Borderline personality disorder and Cedrick Hardman: Difference between pages

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{{NFLretired
{{DiseaseDisorder infobox |
|name=Cedrick Hardman
| Name =  Emotionally unstable personality disorder 
|image=Cedrick Hardman at 2003 NFL Combine.JPG
| ICD10 = ({{ICD10|F|60|3|f|60}})
|position=[[Defensive end]]
| ICD9 = {{ICD9|301.83}}
|number=
|
|birthdate={{birth date and age|1948|10|4}}<BR>[[Houston, Texas]]
|debutyear=1970
|finalyear=1983
|draftyear=1970
|draftround=1
|draftpick=9
|college=[[North Texas University|North Texas]]
|teams=<nowiki></nowiki>
* [[San Francisco 49ers]] ([[1970 NFL season|1970]]-[[1979 NFL season|1979]])
* [[Oakland Raiders]] ([[1980 NFL season|1980]]-[[1981 NFL season|1981]])
* ([[USFL]]) [[Oakland Invaders]] (1983)
|stat1label=[[Tackle (football move)|Tackles]]
|stat1value=--
|stat2label=[[Quarterback sack|Sacks]]
|stat2value=112.5
|stat3label=[[Interceptions]]
|stat3value=0
|nfl=HAR068848
|highlights=<nowiki></nowiki>
* 2x [[Pro Bowl]] selection ([[1972 Pro Bowl|1971]], [[1976 Pro Bowl|1975]])
|HOF=
|CollegeHOF=
}}
}}
'''Cedrick Ward Hardman''' (born [[October 4]], [[1948]] in [[Houston, Texas]]) is a former [[American Football]] [[defensive end]] who played for the [[National Football League]]'s [[San Francisco 49ers]] and [[Oakland Raiders]] and the [[United States Football League]]'s [[Oakland Invaders]]. Hardman's thirteen year professional football career lasted from 1970 to 1983 in the [[National Football League]] and ended as a player/coach in 1983 with the [[USFL]]'s [[Oakland Invaders]]. Since 2002, Hardman has worked closely with sports attorney [[Don West, Jr.]]
'''Borderline personality disorder''' ('''BPD''') is a [[psychiatry|psychiatric diagnosis]] in the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' ([[DSM-IV Codes#Personality Disorders|DSM-IV Personality Disorders]] 301.83<ref name="DSM-IV_301.83">[http://www.psychiatryonline.com/content.aspx?aID=3974 301.83 Borderline Personality Disorder]" in ''Diagnostic and Statistical Manual of Mental Disorders'', Fourth Edition. [[DOI: 10.1176/appi.books.9780890423349.3831]]. Retrieved on [[2007-09-21]].</ref>) that describes a prolonged [[personality disorder|disturbance of personality function]] characterized by depth and variability of moods.<ref name=millon>{{cite book
| first=Theordore
| last= Millon
| year= 1996
| title=Disorders of Personality: DSM-IV-TM and Beyond
| edition=
| publisher=John Wiley and Sons
| location=New York
| pages= pp. 645&ndash;690
| id= ISBN 0-471-01186-X }}</ref> The [[mental disorder|disorder]] typically involves unusual levels of instability in [[Mood (psychology)|mood]]; "black and white" thinking, or "[[splitting (psychology)|splitting]]"; chaotic and unstable [[interpersonal relationship]]s, [[self-image]], [[Identity (social science)|identity]], and [[human behavior|behavior]]; as well as a disturbance in the individual's [[Psychological identity|sense of self]]. In extreme cases, this disturbance in the sense of self can lead to periods of [[dissociation]].<ref name="DSM-IV-TR">(2004). ''Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR'' (Text Revision). Washington, DC: American Psychiatric Association. ISBN [[Special:Booksources/0890420246|0890420246]]. [http://www.behavenet.com/capsules/disorders/borderlinepd.htm DSM-IV & DSM-IV-TR Borderline Personality Disorder criteria]. BehaveNet.com. Retrieved on [[2007-09-21]].</ref> These disturbances can have a pervasive negative impact on many or all of the psychosocial facets of life. This includes difficulties maintaining relationships in work, home, and social settings. Attempted suicide and completed suicide are possible outcomes, especially without proper care and effective therapy.<ref name="Robinson">{{cite book|last = Robinson|first = David J.| title = Disordered Personalities| publisher = Rapid Psychler Press| date = 2005| pages =pp. 255-310| isbn = 1-894328-09-4}}</ref> Onset of symptoms typically occurs during adolescence or young adulthood. Symptoms may persist for several years, but the majority of symptoms lessen in severity over time.<ref name="Robinson"/> with some individuals fully recovering. The mainstay of treatment is various forms of [[psychotherapy]], although medication and other approaches may also improve symptoms.


