Borderline Personality Disorder: An Evidence-Based Guide for Generalist Mental Health Professionals

Borderline Personality Disorder: An Evidence-Based Guide for Generalist Mental Health Professionals Anthony W. Bateman, & Roy Krawitz Oxford University Press, 2013, £24.99, pb, 240 pp. ISBN: 9780199644209 

A 350-word review is not enough to do this book justice. Written by two psychiatrists, one

This book is timely, coinciding with the publication of DSM-5 and the pending publication of ICD-11. Perhaps wisely, it steers clear of debating what should (or should not) be included within these classifications. Instead, this slim guide aims to further our understanding of how international classification systems have developed over time, and how they can be best used by working psychiatrists.
The book is divided into a large number of small chapters and includes several useful appendices. This helps accessibility, allowing the reader to dip in and out of sections of interest, though perhaps the resulting reading experience is a little broken in terms of narrative style.
The authors begin by highlighting the pitfalls that occur in the absence of an internationally accepted classification system. This serves to reinforce the importance and relevance of classification systems today. The book then continues with several chapters that explore the history of classification. Topics covered include the development of rating scales, progress made through international epidemiological projects, and the development of the classification systems of ICD and DSM. The second half of the book looks at the construction of current classification systems. Challenges occurring in this process are highlighted, such as the existence of a large number of sub-committees, each keen for 'their' disorder to be fully accommodated. The issue of individual personality differences within committees is discussed, and tolerance of different approaches is suggested as essential. These chapters go some way to exploring current controversy in classification.
The authors' conclusions are centred around the best use of classification systems, suggesting that psychiatrists need a strong knowledge of their patient and understanding of the categories of mental disorder within a classification system. The authors also give a nod to the future, predicting that further revisions of classification will occur as scientific understanding of mental disorder improves, that more 'super-specialist' classifications will emerge and that new disorders will be described as society changes.
This book provides context to current classification systems, acknowledges the limitations of each and encourages the reader to think more deeply about classification. This is a small, dense book written by two American academics as a primer for their undergraduate course in (health and) mental health informatics. It is unashamedly US focused; the final section on an international perspective is devoted to technologies and processes suitable for the developing world. It will be of interest to European informatics specialists in academic settings and possibly industry, but it is not for the interested clinician or even the chief clinical information officer, unless they need familiarity and credibility in the US context.
There are four sections: mental health and informatics, standards and implementation, competencies and strategies, and a short section on globalisation and the future. The style is didactic; it gives a recent history of the American sociopolitical context of health informatics and some of the challenges in the application to mental health, ranging from systems processes, patient administration systems, with the addition of billing procedures and cross-state accreditation and licensing, to the particular challenges of mental health electronic records, which are primarily narrative rather than quantitative. However, while it links changes and developments in information processing capabilities and the federal political imperative, (created by the demographic challenge of the increasing ratio of those with chronic ill health and mental health to the economically productive population), the lack of comparative analysis of the impact of various natural experiments in legislation and informatics will frustrate the reader who seeks to do more than get to know the current US model.
The chapters addressing implementation research are interesting to the non-academic, but again describe a system and methodology rather than analysing its strengths and weaknesses compared against others. This is appropriate for the specific target audience but limits the readership and does not facilitate ready extraction of knowledge and understanding from the data. A 350-word review is not enough to do this book justice. Written by two psychiatrists, one with a psychodynamic and the other a behavioural orientation, the book succeeds in outlining different psychological and pharmacological approaches to the treatment of borderline personality disorder in a harmonious and enlightened way.
This book is in part a spin-off from a research project comparing mentalisation-based therapy with structured clinical management. The latter proved strikingly effective as a comparator treatment for borderline personality disorder and much of this book describes the components of this approach. It contains, however, far more than this.
The book is written with compassion and a clear commitment to working with this patient group, and as well as being comprehensively researched it is accessible and easy to read. There are eight chapters, each with a helpful summary.
For the busy clinician, I would recommend the sections on crisis management and planning, self-harm and chain analysis. For those with a bit more time, many chapters stand alone as a good read -I found chapter one, a comprehensive overview of borderline personality disorder, and chapter six, on prescribing and in-patient management, particularly helpful. Throughout there are plenty of practical tips, 'consumer comments' that bring the clinical picture of borderline personality disorder to life, and an excellent finale: 'top 10 additional resource-efficient treatment strategies', which is a great addition to psychological strategies that are discussed in more depth in the rest of the book.
The book is generous in its scope and is clearly written to be shared with patients, their relatives and their friends. The chapter on their involvement is packed full of useful information and I was impressed by the clever use of editing, whereby written materials suitable for copying and distributing are printed on separate pages for ease of use. This book is highly recommended and I consider the authors to have achieved what they set out to do: instil hope in all of us working with patients with borderline personality disorder and, in so doing, instil hope in patients themselves.