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BORDERLINE PERSONALITY DISORDER
Primer on Series
Anxiety Disorders
Kerry J. Ressler, Daniel S. Pine, Barbara Olasov Rothbaum

Autism Spectrum Disorder

Christopher J. McDougle

Schizophrenia and Psychotic Spectrum Disorders

S. Charles Schulz, Michael F. Green, Katharine J. Nelson

Mental Health Practice and the Law

Ronald Schouten
BORDERLINE
PERSONALITY
DISORDER
Edited by
Barbara Stanley, PhD
Professor of Medical Psychology
Department of Psychiatry
Columbia University College of Physicians and Surgeons
Director, Suicide Prevention Training, Implementation and Evaluation
New York State Psychiatric Institute
New York, NY

Antonia S. New, MD
Associate Professor of Psychiatry
Director, Medical Student Education
Department of Psychiatry
Mount Sinai School of Medicine
New York, NY

1
1
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.

Published in the United States of America by Oxford University Press

198 Madison Avenue, New York, NY 10016, United States of America.

© Oxford University Press 2018

All rights reserved. No part of this publication may be reproduced, stored in

a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by license, or under terms agreed with the appropriate reproduction
rights organization. Inquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above.

You must not circulate this work in any other form

and you must impose this same condition on any acquirer.

CIP data is on file at the Library of Congress

ISBN 978–​0–​19–​999751–​0

This material is not intended to be, and should not be considered, a substitute for medical or other professional
advice. Treatment for the conditions described in this material is highly dependent on the individual
circumstances. And, while this material is designed to offer accurate information with respect to the subject
matter covered and to be current as of the time it was written, research and knowledge about medical and health
issues is constantly evolving and dose schedules for medications are being revised continually, with new side
effects recognized and accounted for regularly. Readers must therefore always check the product information
and clinical procedures with the most up-​to-​date published product information and data sheets provided by
the manufacturers and the most recent codes of conduct and safety regulation. The publisher and the authors
make no representations or warranties to readers, express or implied, as to the accuracy or completeness of this
material. Without limiting the foregoing, the publisher and the authors make no representations or warranties as
to the accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publisher do not
accept, and expressly disclaim, any responsibility for any liability, loss or risk that may be claimed or incurred
as a consequence of the use and/​or application of any of the contents of this material.

9 8 7 6 5 4 3 2 1
Printed by WebCom, Inc., Canada
 This primer is dedicated to two leaders in our field, Dr. Larry J Siever and
Dr. Kenneth Silk. Both have been very valued mentors and colleagues to the
Editors of this volume as well as to many of the chapter authors. Dr. Siever
has been a moving force in the reconceptualization of personality disorders by
bringing the tools of neuroscience and genetics to the study of these illnesses.
Neurobiological scrutiny has brought hope to patients through a better
understanding, and better treatments, of their illnesses. Larry was also an
inspiringly brilliant mentor to a generation of research scientists in the study
of personality disorders. He has now retired due to an ongoing illness. Dr. Silk,
who died in April of 2016, was a true leader in the development of treatments
for personality disorders. He worked tirelessly to enhance the assessment,
psychosocial and pharmacologic management of personality disorders. He
was also a mentor to many of the authors in this primer and was known for his
wonderful sense of humor, his warmth and his generosity to his mentees.
CONTENTS

Contributors xi

1. A History of Borderline Personality Disorder 1

Antonia S. New and Joseph Triebwasser

2. Diagnosis of Borderline Personality Disorder 17

Barbara Stanley and Tanya Singh

3. Onset, Course, and Prognosis for Borderline Personality Disorder 35

Mary C. Zanarini and Lindsey C. Conkey

4. Clinical Phenomenology of Borderline Personality Disorder 55

Larry Siever

5. The Relationship Between Childhood Adversity

and Borderline Personality Disorder 71
Joel Paris

6. Neurobiology of Borderline Personality Disorder 83

Annegret Krause-​Utz, Inga Niedtfeld, Julia Knauber, and Christian Schmahl

7 Genetic Influences on Borderline Personality Disorder 111

Marijn A. Distel and Marleen H. M. de Moor

8. Suicidal and Nonsuicidal Self-​Injury in Borderline

Personality Disorder 129
Margaret S. Andover, Heather T. Schatten, and Blair W. Morris

