans were implemented for only 3 subjects. Current moves toward community psychiatric treatment represent a unique opportunity for improving treatment of BPD by using existing resources more effectively.

Treatment Utilization by Patients With Personality Disorders

“…The patients with borderline personality disorder used virtually every mode of psychosocial treatment more often and in greater amounts than the other groups. This finding is consistent with earlier reports of more frequent psychiatric hospitalizations and extensive, but sometimes erratic, use of outpatient mental health services (24)(25)(26)37). The nature, severity, and varying phenomenology of the borderline personality disorder diagnosis continue to pose significant challenges to treating clinicians.…”

“…Several studies (20,(24)(25)(26) have examined treatment history patterns of patients with borderline personality disorder, and they have shown more frequent psychiatric hospitalizations, greater use of outpatient psychotherapy, more visits to emergency rooms, and worse implementation of treatment plans by hospital and clinic staff, as compared to groups with other personality disorders or axis I diagnoses.…”

The empirical basis of dialectical behavior therapy: Summary, critique, and implications.

“…In addition to level of training and supervision, level of therapist motivation may have contributed to outcome. The researchers in these studies were often also the therapists, and being part of a team establishing a new approach may have resulted, as first suggested by Hoffman (1993), in a particularly motivated group of therapists in an area where discouragement, even “therapeutic nihilism” and related “haphazard and ineffective treatment” (Clarke, Hafner, & Holme, 1995), is frequently observed. Linehan and Heard (1993) do make the counterargument that if being part of a research study explains outcome, positive results should also have been seen for the subjects receiving only the group skills component of DBT.…”

“…To their suggestions might be added a dismantling approach in which DBT influenced supervision/consultation for therapists is added to “treatment as usual” therapy. The strains therapists face in their relationships with BPD clients are frequently acknowledged (e.g., Clarke et al, 1995) and may challenge the development or maintenance of the supportive therapeutic relationship known to be of importance to general treatment outcome (Bergin & Garfield, 1994). The DBT process finding of increases in warm feelings in the therapeutic relationship being related to short‐term decreases in parasuicidal behavior further supports the importance of the therapeutic relationship.…”

2 Die Borderline-Persönlichkeitsstörung

“…Auch Barley et al (1986) und Bender et al (2006) (Clarke et al 1995, Jerschke at al. 1998 wobei die durchschnittliche Liegezeit 70 bzw.…”