Borderline Personality Disorder (BPD): Symptoms, Etiology, Treatments and Legal/Ethical Challenges
Online Course Materials: Articles
Developed by Garry Cooper, LCSW
General Course Description
Probably no other mental disorder has stirred up more emotions and evoked more fascination and trepidation in therapists as the treatment of borderline personality disorder (BPD). In the past, it has been considered to be untreatable and hazardous to therapists who attempt treatment. Defense attorneys have warned therapists, “You’re one borderline away from losing your license.” However the BPD has undergone a significant re-conceptualization in the last decade in terms of understanding its symptoms and causes, and getting better clarity in regard to prognosis and treatment. Once considered an intractable condition, it is actually amenable to several treatments, which have gained empirical support. Research shows that some of the most traditional therapeutic techniques can also be effective with some BPD clients.
Due to the intense transference and the counter-transference, BPD treatment can be very volatile, unpredictable, intriguing and stressful. Taking into consideration that clients who have been diagnosed with BPD, more than any other group, are likely to file lawsuits and complaints with licensing boards, this course will help insulate therapists against the legal actions by people with BPD. Understanding the nature of BPD, the likely actions and reactions that are common during therapy, the course outlines simple therapeutic, consultations and record-keeping steps that therapists can take to reduce the risk. This intermediate level course introduces students to treatment principles and techniques, the latest theories and understanding of BPD so therapists who have shied away from treating BPD clients in the past need no longer automatically fear volatile therapy relationships and treatment failures.
This course covers the diverse symptoms of BPD, explores its etiologies from several perspectives, including cognitive, behavioral and psychodynamic. It reviews the important work of John G. Gunderson, MD and Marsha Linehan, Ph.D. and explains several of the effective treatments, including Cognitive behavioral: Dialectical behavior therapy; Psychodynamic and psychoanalytically-based therapies; Interpersonal psychotherapy: Principles and applications; and Mentalization-focused therapies. It covers the complicated comorbidity between BPD and Axis I mood disorders and how that affects treatment decisions. The strange phenomenon of “vanishing” BPD is explored in depth-clients who, sometimes even without treatment, eventually no longer meet DSM criteria for BPD. The common antidepressants and anti-anxiety medications used for addressing the comorbid Axis I symptoms of BPD are explained in depth. Two articles look at the potential legal and ethical pitfalls of working with BPD clients and explain how those situations can arise and how to avoid these pitfalls while still doing effective therapy. Additional resources and references are provided for further study, but they are not part of the course.
- This course will teach the participant to
- Identify the symptoms of BPD and accurately diagnose it.
- Summarize the diverse etiologies of BPD.
- Specify the characteristics and side effects of the medications used to treat BPD.
- Summarize the principles of dialectical behavior therapy, interpersonal psychotherapy and mentalization-focused treatments.
- Summarize the debate about the current DSM taxonomy of BPD.
- List the common ethical and legal pitfalls in treating BPD.
- Bateman, A., & Fonagy, P. (2008). 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. American Journal of Psychiatry, 165 (5), 631-638. Doi: https://doi.org/10.1176/appi.ajp.2007.07040636
- Silk, K. R. (2008). Augmenting psychotherapy for borderline personality disorder: the STEPPS program. The American journal of psychiatry, 165 (4), 413-415. Doi: https://doi.org/10.1176/appi.ajp.2008.08010102
- United States National Library of Medicine. (2018). Drugs, herbs, and supplements. Retrieved from https://medlineplus.gov/druginformation.html
- An overview of BPD’s symptoms and treatments
- Explanation of symptoms and treatments
- Comparison of symptoms between DSM and PDM
- Perspective on BPD diagnosis and treatment from the National Education Alliance for Borderline Personality Disorder
- What BPD feels like
- Medications: Their mechanisms, effects, side effects and warnings
- Anti-anxiety medications
- Developmental pathways for BPD
- How BPD mothers may pass it on to infants
- How biology and psychosocial events may lead to BPD
- Changing perspectives on BPD
- Why BPD often goes into remission-with or without treatment
- Concerns with DSM taxonomy of BPD
- The relationship between BPD and Axis I mood disorders
- A new model for conceptualizing BPD: The four symptom clusters
- How innate vulnerability and a “kindling” experience leads to BPD
- The difference between acute and temperamental symptoms
- Treatments that work
- Cognitive behavioral: Dialectical behavior therapy
- Psychodynamic and psychoanalytically-based therapies
- Interpersonal psychotherapy: Principles and applications
- Mentalization-focused therapies
- Legal pitfalls in treating BPD
- How intense positive and negative transference and countertransference inherent in relationships with BPD clients can cause trouble
- Booby-trapped trails leading to boundary violations
- The four characteristics of BPD that can lead to sanctions and lawsuits
- False and true complaints against therapists
- Ways to protect yourself and still do effective therapy
- The ethics of treating (or not treating) people with BPD
- Knowing the difference between diagnosing and name-calling
- Therapists’ ‘Ego’ and the treatment of BPD
- Do therapists listen to the client or to the diagnosis?