Abstract
The pharmacotherapy of severe personality disorder pathology is a challenging subject. Patients with certain personality disorder diagnoses, particularly borderline personality disorder, take medications at high rates, despite limited dating supporting efficacy. Prescribers will often struggle when patients exhibit primitive defenses (idealization/devaluation, splitting, omnipotent control, projection), which can lead to serious problems including polypharmacy, prescription medication misuse or dependence, and the clinician’s departure from customary prescribing practices. Transference-focused psychotherapy (TFP) principles can offer prescribers a set of tools in managing “difficult” patients. TFP principles in this context will include openness to making a diagnosis of personality disorder pathology, sharing the diagnosis with patients, establishing a treatment contract, and family education about personality disorder pathology and medications.
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References
Silk KR. The process of managing medications in patients with borderline personality disorder. J Psychiatr Pract. 2011;17(5):311–9.
Bender DS, Dolan RT, Skodol AE, Sanislow C, Dyck IR, McGlashan TH, Shea MT, Zanarini MC, Oldham JM, Gunderson JG. Treatment utilization by patients with personality disorders. Am J Psychiatr. 2001;158:295–302.
Hersh RG. Using transference-focused psychotherapy principles in the pharmacotherapy of patients with severe personality disorders. Psychodyn Psychiatry. 2015;43(2):181–200.
Clarkin JF, Yeomans FE, Kernberg OF. Psychotherapy for borderline personality disorder: focusing on object relations. Washington, DC: American Psychiatric Publishing, Inc.; 2010.
Feurino L, Silk KR. State of the art in the pharmacologic treatment of borderline personality disorder. Curr Psychiatr Rep. 2011;13(1):69–75.
American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatr. 2001;158:1–52.
Paris J. Commentary on the American Psychiatric Association guidelines for the treatment of borderline personality disorder: evidence-based psychiatry and the quality of evidence. J Pers Disord. 2002;16(2):130–4.
Lieb K, Vollm B, Rucker G, Timmer A, Stoffers H. Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials. Br J Psychiatry. 2010; 196(1):4–12.
National Institute for Health and Clinical Excellence (NICE). Borderline personality disorder, treatment and managements. London: The British Psychologist Society and the Royal College of Psychiatrists; 2009. www.nice.org.uk/cg78.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC; 2014.
Gunderson JG, Links P. Handbook of good psychiatric management for borderline personality disorder. Arlington, VA: American Psychiatric Association; 2014.
Paris J. Why psychiatrists are reluctant to diagnose borderline personality disorder. Psychiatry. 2007;4(1):35–9.
Gutheil TG. Medicolegal pitfalls in the treatment of borderline patients. Am J Psychiatr. 1985;142(1):9–14.
Zanarini MC, Frankenburg FR. A preliminary, randomized trial of psychoeducation for women with borderline personality disorder. J Pers Disord. 2008;22(3):284–90.
Weinberg I, Ronningstam E, Goldblatt M. Common factors in empirically supported treatments of borderline personality disorder. Curr Psych Rep. 2011;12:60–8.
Zanarini MC, Frankenburg F, Reich DB. Time to attainment of recovery from borderline personality disorder and stability of recovery: a 10-year prospective follow-up study. Am J Psychiatr. 2010;167:663–7.
LeQuesne ER, Hersh RG. Disclosure of a diagnosis of borderline personality disorder. J Psychiatr Pract. 2004;10:170–6.
Zanarini M, Frankenburg F, Hennen J, Silk K. Mental health service utilization by borderline personality disorder patients and axis II comparison subjects followed prospectively for 6 year. J Clin Psychiatr. 2004;65(1):28–36.
Gunderson JG, Morey LC, McGlashan TH. Major depressive disorder and borderline personality disorder revisited: longitudinal interactions. J Clin Psychiatr. 2004;65:1049–56.
Pincus HA, Tanielian TL, Marcus SC, Olfson MA, Zarin DA, Thompson J, Zito JM. Prescribing trends in psychotropic medications. J Am Med Assoc. 1998;279(7):526–31.
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Hersh, R.G., Caligor, E., Yeomans, F.E. (2016). Transference-Focused Psychotherapy (TFP) Principles in the Pharmacotherapy of Personality Disorders. In: Fundamentals of Transference-Focused Psychotherapy. Springer, Cham. https://doi.org/10.1007/978-3-319-44091-0_6
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