9. Substance Use Disorder in Borderline Personality Disorder 149

Beth S. Brodsky and Linda Dimeff

vii
viii    / / Contents

10. Eating Disorders in Borderline Personality Disorder 167

Eunice Chen

11. Borderline Personality Disorder and Mood Disorders 185

Eric A. Fertuck, Megan S. Chesin, and Brian Johnston

12. Aggressive Behavior and Interpersonal Difficulties

in Borderline Personality Disorder 205
Lori N. Scott and Paul A. Pilkonis

13. Pharmacological Interventions for Borderline Personality Disorder 225

Kenneth R. Silk

14. Mentalization-​Based Treatment 247

Lois W. Choi-​Kain

15. Transference-​Focused Psychotherapy: A Psychodynamic

Treatment of Personality Disorders 271
Frank E. Yeomans and Jill C. Delaney

16. Dialectical Behavior Therapy 289

Shireen L. Rizvi and Kristen M. Roman

17. Cognitive Therapy for Personality Disorders 307

Kate M. Davidson

18. Supportive Psychotherapy and Case Management 325

David J. Hellerstein and Ron B. Aviram

19. Family Psychoeducation Approaches

for Borderline Personality Disorder 349
Valerie Porr

20. Meeting the Clinical Challenges of Managing Borderline

Personality Disorder 363
Beth S. Brodsky

21. Assessing, Managing, and Resolving Suicide Risk

in Borderline Personality Disorder 377
Adam Carmel, Jeffrey Sung, and Katherine Anne Comtois
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 Contents  //    ix

22. Forensic Issues in Borderline Personality Disorder 403

Alexander L. Chapman and André Ivanoff

23. Borderline Personality Disorder and Advocacy: Individuals

and Family Members Speaking Out for Change 421
Paula Tusiani-​Eng and Bea Tusiani

Index 437
CONTRIBUTORS

Margaret S. Andover, PhD Megan S. Chesin, PhD

Department of Psychology Department of Psychology
Fordham University William Paterson University
Bronx, New York Wayne, New Jersey

Ron B. Aviram, PhD Lois W. Choi-​Kain, MD

Ferkauf Graduate School Department of Psychiatry
Yeshiva University Harvard Medical School
Private Practice McLean Hospital
New York, New York Belmont, Massachusetts

Beth S. Brodsky, PhD Katherine Anne Comtois, PhD, MPH

Department of Psychiatry Department of Psychiatry and
Columbia University Behavioral Sciences
New York State Psychiatric Institute University of Washington
New York, New York Harborview Medical Center
Seattle, Washington
Adam Carmel, PhD
Department of Psychiatry Lindsey C. Conkey, MA
Harvard Medical School Psychological and Brain Sciences
Massachusetts Mental Health Center University of Massachusetts
Beth Israel Deaconess Medical Center Amherst, Massachusetts
Boston, Massachusetts
Kate M. Davidson, PhD
Alexander L. Chapman, PhD Institute of Health and Well Being
Department of Psychology University of Glasgow
Simon Fraser University Glasgow, Scotland
Burnaby, British Columbia, Canada
Marleen H. M. de Moor, PhD
Eunice Chen, PhD Department of Clinical Child and
Department of Psychology Family Studies
Temple University Vrije University
Philadelphia, Pennsylvania Amsterdam, the Netherlands
xi
xii    / / Contributors

