Skip to main content
SpringerLink
Log in

Developing a systems approach to caring for persons with borderline personality disorder

  • Clinical Care Update
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

Most community mental health centers have not established a treatment approach for seriously ill persons with borderline personality disorder that is multi-focused, coordinated, comprehensive, and continuous. The authors propose that the systems approach to caring for persons with schizophrenia (Stein, Diamond, & Factor, 1990) be modified and tested for its efficacy in helping seriously ill persons with borderline personality disorder. The rationale for proposing this model of care and its underlying principles and clinical components is described in this paper.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (1987).Diagnostic and statistical manual of mental disorders (3rd ed. rev.), Washington, DC: Author.

    Google Scholar 

  • Beard, J., Propst, R., & Malamud, T. (1982). The fountain house model of psychiatric rehabilitation.Psychosocial Rehabilitation Journal, V, 47–53.

    Google Scholar 

  • Briere, J. (1989).Therapy for adults molested as children. New York: Springer Publishing Company.

    Google Scholar 

  • Crafoord, C. (1977). Day hospital treatment for borderline patients: The institution as transitional object. In P. Hartocollis (Ed.),Borderline personality disorders: The concept, the syndrome, the patient (pp. 385–397). New York: International Universities Press.

    Google Scholar 

  • Cornelius, J.R., Fyer, M.R., Haas, G.L., Sullivan, T., & Frances, A.J. (1990). Substance use in borderline personality disorder.American Journal of Psychiatry, 147(8), 1002–1007.

    Google Scholar 

  • Cornelius, J.R., Soloff, P.H., George, A.W.A., Schultz, S., Tarter, R., Brenner, R.P., & Schulz, P.M. (1989). An evaluation of the significance of selected neuropsychiatric abnormalities in the etiology of borderline personality disorder.Journal of Personality Disorders, 3, 19–25.

    Google Scholar 

  • Cowdry, R., & Gardner, D. Pharmacotherapy of borderline personality disorder.Archives of General Psychiatry, 45, 111–119.

  • Dulit, R.A., Fyer, M.R., Haas, G.L., Sullivan, T., & Frances, A.J. (1990). Substance use in borderline personality disorder.American Journal of Psychiatry, 147, 1002–1007.

    Google Scholar 

  • Drob, S., Stewart, S., & Bernard, H. (1982). The problem of reinterpretive distortions in group psychotherapy with borderline patients.Group, 6, 14–22.

    Google Scholar 

  • Friedman, H. (1969). some problems of inpatient management with borderline patients.American Journal of Psychiatry, 126, 299–304.

    Google Scholar 

  • Group for the Advancement of Psychiatry. (1987).Interactive fit: A guide to nonpsychotic chronic patients (Report No. 121), New York: Brunner/Mazel.

    Google Scholar 

  • Goodpastor, W.A., Pitts, W.M., Snyder, S., Sajadi, C., & Gustin, Q.L. (1983). A social learning approach to group psychotherapy for hospitalized DSM III borderline patients.Journal of Psychiatric Treatment and Evaluation, 5, 331–335.

    Google Scholar 

  • Gordon, C., & Beresin, E. (1983). Conflicting treatment models for the inpatient management of borderline patients.American Journal of Psychiatry, 140, 979–983.

    Google Scholar 

  • Greenblum, D.N., & Pinney, E.L. (1982). Some comments on the role of co-therapists in group psychotherapy with borderline patients.Group, 6, 41–47.

    Google Scholar 

  • Grobman, J. (1980). The borderline patient in group psychotherapy: A case report.International Journal of Group Psychotherapy, 30, 299–318.

    Google Scholar 

  • Gunderson, J. (1984).Borderline personality disorder. Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Gunderson, J. (1986). Pharmacotherapy for patients with borderline personality disorder.Archives of General Psychiatry, 43, 698–700.

    Google Scholar 

  • Hellman, J. (1981). Alcohol abuse and the borderline patient.Psychiatry, 44, 307–317.

    Google Scholar 

  • Horwitz, L. (1977). Group psychotherapy of the borderline patient. In P. Harticollis (Ed.),Borderline personality disorders: The concept, the syndrome, the patient (pp. 399–422). New York: International Universities Press, Inc.

    Google Scholar 

  • Kibel, H.D. (1978). The rationale for the use of group psychotherapy for borderline patients on a short-term unit.International Journal of Group Psychotherapy, 28, 339–358.

    Google Scholar 

  • Koenigsberg, H. (1984). Indications for hospitalization in the treatment of borderline patients.Psychiatric Quarterly, 56, 247–258.

    Google Scholar 

  • Kretsch, R., Goren, Y., & Wasserman, A. (1987). Change patterns of borderline patients in individual and group therapy.International Journal of Group Psychotherapy, 37, 95–112.

    Google Scholar 

  • Langsley, D., & Kaplan, D. (1968).The treatment of families in crisis. New York: Grune & Stratton, Inc.

    Google Scholar 

  • Linehan, M.M. (1987). Dialectical behavior therapy in groups: Treating borderline personality disorders and suicidal behavior. In C.M. Brody (Ed.),Women's therapy groups: Paradigms of feminist treatment (pp. 145–162). New York: Springer Publishing.

