A Developmental Model of Borderline Personality Disorder: Understanding Variations in Course and Outcome

246 Pages·2002·1.6 MB·English

by  Patricia Hoffman Judd, Thomas H. McGlashan

A Developmental Model of
Borderline Personality
Disorder
Understanding Variations in
Course and Outcome
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A Developmental Model of
Borderline Personality
Disorder
Understanding Variations in
Course and Outcome
Patricia Hoffman Judd, Ph.D.
Clinical Professor of Psychiatry
University of California, San Diego, School of Medicine;
Program Director, Outpatient Psychiatric Services
University of California, San Diego,
San Diego, California
Thomas H. McGlashan, M.D.
Professor of Psychiatry
Yale University School of Medicine
Yale Psychiatric Institute
New Haven, Connecticut
Washington, DC
London, England
Note: The authors have worked to ensure that all information in this book is
accurate at the time of publication and consistent with general psychiatric and
medical standards, and that information concerning drug dosages, schedules,
and routes of administration is accurate at the time of publication and consis-
tent with standards set by the U. S. Food and Drug Administration and the gen-
eral medical community. As medical research and practice continue to advance,
however, therapeutic standards may change. Moreover, specific situations may
require a specific therapeutic response not included in this book. For these rea-
sons and because human and mechanical errors sometimes occur, we recom-
mend that readers follow the advice of physicians directly involved in their care
or the care of a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the views
and opinions of the individual authors and do not necessarily represent the pol-
icies and opinions of APPI or the American Psychiatric Association.
Copyright © 2003 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
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Library of Congress Cataloging-in-Publication Data
Judd, Patricia Hoffman, 1946–
A developmental model of borderline personality disorder : under-
standing variations in course and outcome / Patricia Hoffman Judd,
Thomas H. McGlashan.—1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-88048-515-9 (alk. paper)
1. Borderline personality disorder—Etiology. 2. Borderline personality
disorder—Treatment. 3. Borderline personality disorder—Case studies.
I. McGlashan, Thomas H., 1941– . II. Title.
[DNLM: 1. Borderline Personality Disorder—therapy—Case Report.
2. Treatment Outcome—Case Report. WM 190 J92d 2003]
RC569.5.B67 J834 2003
616.85 85206—dc21
2002027686
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
In memory of Rusty Bullard, M.D.,
Director of Chestnut Lodge Hospital from 1974 to 1994
With thanks to the patients, trainees, and my colleagues
over the years at UCSD Gifford Clinic—P.H.J.
With thanks to the patients and staff of
Chestnut Lodge Hospital—T.H.M.
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Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
I
Etiology
1 An Integrated Developmental Model. . . . . . . . . . . . . . . .3
II
Variations in Course and Outcome:
Case Histories
2 The Chestnut Lodge Follow-Up Study. . . . . . . . . . . . . .51
3 When She Was Good...Lillian . . . . . . . . . . . . . . . . . . .65
4 Love Having No Geography...Susan . . . . . . . . . . . . . . .91
5 Kindness of Strangers. . .Sylvia . . . . . . . . . . . . . . . . . . .109
6 Wild at Heart.. .Wendy . . . . . . . . . . . . . . . . . . . . . . . .131
III
Treatment
7 Universal Features of Treatment . . . . . . . . . . . . . . . . .157
8 Recurrent Themes and Issues . . . . . . . . . . . . . . . . . . . .185
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221
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Introduction
This book is designed for clinicians interested in under-
standing and treating patients with borderline personality disorder
(BPD) in both public mental health and private practice settings. The
book is based on the authors’ combined clinical, supervisory, and re-
search experience over the past 30 years and a detailed study of the BPD
patients included in the Chestnut Lodge Follow-Up Study described in
Chapter 2.
In the late 1980s, we embarked on a project to elucidate the course
and outcome of BPD through intensive case study of the rich clinical in-
formation available through the Chestnut Lodge study. Over the subse-
quent decade, the project lay dormant for long periods as we pursued
other professional and personal activities on opposite coasts inter-
spersed with revisions and resubmissions in response to suggestions by
American Psychiatric Press peer reviewers. When the book was ap-
proved for publication, a whole decade’s worth of new research had been
conducted and required incorporation. We were pleasantly surprised to
learn that, on careful review, the research provided empirical support
for much of our original thinking on the disorder. In addition, the grow-
ing body of research conducted on maltreated children added im-
mensely to our understanding of developmental course and outcome.
Out of this lengthy incubation period emerged a developmental
model of etiology that promised to elucidate the enormous heterogene-
ity in BPD course and outcome and to inform treatment. Thus, we em-
barked on our final revision, and what started as a descriptive book on
course and outcome was transformed into a theory-driven elaboration
of etiology, course, and outcome illustrated by four prototypical cases
and followed by a discussion of treatment implications.
ix