Section I: General principles and techniques1. Joanna. What is BPD? - Brian Palmer, MD, and Brandon Unruh, MDThis case presents a general discussion of BPD etiology, neurobiology, prognosis, course, and core therapeutic principles proven effective across multiple treatment approaches.
Section II: Specific principles and techniques drawn from empirically validated treatments2. Kelly. Good psychiatric management approach to BPD - John Gunderson, MD, or Brian Palmer, MDGeneral ("Good") psychiatric management has been shown to be effective for BPD and relies heavily on psychoeducation, case management / vocational rehabilitation, goals, . Proported to be a "non-expert" treatment, the approach is probably most close to the goal of the book (understanding principles that work across treatments rather than learning a treatment in depth). 3. Susan. Behavioral approach to BPD - Marsha Linehan, PhD, or Joan Wheelis, MDThis case illustrates how BPD can be understood and treated from a behavioral perspective (using reinforcement principles, contingency management, skills training, etc) and how dialectal thinking (e.g., balancing validation and change) can help clinicians improve treatment outcomes.4. Erik. Mentalization-based approach to BPD - Brandon Unruh, MD, or Shauna Dowden, PhDMentalization is the capacity to accurately observe the implied and explicit mental states of self and other. This case illustrates how to recognize mentalizing deficits characteristic of BPD and demonstrates generally applicable therapeutic techniques developed and empirically validated as mentalization-based treatment. 5. Tamica. Self-psychology approach to BPD - Russell Meares, MD, or colleague. Self-psychology approaches consider the poorly integrated self as the primary problem and have a heavy emphasis on narrative development. Material in this case would emphasize the development of a sense of self.6. Kristin. Cognitive and schema-focused approach to BPD - Karen Jacob, PhD, or colleague7. Shane. Transference-focused approach to BPD - Igor Weinberg, PhD
Section III: Tailoring goals and approaches to specific treatment settings and presentations8. Marcus. BPD in primary care settings with medical comorbidities - Alex Keuroghlian, MD, or colleagueA patient who presents to a primary care office or specialty medical clinic with multiple chronic medical complaints (fibromyalgia, migraines, chronic fatigue) and rejects psychological interventions and referrals.9. Bonnie. BPD in acute emergency room, inpatient, and partial hospital settings - Victor Hong, MD, or colleagueAn "un-dischargeable" patient who presented to the emergency room with suicidal ideation then improved rapidly upon inpatient admission, but who now reports suicidal intent upon discharge planning. 10. Beatrice. "I'm not borderline, I'm..." - ????A patient who deflects the BPD diagnosis and pursues repeated treatments targeting specific behavioral symptoms (substance abuse, binge eating and purging, trichotillomania) rather than BPD.11. Clive. BPD with comorbid narcissistic features - Elsa Ronningstam, PhDA previously high-functioning middle-age professional who presents with entitlement, blustery deflection, and self-esteem dysregulation following an initial suicide attempt.12. Jennifer. Adolescent presentations of BPD - Blaise Aguirre, MD, or Claire Brickell, MDA patient who presents at age 14 with anorexia and repeated self-injurious behavior.
Section IV: Common clinical dilemmas and challenges
13. Mark. Misunderstandings about proper uses and limits of medications - Kenneth Silk, MD, or colleagueA depressed BPD patient who overvalues but insists on pursuing somatic treatments for depression such as medications, ECT, and TMS. He has arrived with an overly complex medication regimen and continues to seek additional polypharmacy.14. Lauren. Boundary-testing and challenges to the alliance - Shauna Dowden, PhDA patient who seeks to make contact with the clinician through inappropriate or provocative behavior and escalating inter-session contact.15. Alice. Managing self-injurious/suicidal behavior and countertransference reactions - Igor Weinberg, PhDA patient who induces anxiety and repulsion in the clinician through repeated self-harming behavior and angry devaluation.16. Kurt. Patients who do not get better: when to reduce or end treatment - Brandon Unruh, MD, or colleagueA "professional patient" who despite ten years of therapy remains jobless, friendless, single, dependent on treatment, and who takes pride in "teaching" trainee after trainee about BPD.