    Google Scholar 

  • Links, P., Steiner, M., Bioago, I., & Irwin, D. (1990). Lithium therapy for borderline patients: Preliminary findings.Journal of Personality Disorders, 4(2), 173–181.

    Google Scholar 

  • Lofton, P., Daugherty, C., & Mayerson, P. (1983). Combined group and individual treatment for the borderline patient.Group, 7, 21–26.

    Google Scholar 

  • Macaskill, N.D. (1980). The narcissistic core as a focus in the group therapy of the borderline patient.British Journal of Medical Psychology, 53, 137–143.

    Google Scholar 

  • Macaskill, N.D. (1982). Therapeutic factors in group therapy with borderline patients.International Journal of Group Psychotherapy, 32, 61–73.

    Google Scholar 

  • Miller, L.J. (1989). Inpatient management of borderline personality disorder: A review and update.Journal of Personality Disorders, 3(2), 122–134.

    Google Scholar 

  • Mosher, L., Menn, A., & Mathews, S. (1975). Soteria: Evaluation of a home-based treatment for schizophrenia.American Journal of Orthopsychiatry, 45, 455–469.

    Google Scholar 

  • Nace, E., Saxon, J., & Shore, N. (1983). A comparison of borderline and nonborderline alcoholic patients.Archives of General Psychiatry, 40, 54–56.

    Google Scholar 

  • Nehls, N. (1991). Borderline personality disorder and group therapy.Archives of Psychiatric Nursing, 5(3), 137–146.

    Google Scholar 

  • Pasamanick, B., Scarpitti, F., & Dinitz, S. (1967).Schizophrenics in the community: An experimental study in the prevention of hospitalization. New York: Appleton-Century-Crofts.

    Google Scholar 

  • Perry, J.C., Herman, J.L., Van Der Kolk, B.A., & Hoke, L.A. (1990). Psychotherapy and Psychological trauma in borderline personality disorder.Psychiatric Annals, 20, 33–43.

    Google Scholar 

  • Pildis, M., Soverow, G., Salzman, C., & Wolf, J. (1978). Day hospital treatment of borderline patients: A clinical perspective.American Journal of Psychiatry, 135(5), 594–596.

    Google Scholar 

  • Polak, P., & Kirby, M. (1976). A model to replace psychiatric hospitals.Journal of Nervous and Mental Disease, 162, 13–22.

    Google Scholar 

  • Poldrugo, F., & Forti, B. (1988). Personality disorders and alcoholism treatment outcome.Drug and Alcohol Dependence, 21, 171–176.

    Google Scholar 

  • Rittenhouse, J. (1970). Endurance of effect: Family-unit treatment compared to identified-patient treatment.Proceedings of the Annual Convention of the American Psychological Association (Vol. 2), pp. 535–536. Washington, DC: American Psychological Association.

    Google Scholar 

  • Sadavoy, J., Silver, D., & Book, H. (1979). Negative responses of the borderline to inpatient treatment.American Journal of Psychotherapy, 33, 404–417.

    Google Scholar 

  • Sederer, L., & Thorbeck, J. (1986). First do no harm: Short-term inpatient psychotherapy of the borderline patient.Hospital and Community Psychiatry, 37, 692–697.

    Google Scholar 

  • Stein, L., Diamond, R., & Factor, R. (1990). A system approach to the care of persons with schizophrenia. In M.I. Herz, S.J. Keith, and J.P. Docherty (Eds.),Schizophrenia: Vol. 5 psychological therapies. Amsterdam: Elsevier Science Publishers.

    Google Scholar 

  • Stein, L., & Test, M. (1980). Alternative to mental hospital treatment.Archives of General Psychiatry, 37, 392–397.

    Google Scholar 

  • Stein, L., Test, M., & Marx, A. (1975). Alternative to the hospital: A controlled study.American Journal of Psychiatry, 132(5), 517–521.

    Google Scholar 

  • Stone, W.N., & Gustafson, J.P. (1982). Technique in group psychotherapy of narcissistic and borderline patients.International Journal of Group Psychotherapy, 32, 29–47.

    Google Scholar 

  • Tousignant, M., & Kovess, V. (1989). Borderline traits among community alcoholics and problemdrinkers: Rural-urban differences.Can. J. Psychiatry, 34, 796–799.

    Google Scholar 

  • Vaccani, J. (1989). Borderline personality and alcohol abuse.Archives of Psychiatric Nursing, 3(2), 113–119.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Wisconsin-Madison School of Nursing-H6/248, 600 Highland Avenue, Madison, WI, 53792

    Nadine Nehls Ph.D.

  2. Department of Psychiatry, University of Wisconsin-Madison, Madison, USA

    Ronald J. Diamond M.D.

  3. Mental Health Center of Dane County, Madison, USA

    Ronald J. Diamond M.D.

Authors
  1. Nadine Nehls Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ronald J. Diamond M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nehls, N., Diamond, R.J. Developing a systems approach to caring for persons with borderline personality disorder. Community Ment Health J 29, 161–172 (1993). https://doi.org/10.1007/BF00756341

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00756341

Keywords

Search

Navigation