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Chapter 4 - The Inpatient with Borderline Personality Disorder

Published online by Cambridge University Press:  05 March 2020

By
Victor Hong  and
Michael I. Casher
Edited by
Michael I. Casher  and
Joshua D. Bess
Michael I. Casher
Affiliation:
University of Michigan
Joshua D. Bess
Affiliation:
University of Michigan
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Summary

Patients with the diagnosis of borderline personality disorder (BPD) utilize a disproportionate percentage of mental health services in the USA, representing 12% of all visits to psychiatric emergency departments and 15–18% of psychiatric inpatients [1]. Examples and characteristics of this disorder are often included in psychiatric writings on “the difficult patient.” (A classic example of this is the Groves paper “Taking Care of the Hateful Patient” [2].) BPD patients can stir up extreme feelings in providers because of their dangerous behaviors, unstable emotions, interpersonal hypersensitivity, and intense likes and dislikes. One psychiatrist had this to say about his work with borderline patients.

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Manual of Inpatient Psychiatry , pp. 82 - 105
Publisher: Cambridge University Press
Print publication year: 2020

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References

Gunderson, J, Links, P. Borderline personality disorder: a clinical guide. American Psychiatric Publishing, Inc.; 2008.Google Scholar
Groves, JE. Taking care of the hateful patient. The New England Journal of Medicine 1978;298(16):883–7.CrossRefGoogle ScholarPubMed
Gimbel, B. Personal communication. Ann Arbor, MI; 2008.Google Scholar
Gabbard, GO. An overview of countertransference with borderline patients. Journal of Psychotherapy Practice and Research 1993;2(1):7–18.Google Scholar
Deans, C, Meocevic, E. Attitudes of registered psychiatric nurses towards patients diagnosed with borderline personality disorder. Contemporary Nurse 2006;21(1):43–9.Google Scholar
Rossberg, J, Karterud, S, Pedersen, G, Friis, S. An empirical study of countertransference reactions toward patients with personality disorders. Comprehensive Psychiatry 2007;48(3):225–30.Google Scholar
Lieb, K, Zanarini, M, Schmahl, C, Linehan, M, Bohus, M. Borderline personality disorder. Lancet 2004;364(9432):453–61.CrossRefGoogle ScholarPubMed
Torgersen, S LS, Oien, PA, Skre, I, et al. A twin study of personality disorders. Comprehensive Psychiatry 2000;41(6):416–25.CrossRefGoogle ScholarPubMed
Donegan, NH, Sanislow, CA, Blumberg, HP, et al Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation. Biological Psychiatry 2003;54(11):1284–93.Google Scholar
Krause-Utz, A, Winter, D, Niedtfeld, I, Schmahl, C. The latest neuroimaging findings in borderline personality disorder. Current Psychiatry Reports 2014;16(3):438.Google Scholar
Zanarini, MC, Frankenburg, FR. Pathways to the development of borderline personality disorder. Journal of Personality Disorders 1997;11(1):93–104.Google Scholar
Kernberg, O. Borderline conditions and pathological narcissism. New York: Jason Aronson; 1975.Google Scholar
Adler, G, Buie, DH Jr. Aloneness and borderline psychopathology: the possible relevance of child development issues. International Journal of Psycho-Analysis 1979;60(1):83–96.Google Scholar
Gunderson, J. Borderline personality disorder. Washington, DC: American Psychiatric Press; 1984.Google Scholar
Gunderson, JG. The borderline patient’s intolerance of aloneness: insecure attachments and therapist availability. American Journal of Psychiatry 1996;153(6):752–8.Google Scholar
Gunderson, JG, Links, P. Handbook of good psychiatric management for borderline personality disorder. Arlington, VA: American Psychiatric Publishing Inc.; 2014.Google Scholar
MacKinnon, D, Pies, R. Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders. Bipolar Disorders 2006;8(1):1–14.Google Scholar
