Borderline Personality Disorder Comprehensive Management in Ordinary Clinical

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Borderline Personality Disorder: Comprehensive Management in Ordinary Clinical Practice Michael H Stone, MD Professor of Clinical Psychiatry Columbia College of Physicians & Surgeons

Borderline Domains

BPD: More a Syndrome than a True Personality Disorder

Common Symptom Disorders that may Accompany BPD

Some Less Common Symptoms Disorders in BPD Patients

Neuroscience Looks at BPD

Mary Zanarini’s Comments on the Essential Nature of BPD Psychopathology BPD

Management Issues

Common Personality Configurations that may Accompany BPD

Therapists Need to Take into Account the Total “Profile” of Personality Traits

Good vs Bad Prognosis, as judged by the array of other traits The BPD patient who showed the profile of traits in the first diagram (red lines) was predominantly histrionic, masochistic, avoidant, depressive, and narcissistic. This is a much more favorable situation, prognostically, than the profile of the second BPD patient (green lines), who was predominantly narcissistic, antisocial, paranoid, passiveaggressive, and hypomanic. Such a patient would be less amenable to any of the treatment approaches now in common usage, whereas the first might do well with any of a variety of approaches.

Demographic & Background Factors

No Two BPD Patients are Entirely Alike Background Factors Traits Other X Symptoms X Pers.

Optimal Management Depends on the Mixture Relevant to each Patient CURRENTLY WIDELY USED TREATMENT METHODS Transference Focused Psychotherapy [TFP] Dialectic Behavior Therapy [DBT] Cognitive-Behavioral Therapy [CBT] Mentalization-Based Therapy [MBT] Schema-Based Therapy [SBT] Supportive Psychotherapy [SPT]