== Biography==
As with other mental disorders, the causes of BPD are complex and unknown.<ref name="mayo">{{cite web|url=http://www.mayoclinic.com/health/borderline-personality-disorder/DS00442/DSECTION=3|title=Borderline personality disorder|publisher=MayoClinic.com|accessdate=2008-05-15}}</ref> One finding is a history of childhood trauma (possibly [[child sexual abuse]]),<ref name=kluft/> although researchers have suggested diverse possible causes, such as a genetic predisposition, neurobiological factors, environmental factors or brain abnormalities.<ref name="mayo" /> The prevalence of BPD in the United States has been calculated as 1 to 3 percent of the adult population,<ref name="mayo"/> with approximately 75% of those diagnosed being female, 25% male.<ref>[http://www.ncbi.nlm.nih.gov/pubmed/18555059 PubMed]</ref> It has been found to account for 20 percent of psychiatric hospitalizations. Common [[comorbid]] (co-occurring) conditions are other mental disorders such as substance abuse, depression and other [[mood disorders]], and other personality disorders. BPD is one of four diagnoses classified as "cluster B" ("dramatic-erratic") personality disorders typified by disturbances in impulse control and [[emotional dysregulation]], the others being [[Narcissistic personality disorder|narcissistic]], [[Histrionic personality disorder|histrionic]], and [[antisocial personality disorder]]s.
===College years===
Hardman played college football at North Texas State University, (renamed the [[University of North Texas]] in 1988). Hardman was an All-[[Missouri Valley Conference]] football defensive lineman. In a historic manner, Hardman recorded 38 sacks in his senior season at North Texas State<ref>{{cite web|url=http://www.unt.edu/northtexan/archives/f01/homecoming3.htm|title=The North Texan Online - Homecoming 2001|accessdate=2007-03-07}}</ref> and represented North Texas State in the Blue-Gray and Senior Bowl all-star games in 1970.
Cedrick started playing college football as a defensive back, then moved to linebacker in his sophomore season. His final two college years were spent playing defensive end. Hardman was drafted with the ninth overall selection in the first round of the [[1970 NFL Draft]] by the [[San Francisco 49ers]].<ref>{{cite web|url=http://www.drafthistory.com/years/1970.html|title=DraftHistory.com 1970 |accessdate=2007-03-07}}</ref>


===NFL career===
The term borderline, although it was used in this context as early as the 17th century, was employed by Adolph Stern in 1938 to describe a condition as being on the borderline between [[neurosis]] and [[psychosis]]. Because the term no longer reflects current thinking, there is an ongoing debate concerning whether this disorder should be renamed.<ref name="mayo" /> There is related concern that the diagnosis [[Social stigma|stigmatizes]] people, usually women, and supports pejorative and discriminatory practices.
Hardman is the current all-time sack leader for the San Francisco 49ers franchise, recording 112.5 sacks between 1970 and 1979.<ref>{{cite web|url=http://www.49ers.com/history/career_stats.php?section=HI%20Career%20Stats%20Leaders|title=Official Site of San Francisco 49ers - Career Stat Leaders |accessdate=2007-03-07}}</ref> Hardman was a two-time [[Pro Bowl]]er in 1971 and 1975<ref>{{cite web|url=http://www.49ers.com/history/pro_bowlers.php?section=HI%20Pro%20Bowlers|title=Official Site of San Francisco 49ers - Pro Bowlers |accessdate=2007-03-07}}</ref> and he was a member of the [[Oakland Raiders]] [[Super Bowl XV]] winning team.<ref>{{cite web|url=http://www.theredzone.org/superbowl/games/sbxv.asp|title=The Red Zone -Super Bowl XV |accessdate=2007-03-07}}</ref> Cedrick's lifetime stats are borderline NFL Hall of Fame.