Grossman, R. Psychopharmacologic treatment of patients with borderline personality disorder. Psychiatric Annals 2002;32(6):357–72.CrossRefGoogle Scholar
Triebwasser, J, Siever, L. Pharmacotherapy of personality disorders. Journal of Mental Health 2007;Feb;16(1):5–50.CrossRefGoogle Scholar
Becker, D. When she was bad: borderline personality disorder in a posttraumatic age. American Journal of Orthopsychiatry 2000;70:422–32.Google Scholar
Bradley, R, Jenei, J, Westen, D. Etiology of borderline personality disorder: disentangling the contributions of intercorrelated antecedents. Journal of Nervous & Mental Disease 2005;193(1):24–31.Google Scholar
Paris, J. Is hospitalization useful for suicidal patients with borderline personality disorder? Journal of Personality Disorders 2004;18(3: Special issue):240–7.Google Scholar
Links, PS, Gould, B, Ratnayake, R. Assessing suicidal youth with antisocial, borderline, or narcissistic personality disorder. Canadian Journal of Psychiatry 2003;48(5):301–10.CrossRefGoogle ScholarPubMed
Silk, KR. Personal communication. Ann Arbor, MI; 2008.Google Scholar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders(DSM-5), 5th ed. Washington, DC: American Psychiatric Association; 2013.Google Scholar
Senger, HL. Borderline mnemonic. American Journal of Psychiatry 1997;154(9):1321b.Google ScholarPubMed
Sansone, R, Sansone, L. A longitudinal perspective on personality disorder symptomatology. Psychiatry 2008;5(1):53–61.Google Scholar
Zanarini, MC, Frankenburg, FR, Dubo, ED, et al. Axis I comorbidity of borderline personality disorder. American Journal of Psychiatry 1998;155(12):1733–9.Google Scholar
Zanarini, MC, Frankenburg, FR, Hennen, J, Reich, DB, Silk, KR. Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. American Journal of Psychiatry 2004;161(11):2108–14.Google Scholar
Frankenburg, FR, Fitzmaurice, GM, Zanarini, M. The use of prescription opioid medication by patients with borderline personality disorder and axis II comparison subjects: a 10-year follow-up study. Journal of Clinical Psychiatry 2014;75(4):357–61.Google Scholar
Schroeder, K, Fisher, HL, Schäfer, I, et al. Psychotic symptoms in patients with borderline personality disorder: prevalence and clinical management. Current Opinion in Psychiatry 2013;26(1):113–19.CrossRefGoogle ScholarPubMed
Paris, J. Borderline personality disorder. Canadian Medical Association Journal 2005;172(12):1579–83.CrossRefGoogle ScholarPubMed
Zanarini, M, Gunderson, J, Frankenburg, F. Cognitive features of borderline personality disorder. American Journal of Psychiatry. 1990;147(1):57–63.Google Scholar
Schultz, H. Hong, V.Psychosis in borderline personality disorder: how assessment and treatment differs from a psychotic disorder. Current Psychiatry 2017;16(4):24–9.Google Scholar
Brand, BL, Sar, V, Stavropoulos, P, et al. Separating fact from fiction: an empirical examination of six myths about dissociative identity disorder. Harvard Review of Psychiatry 2016;24(4):257–70.Google Scholar
Sar, V, Koyuncu, A, Ozturk, E, et al. Dissociative disorders in the psychiatric emergency ward. General Hospital Psychiatry 2007;29(1):45–50.Google Scholar
Bernstein, E, Putnam, F. Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease 1986;174(12):727–35.Google Scholar
Jaeger, S, Steinert, T, Uhlmann, C, Flammer, E, Bichescu-Burian, D, Tschoke, S. Dissociation in patients with borderline personality disorder in acute inpatient care – a latent profile analysis. Comprehensive Psychiatry 2017;78:67–75.Google Scholar
Silk, K, Eisner, W, Allport, C, et al. Focused time-limited inpatient treatment of borderline personality disorder. Journal of Personality Disorders 1994;(8):268–78.CrossRefGoogle Scholar
Bohus, M, Haaf, B, Stiglmayr, C, et al. Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder – a prospective study. Behaviour Research and Therapy 2000;38:875–87.Google Scholar
