by John G. Gunderson and Perry D. Hoffman (Editors)
American Psychiatric Association, 2005
Review by David A. Flory on Jul 18th 2005
Borderline Personality Disorder is a very depressing
topic. As the authors of this book point out, research on BPD is about twenty
to thirty years behind other mental disorders. Learning more about BPD seems
to worsen stress and depression in affected families. The prognosis for people
suffering from this disorder is highly variable, recovery is extremely
difficult, and treatment options are limited at best. Many books and Internet
sites on this disorder are biased and inaccurate, to put it mildly.
Fortunately, Understanding and
Treating Borderline Personality Disorder is one of the most complete and
responsibly written books I have found on any mental illness. I recommend it
without reservation to anyone who needs a comprehensive introduction to what is
known--and not known--about BPD.
This book is written in a textbook
style with glossaries and summaries at the end of each chapter. The chapters
are written by a number of authorities in the field and can be read
independently of each other. The editors obviously went to considerable effort
to make their work comprehensive and accessible to the general reader.
The intended audiences for this
book are the families and therapists of those who suffer from BPD. The
relationship between a person with BPD and other family members is often very
difficult, with a great deal of disappointment, blame, guilt, and resentment on
all sides. It is common for therapists to assume that BPD is simply the result
of bad parenting, which can lead to therapy that does more harm than good.
While many individuals with BPD have abusive backgrounds, many do not; and most
people who suffer abuse do not develop BPD. The authors stress the importance
of validating the feelings of clients and loved ones while avoiding patterns of
blame and guilt, and give concrete advice on how to achieve this difficult
The authors give detailed
descriptions of all the major therapies and treatment programs used with BPD,
and discuss the evidence for the effectiveness of each type. The reader may be
discouraged to learn that the outcome of therapy and medication is very unpredictable.
Certain types of therapies, like Dialectical Behavioral Therapy, have been
shown to be helpful in the short term, but the long-term benefits are less
certain. Medications can relieve symptoms but rarely cause dramatic
This book also includes four
personal accounts of BPD: two by persons suffering from the disorder and two
by family members. I was somewhat disappointed by the former two accounts.
They were clear and heartfelt, but seem to play into the stereotype of the "good
BPD patient"--female, showing great improvement with treatment, and
devoted to (and able to afford) apparently perpetual therapy. Unfortunately,
the research in this book suggests that many people with BPD are not helped
much by medication or therapy, assuming they can afford it at all. While I
understand the authors' desire to be optimistic, it would be helpful to have an
idea of how people with this disorder manage despite ineffective or
unaffordable treatment, poor emotional support, and employment troubles.
In my opinion, the most serious
failing of this book is that it presents BPD as a purely female disorder.
Twenty-five percent of people diagnosed with BPD are male, but the reader never
gets a basic idea of what a man with this condition would be like. Many
borderline behaviors are stereotypically female, and it is hard to imagine how
they would appear in a male. The authors mention that substance abuse and
acting out is more common in males, but give no examples.
In general, the prognosis for BPD is
highly variable. Some patients improve, some stay the same and some get
worse. Up to 10% of people diagnosed with the disorder eventually commit
suicide. The authors emphasize the poor state of research and treatment
options, and hopefully their articulate summary of what is and is not known
about BPD will lead to more vigorous study of this serious condition.
© 2005 David A. Flory
David Flory is a writer and
musician with a long-term interest in clinical psychology. He has a B.S. in
math from the University of Texas, and he lives in Texas.