Changing views of borderline personality disorder

Anthony W. Bateman and Peter Fonagy

in Mentalization-based Treatment for Borderline Personality Disorder

Published on behalf of Oxford University Press

Published in print September 2006 | ISBN: 9780198570905
Published online February 2013 | e-ISBN: 9780191754456 | DOI:

Series: International Perspectives in Philosophy & Psychiatry

Changing views of borderline personality disorder

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In this chapter we will consider the changing views of BPD as a severe and enduring personality disorder. Before we begin to discuss treatment it is necessary to understand the longitudinal course of BPD because it is against this background that treatment is applied and can potentially provide great benefit or induce considerable harm. We argue that a focus on mentalization as a core component of treatment provides the best chance of a successful outcome, not only because it addresses the central problem of the patient but also because it reduces the likelihood of causing harm in a group of patients who may be particularly sensitive to psychotherapeutic intervention.

Few areas of psychiatric treatment have seen progress as radical as the field of personality disorder. Personality Disorder, No Longer a Diagnosis of Exclusion (Department of Health, 2003), formally marked the end of a sad era during which individuals with a primary diagnosis of personality disorder received inappropriate, inadequate, haphazard, and reluctant care from disorganized services; a haphazard delivery of services undoubtedly made worse by the curious mixture of reasonable and irrational conduct so common in individuals with severe personality disorders which itself generates confusion amongst those working to help them.

The advance in therapeutics and services for PD has been influenced by two developments: (1) the increasing recognition that the disorder has a far more benign course than previously thought; and (2) the emergence of a range of relatively effective and practical psychosocial interventions that appear to accelerate the rate of improvement. Taken together and placed in the context of recent neuro-scientific work, these observations suggest new opportunities for the organization of PD services highlighting both opportunities and risks.

Chapter.  3187 words. 

Subjects: Psychiatry

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