Swenson, C, Sanderson, C, Dulit, R, Linehan, M. The application of dialectical behavior therapy for patients with borderline personality disorder on inpatient units. Psychiatric Quarterly 2001;72(4):307–24.Google Scholar
Stanley, B, Brown, GK. Safety planning intervention: a brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice 2012;19:256–64.Google Scholar
Berk, MS, Henriques, GR, Warman, DM, Brown, GK, Beck, AT. A cognitive therapy intervention for suicide attempters: an overview of the treatment and case examples. Cognitive and Behavioral Practice 2004;11(3):265–77.Google Scholar
Jobes, DA, Au, JS, Siegelman, A. Psychological approaches to suicide treatment and prevention. Current Treatment Options in Psychiatry 2015;2(4):363–70. https://doi.org/10.1007/s40501-015-0064-3.Google Scholar
Linehan, M. The skills training manual for treating borderline personality disorder. New York: Guilford Press; 1993.Google Scholar
Linehan, MM, Armstrong, HE, Suarez, A, Allmon, D, Heard, HL. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry 1991;48(12):1060–4.Google Scholar
Linehan, M. The empirical basis of dialectical behavior therapy: development of new treatments versus evaluation of existing treatments. Clinical Psychology Science and Practice 2000;7(1):113–19.Google Scholar
Bateman, A, Fonagy, P. Psychotherapy for borderline personality disorder: mentalization-based treatment. Oxford: Oxford University Press; 2004.Google Scholar
Choi-Kain, LW, Gunderson, JG. Mentalization: ontogeny, assessment, and application in the treatment of borderline personality disorder. American Journal of Psychiatry 2008;165(9):1127–35.Google Scholar
McMain, S, Guimond, T, Streiner, D, Cardish, R, Links, P. Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: clinical outcomes and functioning over a 2-year follow-up. American Journal of Psychiatry 2012;169(6):650–61.CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (NICE). Borderline personality disorder: treatment and management (CG 78). London; 2009.Google Scholar
Saunders, E, Silk, K. Personality trait dimensions and the pharmacological treatment of borderline personality disorder. Journal of Clinical Psychopharmacology 2009;29(5):461–7.CrossRefGoogle ScholarPubMed
Cowdry, RW, Gardner, D. Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine. Archives of General Psychiatry 1988;45(2):111–19.Google Scholar
Kayser, A, Robinson, D, Nies, A, Howard, D. Response to phenelzine among depressed patients with features of hysteroid dysphoria. American Journal of Psychiatry 1985;142(4):486–8.Google Scholar
Bohus, M, Landwehrmeyer, B, Stiglmayr, C, et al. Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial. Journal of Clinical Psychiatry 1999;60(9):598–603.Google Scholar
Zanarini, M. Antiepileptic drugs and borderline personality disorder. In: McElroy, SL, Keck, PE, Post, RM eds., Antiepileptic drugs to treat psychiatric disorders. New York: Informa Healthcare, Inc.; 2008: 343–8.Google Scholar
Lieb, K, Völlm, B, Rücker, G, et al. Pharmacotherapy for borderline personality disorder: cochrane systematic review of randomised trials. British Journal of Psychiatry 2010;196(1):4–12.CrossRefGoogle ScholarPubMed
Crawford, MJ, Sanatinia, R, Barrett, B, et al. Lamotrigine for people with borderline personality disorder: a RCT. Health Technology Assessment 2018;22(17):1–68.CrossRefGoogle ScholarPubMed
Lee, J, Kung, S, Rasmussen, K, Palmer, B. Effectiveness of electroconvulsive therapy in patients with major depressive disorder and comorbid borderline personality disorder. Journal of ECT 2019;35(1):44–7.Google Scholar
Zanarini, MC, Frankenburg, FR, Reich, DB, Fitzmaurice, G. Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. American Journal of Psychiatry 2012;169(5):476–83.Google Scholar
Olfson, M, Wall, M, Wang, S, et al. Short-term suicide risk after psychiatric hospital discharge. JAMA Psychiatry 2016;73(11):1119–26.Google Scholar

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