==History==
===USFL career===
On October 20, 1982, Hardman was the first player ever signed by the [[Oakland Invaders]] of newly formed [[United States Football League]].<ref>{{cite web|url=http://query.nytimes.com/gst/fullpage.html?res=9A00E5DB153BF933A15753C1A964948260|title=Sports People; Comings and Goings |accessdate=2007-02-17}}</ref>
Since the earliest record of medical history, the coexistence of intense, divergent moods within an individual has been recognized by such writers as [[Homer]], [[Hippocrates]] and [[Aretaeus of Cappadocia|Aretaeus]], the last describing the vacillating presence of impulsive anger, melancholia and mania within a single person. After medieval suppression of the concept, it was revived by Bonet in 1684 who, using the term ''folie maniaco-mélancolique'', noted the erratic and unstable moods with periodic highs and lows that rarely followed a regular course. His observations were followed by those of other writers who noted the same pattern, including writers such as the American psychiatrist C. Hughes in 1884 and J.C. Rosse in 1890, who described "borderline insanity". [[Emil Kraepelin|Kraepelin]], in 1921, identified an "excitable personality" that closely parallels the borderline features outlined in the current concept of borderline.<ref name=millon/>
Hardman served as a player/coach during the team's inaugural 1983 division winning 9-9 season.
===Acting career===


'''Movies'''<ref>{{cite web|url=http://movies2.nytimes.com/gst/movies/filmography.html?p_id=30352&mod=main|title=New York Times Cedrick Hardman Filmography |accessdate=2007-03-07}}</ref>
Adolf Stern wrote the first significant psychoanalytic work to use the term "borderline" in 1938, referring to a group of patients with what was thought to be a mild form of [[schizophrenia]], on the borderline between [[neurosis]] and [[psychosis]]. For the next decade the term was in popular and colloquial use, a loosely conceived designation mostly used by theorists of the psychoanalytic and biological schools of thought. Increasingly, theorists who focused on the operation of social forces were recognized as well. During the 1940s and 1950s a variety of other terms were also used for this group of patients, such as "ambulatory schizophrenia" (Zilboorg), "preschizophrenia" (Rapaport), "latent schizophrenia" (Federn), "pseudoneurotic schizophrenia" (Hoch and Polatin), "schizotypal disorder" (Rado), and "borderline state" (Knight).


[[House Party]] (1990) .... Rock
The 1960s and 1970s saw a shift from thinking of the borderline syndrome as borderline ''schizophrenia'' to thinking of it as a borderline ''affective disorder'' ([[mood disorder]]), on the fringes of [[Bipolar disorder|manic depression]], [[cyclothymia]] and [[dysthymia]]. In [[DSM-II]], stressing the affective components, the diagnosis was known as the personality disorder, [[Cyclothymic personality]] (Affective personality).<ref name=dsm2>{{cite book
| first=
| last= American Psychiatric Association
| year= 1968
| title=DSM-II:Diagnostic and Statistical Manual of Mental Disorders
| edition= 2nd Ed.
| publisher=American Psychiatric Association
| location=Washington, D.C.
| pages= p. 42
| id= }}</ref> In parallel to this evolution of the term "borderline" to refer to a distinct category of disorder, psychoanalysts such as [[Otto Kernberg]] were using it to refer to a broad [[Spectrum disorder|spectrum]] of issues, describing an intermediate level of personality organization<ref name=millon/> between neurotic and psychotic processes.<ref name="autogenerated1">Aronson, T (1985) Historical perspectives on the borderline concept: A review and critique. Psychiatry: Journal for the Study of Interpersonal Processes. Vol 48(3), pp. 209-222</ref>


