The Complexities of Patient Secrecy

In this episode of the Psychiatry & Psychotherapy Podcast, Dr. David Puder is joined by Mark Ruffalo to dive deep into the complexities of borderline personality disorder (BPD). Together, they unpack Donald Burnham’s influential 1966 paper on splitting and identity diffusion, exploring themes of self-concept, relational dynamics, and the therapeutic challenges posed by BPD patients.

Learn how splitting impacts interpersonal relationships and therapeutic teams, the historical evolution of BPD from "pseudoneurotic schizophrenia" to a recognized DSM diagnosis, and the significance of psychodynamic and mentalization-based therapies in treatment.

Key topics include:

• The history of BPD diagnosis and theory
• Splitting and its effects on therapy teams and relationships
• Identity diffusion and its manifestations in gender, sexuality, and self-worth
• The role of childhood trauma, attachment, and genetic factors in BPD
• Practical insights for clinicians working with complex personality dynamics

Whether you’re a mental health professional, a student of psychiatry, or someone seeking a deeper understanding of BPD, this episode offers rich insights and evidence-based approaches for navigating this challenging and often misunderstood condition.

By listening to this episode, you can earn 1.75 Psychiatry CME Credits.

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