Borderline personality disorder (BPD) affects about 1% of the population.1 Until recently, little information has been available on the subject for patients with BPD and/or their families. Now there is a fairly crowded market—I found several books online.
So how does this volume stand out?
Borderline Personality Disorder: New Reasons for Hope is one in a series being published by Johns Hopkins University Press on major psychiatric disorders. It skillfully frames the complexities of BPD within a theoretical model of mental illness developed at the Johns Hopkins Department of Psychiatry and Behavioral Sciences.
The book is grounded in research, and its judgments are generally cautious. The authors usefully identify the reasons why clinicians often fail to diagnose BPD. The problems are based on the complexity of the disorder, its unfairly deserved reputation for chronicity, and the absence of any specific pharmacological treatment.2 Issues not dealt with in competing books, such as epidemiology, differential diagnosis, and cross-national differences, are described. The section on neuroimaging notes that such data are descriptive rather than explanatory.
A well-judged section on BPD in adolescence validates the diagnosis in that age-group. It cautions, however, that not all adolescents who self-mutilate or overdose on drugs go on to have BPD. In addition, the discussion of psychosocial risk factors avoids blaming parents for their child’s disorder.
Overall, the authors review a wide range of concepts with admirable simplicity. I had only a few differences of opinion with its conclusions. For example, they overestimate the value of medications in BPD, which have marginal efficacy and never lead to remission. However, it would not be possible to write a book on this subject that did not arouse controversy.
In summary, the book is thoughtful, accurate, and user-friendly. Because the authors avoid exaggeration and closely follow empirical evidence, it does not present the attractive, but misleading, impression that we understand what causes BPD or how to treat the most difficult cases.
1. Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;62:553-564.
2. Paris J. Treatment of Borderline Personality Disorder: A Guide to Evidence-Based Practice. New York: Guilford Press; 2008.