Access to Evidence-Based Services for Individuals With Borderline Personality Disorder

Access to Evidence-Based Services for Individuals With Borderline Personality Disorder

Peter Leslie King, Jennifer M. Martin
DOI: 10.4018/978-1-5225-7402-6.ch009
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This chapter outlines the key features of the diagnosis of borderline personality disorder. This is a diagnosis that has attracted significant levels of stigma and has generally been viewed as difficult to treat. This has resulted in often inadequate service responses for people experiencing high levels of distress. Increased understanding is facilitated by exploring precipitating factors leading to this diagnosis, including invalidating and often traumatizing environments. Available evidence from Australian and international literature is considered, with main treatments identified to inform improved treatment outcomes. The need for attention to biological, psychological factors is highlighted and in particular acknowledgment of the high prevalence of trauma, particularly childhood sexual assault, amongst the mostly women who are given this diagnosis.
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Borderline Personality Disorder is thought to be one of the more difficult psychiatric diagnoses to treat. Individuals with a diagnosis of BPD experience feelings of immense emotional distress and feature extremes in an attempt to regulate emotions. An individual diagnosed with BPD can face difficulty in returning to an emotional baseline when aroused. Individuals feel judged or abandoned which makes effective coping during the ups and downs of life seem distant and unattainable. Chronic suicidality, self-injurious behaviours, risk taking, misdiagnosis, chaotic relationships and intense emotional responses add to the complexity of what becomes part of the daily life for an individual diagnosed with BPD. Added to the complex presentation is the conjecture within the mental health profession as to, how and where individuals with BPD can be best supported to overcome this often-debilitating condition? This chapter presents the available evidence on issues of accessibility and effective treatments for BPD. It opens with an introduction to BPD that includes what BPD is considered to be in terms of diagnosis and symptoms. This is followed by background information relating to the origins of this diagnosis and contemporary diagnostic techniques and requirements as identified in the two main diagnostic manuals used in mental health services in Australia today, the Diagnostic and Statistical Manual of Psychiatry by the American Psychiatric Association (DSM-V) and the International Classification of Diseases (ICD-10-AM) by the World Health Organisation. The reported incidence of BPD – both globally and within Australia is looked at followed by consideration of precipitating factors, invalidating environments, trauma, social factors, and theories related to BPD. The focus of the second half of this chapter is on treatment responses.

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