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Dissertation

The diagnosis and inpatient treatment of the borderline personality: A case study

1 May 1985

Abstract

The diagnosis and inpatient treatment of individuals with borderline personality were reviewed prior to the presentation of a single case study. Alternative interpretations of the concept were examined including borderline as (1) a psychostructural organization independent of specific diagnoses, (2) a mild form of schizophrenia, (3) a distinct clinical entity (personality disorder), and (4) a variant of affective disorder. Two prevalent and empirically-based diagnostic systems, including the Diagnostic Interview for Borderlines (DIB, Gunderson & Kolb, 1976) and current DSM-III criteria for Borderline Personality Disorder (3rd ed., 1980) were compared in terms of interrater reliability, comprehensiveness, concordance with established clinical usage, specificity, and validity. An overview of problems encountered in inpatient treatment was reviewed, with specific emphasis on the function of regressive behavior, considerations of short- versus long-term care, stabilization of staff attitudes, the patient's reliance on primitive defenses, and the necessity of an active and confrontive treatment milieu. A brief review of the psychological test literature was undertaken, highlighting the borderline patient's performance on structured versus unstructured tasks. Lastly, a single case study was presented on a patient principally diagnosed according to DSM-III criteria for Borderline Personality Disorder. The results of psychological testing undertaken with both the index patient and her parents were discussed. Associated Axis I and Axis II disorders were examined, as well as the description and results of a multifaceted therapeutic program, including conjoint work with the patient's family.


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