Jill C. Delaney, LCSW Julia Knauber, MD

Private Practice Department of Psychosomatic Medicine
New York, New York Central Institute of Mental Health
Mannheim
Linda Dimeff, PhD Medical Faculty Mannheim
Portland DBT Institute Heidelberg University
Portland, Oregon Heidelberg, Germany

Marijn A. Distel, PhD Annegret Krause-​Utz, PhD

Department of Psychiatry Department of Psychosomatic Medicine
Vrije University Central Institute of Mental Health
Amsterdam, the Netherlands Mannheim
Medical Faculty Mannheim
Eric A. Fertuck, PhD Heidelberg University
Graduate Center Heidelberg, Germany
City University of New York Institute of Psychology
Department of Psychology Leiden University
City College of New York Leiden Institute for Brain and Cognition
New York, New York Leiden, the Netherlands

David J. Hellerstein, MD Blair W. Morris, PhD

Department of Psychiatry Behavioral Health Integration Program
Columbia University Montefiore Medical Center
New York, New York Bronx, New York

André Ivanoff, PhD Antonia S. New, MD

School of Social Work Department of Psychiatry
Columbia University Mount Sinai School of Medicine
New York, New York New York, New York

Brian Johnston, MA Inga Niedtfeld, MD

Graduate Center Department of Psychosomatic Medicine
City University of New York Central Institute of Mental Health
Department of Psychology Mannheim
City College of New York Medical Faculty Mannheim
New York, New York Heidelberg University
Heidelberg, Germany
 Contributors  //     xiii

Joel Paris, MD Lori N. Scott, PhD

Department of Psychiatry Department of Psychiatry
McGill University University of Pittsburgh School of
Montreal, Canada Medicine
Pittsburgh, Pennsylvania
Paul A. Pilkonis, MD
Department of Psychiatry Larry Siever, MD
University of Pittsburgh School of Department of Psychiatry
Medicine Mount School of Medicine
Pittsburgh, Pennsylvania New York, New York

Valerie Porr, MA Kenneth R. Silk, MD (deceased)

TARA4BPD Professor of Psychiatry
New York, New York University of Michigan Health System
Department of Psychiatry
Shireen L. Rizvi, PhD Ann Arbor, Michigan
Graduate School of Applied and
Professional Psychology Tanya Singh, MA
Rutgers University New York State Psychiatric Institute
New Brunswick, New Jersey New York, New York

Kristen M. Roman, PsyD Barbara Stanley, PhD

Graduate School of Applied and Department of Psychiatry
Professional Psychology Columbia University College of
Rutgers University Physicians and Surgeons
New Brunswick, New Jersey New York State Psychiatric Institute
New York, New York
Heather T. Schatten, PhD
Department of Psychiatry and Human Jeffrey Sung, MD
Behavior Department of Psychiatry and
Butler Hospital Behavioral Sciences
The Warren Alpert Medical School University of Washington
Brown University Harborview Medical Center
Providence, Rhode Island Seattle, Washington

Christian Schmahl, MD Joseph Triebwasser, MHCC

Department of Psychosomatic Medicine Attending Physician
Central Institute of Mental Health James J. Peters VA Medical Center
Mannheim West Kingsbridge Road
Medical Faculty Mannheim Bronx, NY
Heidelberg University
Heidlberg, Germany
xiv    / / Contributors

Bea Tusiani Frank E. Yeomans, MD, PhD

Author, Remnants of a Life on Department of Psychiatry
Paper: A Mother and Daughter’s Cornell University Medical College
Struggle with Borderline Personality New York, New York
Disorder
New York, New York Mary C. Zanarini, EdD
Department of Psychiatry
Paula Tusiani-​Eng, LMSW, MDiv Harvard Medical School
Emotions Matter, Inc. Laboratory for the Study of Adult
Author, Remnants of a Life on Paper: Development
A Mother and Daughter’s Struggle McLean Hospital
with Borderline Personality Disorder Belmont, MA
New York, New York
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