Dr. Lois Choi-Kain discusses the prevalence, naturalistic course, and treatments for borderline personality disorder (BPD) and introduces the "Good Psychiatric Management" (GPM) model. The topics covered include challenges faced by BPD patients, the need for sustainable treatment approaches, the significance of listening and understanding patients, and the use of an interpersonal hypersensitivity model in treatment.
Proper training and orientation can lead to rewarding experiences in working with BPD patients and their families.
Understanding personality disorders is crucial for effective psychiatric management.
Good Psychiatric Management (GPM) provides practical support to reduce symptoms and improve functionality in patients with BPD.
Deep dives
Understanding Borderline Personality Disorder
Borderline personality disorder (BPD) is a highly stigmatized diagnosis in psychiatry. However, avoiding the topic only reinforces the stigma surrounding it. In this episode, Dr. Lois Choi-Kane, a psychiatrist and director of the Gunderson Personality Disorders Institute, discusses the importance of clinicians being properly trained to effectively treat patients with BPD. Dr. Choi-Kane emphasizes the need for clinicians to approach the diagnosis without fear, treat it as any other psychiatric disorder, and provide practical, clinical information to help these patients. BPD is a common mental illness, and addressing it is essential in acute psychiatric settings and primary care. Proper training and orientation can lead to incredibly rewarding experiences in working with BPD patients and their families.
Personality Disorders and their Complexity
Personality disorders are complex psychological systems that shape how individuals develop, cope with stressors, and interact with others. Personality is the comprehensive psychological system that moderates internal and external experiences. It helps individuals cope, develop skills, and build relationships. Personality disorders occur when the personality structure, cluster, and function cause distress, impairment, and disruptions in everyday life. Despite the complexity and challenges in understanding personality functioning, it is central to the practice of psychiatry. Nearly half of patients who do not initially respond to treatments may have some element of their personality functioning that needs to be addressed to achieve better outcomes. Understanding personality disorders can be daunting but is crucial for effective psychiatric management.
The Prevalence and Impact of Borderline Personality Disorder
Borderline personality disorder affects approximately 6% of the general population, making it as common as other major mental illnesses like schizophrenia, obsessive-compulsive disorder (OCD), and bipolar disorder. In clinical settings, BPD is highly prevalent, with around 25% of patients in inpatient and outpatient facilities meeting the criteria. BPD is a condition that demands attention and effective management, as patients often struggle with suicidality, self-harm, and intense interpersonal instability. The stigma surrounding BPD should not deter clinicians from addressing it head-on and providing the necessary support and interventions to help patients improve their symptoms and functionality.
The Principles of Good Psychiatric Management (GPM)
Good Psychiatric Management (GPM) is a treatment approach aimed at providing practical help to patients with borderline personality disorder. The principles of GPM consist of active rather than reactive engagement with patients, focusing on goals and solutions, being professional but real in the therapeutic relationship, deprioritizing relationships in favor of patients developing a fulfilling life, and expecting change as a desired outcome. GPM avoids relying solely on medication, emphasizing the importance of psychotherapy and psychosocial treatments that have shown effectiveness. By following these principles, clinicians can offer patients with BPD more comprehensive and practical support to reduce symptoms and improve functionality.
Addressing Suicidal Ideation in Patients with BPD
The assessment and management of suicidal ideation in patients with borderline personality disorder require a comprehensive evaluation of the patient's history, current risk level, and dangerousness. Understanding the acute factors that contribute to suicidality, such as relationship conflicts, unstable moods, and impulsivity, can guide treatment decisions. Different approaches may be appropriate, including immediate interventions, crisis management, supportive therapy, or more formalized treatments like dialectical behavioral therapy (DBT) or mentalization-based treatment (MBT). The aim is to provide timely support, containment, and interventions that address the underlying issues and foster patient safety and stabilization.
Dr. Lois Choi-Kain, Director of the Gunderson Personality Disorders Institute at McLean Hospital and Associate Professor of Psychiatry at Harvard Medical School, introduces us to borderline personality disorder (BPD).
We discuss the prevalence, naturalistic course, and treatments for BPD. We explore BPD using the “Good Psychiatric Management” (GPM) model, which is intended to empower clinicians of all disciplines to manage patients with BPD effectively. We discuss the principles of GPM and walk through some examples of how it might be used in the clinical setting.
(11:30) Grant BF, Chou SP, Goldstein RB, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533-545.
(15:00) Gregory R, Sperry SD, Williamson D, Kuch-Cecconi R, Spink GL Jr. High Prevalence of Borderline Personality Disorder Among Psychiatric Inpatients Admitted for Suicidality. J Pers Disord. 2021;35(5):776-787.
(20:45) Kernberg O. Borderline personality organization. J Am Psychoanal Assoc. 1967;15(3):641-685.
(29:30) Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT. What Works in the Treatment of Borderline Personality Disorder. Curr Behav Neurosci Rep. 2017;4(1):21-30.
(33:00) Skodol AE, Gunderson JG, Shea MT, et al. The Collaborative Longitudinal Personality Disorders Study (CLPS): overview and implications. J Pers Disord. 2005;19(5):487-504.
(33:00) Temes CM, Zanarini MC. The Longitudinal Course of Borderline Personality Disorder. Psychiatr Clin North Am. 2018;41(4):685-694.
Remember Everything You Learn from Podcasts
Save insights instantly, chat with episodes, and build lasting knowledge - all powered by AI.
