Borderline Personality Disorder in Clinical Practice

Conklin, Carolyn Zittel; Westen, Drew

doi:10.1176/appi.ajp.162.5.867

Cited by 119 publications

(84 citation statements)

References 49 publications

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“…From another point of view, this heterogeneity might be related to the lack of coherence of the BPD diagnosis. In other words, BPD diagnosis is associated with a heterogeneous spectrum of clinical presentations, and much research has suggested the existence of different BPD patients subtypes [37,38,39]. In the future, it would be interesting to examine the relationship between these BPD subtypes and the activation of different relational patterns in psychotherapy.…”

Section: Discussionmentioning

confidence: 99%

Empirically Derived Relational Pattern Prototypes in the Treatment of Personality Disorders

Colli

Tanzilli²,

Gualco³

et al. 2016

Psychopathology

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Background: Patient transference patterns play a central role in the psychotherapy of personality disorders. Objective: The aims of this study were to: (1) explore the relationship between patients' personality disorders and specific relational patterns and (2) construct empirically derived prototypes of relational patterns for each personality disorder. Sampling and Methods: A random national sample of 314 clinicians completed the Psychotherapy Relationship Questionnaire, which evaluates patients' relational patterns, and the Shedler-Westen Assessment Procedure-200, which assesses personality disorders in a randomly selected patient currently in the clinician's care and with whom the clinician has worked for a minimum of 8 sessions and a maximum of 6 months (1 session per week). Results: The avoidant/counterdependent transference pattern was associated with all cluster A personality disorders; the angry/entitled transference pattern was strongly positively associated with all cluster B personality disorders, and the anxious/preoccupied transference pattern was positively associated in a significant way with all cluster C personality disorders. Moreover, our empirically derived prototypes showed how the transference phenomena characteristic of each personality disorder are strongly coherent with the personality traits and mental and relational functioning of each specific disorder. Conclusions: The results strongly support a fundamental hypothesis that the patterns emerging in the therapeutic relationship are not arbitrary, and they clearly reflect patterns seen elsewhere in patients' lives that can be crucial to address. Regarding limitations, the same clinician provided data on both the personality pathology and the transference phenomena for each patient.

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Section: Discussionmentioning

confidence: 99%

Empirically Derived Relational Pattern Prototypes in the Treatment of Personality Disorders

Colli

Tanzilli²,

Gualco³

et al. 2016

Psychopathology

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“…Data on inpatient hospitalization and outpatient sessions from therapists were obtained from a questionnaire adapted from Zittel Conklin and Westen (2005) administered at three time points within the 30-month duration of the TOP DD study, including follow-ups at month six (T2), month 18 (T3), and month 30 (T4). Data from patients on their inpatient hospitalization days was obtained from a questionnaire adapted from the National Health and Nutrition Examination Survey (National Center for Health Statistics, n.d.) administered at four time points within the 30-month study, including at baseline (T1) as well as the three follow-ups (T2–T4).…”

Section: Methodsmentioning

confidence: 99%

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

Myrick

Webermann

Langeland

et al. 2017

European Journal of Psychotraumatology

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Background: Interpersonal trauma and trauma-related disorders cost society billions of dollars each year. Because of chronic and severe trauma histories, dissociative disorder (DD) patients spend many years in the mental health system, yet there is limited knowledge about the economic burden associated with DDs. Objective: The current study sought to determine how receiving specialized treatment would relate to estimated costs of inpatient and outpatient mental health services. Method: Patients’ and individual therapists’ reports of inpatient hospitalization days and outpatient treatment sessions were converted into US dollars. DD patients and their clinicians reported on use of inpatient and outpatient services four times over 30 months as part of a larger, naturalistic, international DD treatment study. The baseline sample included 292 clinicians and 280 patients; at the 30-month follow-up, 135 clinicians and 111 patients. Missing data were replaced in analyses to maintain adequate statistical power. The substantial attrition rate (>50%) should be considered in interpreting findings. Results: Longitudinal and cross-sectional analyses of cost estimates based on patient reported inpatient hospitalization significantly decreased over time. Longitudinal cost estimates based on clinician-reported outpatient services also significantly decreased over time. Cross-sectional cost estimates based on patient and clinician reported inpatient hospitalization were significantly lower for patients in later stages of treatment compared to those struggling with safety and stabilization. Cross-sectional cost estimates based on clinician-reported outpatient services were significantly lower for patients in later stages of treatment compared to those in early stages. Conclusions: This pattern of longitudinal and cross-sectional reductions in inpatient and outpatient costs, as reported by both patients and therapists, suggests that DD treatment may be associated with reduced inpatient and outpatient costs over time. Although these preliminary results show decreased mental health care utilization and associated estimated costs, it is not clear whether it was treatment that caused these important changes.

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“…Externalization of the alien self is desirable for the child with a disorganized attachment but is a matter of life and death for a traumatized individual who has internalized the abuser as part of the self. The unbearable emotional experience can include feeling abandoned, evil, misunderstood, victimized, inferior, and monstrous (Bradley & Westen, 2005;Zanarini, Frankenburg, Hennen, & Silk, 2003;Zittel Conklin & Westen, 2005). The externalization of these internal states is widely recognized in the common counter-transferential reactions of therapists working with borderline patients -anger and hatred, helplessness and worthlessness, fear and worry, resentment, and urges to save and rescue the patient (Gabbard & Wilkinson, 1994).…”

Section: (C) Re-externalization Of the Alien Selfmentioning

confidence: 99%

Mentalizing and borderline personality disorder

Fonagy¹,

Bateman²

2007

Journal of Mental Health

169

106

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Background: Mentalization-based treatment is a model of psychodynamic therapy rooted in attachment theory that aims to enhance the individual's capacity to represent thoughts, feelings, wishes, beliefs and desires in themselves and in others in the context of attachment relationships. \ud \ud Aims: To describe the normal development of mentalization as well as anomalies in mentalization that can arise and can ultimately lead to the development of personality disorder. \ud \ud Method: Description of the basic principles of mentalization-based treatment as well as the rationale for use of these techniques. \ud \ud Results: Summaries of randomized controlled trial and a description of an ongoing RCT for the outpatient treatment of BPD. \ud \ud Conclusion: MBT is a generic psychotherapeutic treatment which shares many features with other psychotherapeutic approaches but is unique in focusing on enhancing the patient's capacity to think about and regulate mental states. \ud \u

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Borderline Personality Disorder in Clinical Practice

Cited by 119 publications

References 49 publications

Empirically Derived Relational Pattern Prototypes in the Treatment of Personality Disorders

Empirically Derived Relational Pattern Prototypes in the Treatment of Personality Disorders

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

Mentalizing and borderline personality disorder

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