[[Stir Crazy]] (1980) .... Big Mean
Standardized criteria were developed<ref>Gunderson, J, Kolb, J and Austin, V (1981) The diagnostic interview for borderline patients. American Journal of Psychiatry 138(7) pp. 896-903</ref> to distinguish BPD from affective disorders and other Axis I disorders, and BPD became a personality disorder diagnosis in 1980 with the publication of [[Diagnostic and Statistical Manual of Mental Disorders|DSM-III]].<ref name="PToverview">Oldham, J. (July 2004). "[http://www.psychiatrictimes.com/p040743.html Borderline Personality Disorder: An Overview]" ''Psychiatric Times'' '''XXI''' (8). Retrieved on [[2007-09-21]].</ref> The diagnosis was formulated predominantly in terms of mood and behavior, distinguished from sub-syndromal schizophrenia which was termed "[[Schizotypal personality disorder]]".<ref name="autogenerated1" /> The final terminology in use by the DSM today was decided by the DSM-IV Axis II Work Group of the American Psychiatric Association.<ref name=millon2>{{cite book
| first=Theordore
| last= Millon
| year= 1996
| title=Disorders of Personality: DSM-IV-TM and Beyond
| edition=
| publisher=John Wiley and Sons
| location=New York
| pages= p. viii
| id= ISBN 0-471-01186-X }}</ref>


[[The Candidate]] (1972) .... Actor
==Diagnosis==
Diagnosis is based on a clinical [[psychiatric assessment|assessment]] by a qualified [[mental health professional]]. The assessment incorporates the patient's self-reported experiences as well as the clinician's observations. The resulting profile may be supported or corroborated by long term patterns of behavior as reported by family members, friends or co-workers. The list of criteria that must be met for diagnosis is outlined in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV-TR]].<ref name="DSM-IV-TR"/>


'''Television'''
Borderline personality disorder was once classified as a subset of schizophrenia (describing patients with borderline schizophrenic tendencies). Today BPD is considered a relatively stable personality disorder and is used more generally to describe non psychotic individuals who display emotional disregulation, splitting, and an unstable self image. {{Fact|date=June 2008}} Individuals with BPD are at high risk of developing other psychological disorders such as anxiety and depression. Other symptoms of BPD, such as dissociation, are frequently linked to severely traumatic childhood experiences which some put forth as one of the many root causes of the borderline personality. BPD has many similar characteristics to emotionally unstable personality disorder, subtype borderline; and [[complex post-traumatic stress disorder]].{{Fact|date=June 2008}}


"The Fall Guy" .... Righteous (1 episode, 1981)
===DSM-IV-TR criteria===
The latest version of the ''[[DSM-IV-TR|Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM-IV-TR), the widely-used [[American Psychiatric Association]] guide for clinicians seeking to diagnose [[mental illness]]es, defines Borderline Personality Disorder (BPD) as: "a pervasive pattern of instability of [[interpersonal relationship]]s, [[self-image]] and [[affect (psychology)|affect]]s, as well as marked [[Impulse control|impulsivity]], beginning by early adulthood and present in a variety of contexts."<ref name="criteria">"[http://www.borderlinepersonalitytoday.com/main/dsmiv.htm Borderline Personality Disorder DSM IV Criteria]". ''BPD Today''. Retrieved on [[2007-09-21]].</ref> BPD is classed on "Axis II", as an underlying pervasive or personality condition, rather than "Axis I" for more circumscribed mental disorders. A DSM diagnosis of BPD requires any five out of nine listed criteria to be present for a significant period of time. There are thus 256 different combinations of symptoms that could result in a diagnosis, of which 136 have been found in practice in one study.<ref>Johansen, M.; S. Karterud, G. Pedersen, et al. (2004). "[http://www.blackwell-synergy.com/doi/abs/10.1046/j.1600-0447.2003.00268.x An investigation of the prototype validity of the borderline DSM-IV construct]". ''[[Acta Psychiatrica Scandinavica]]'' '''109''' (4): 289–98. Retrieved on [[2007-09-21]].</ref> The criteria are:<ref name="DSM-IV-TR"/>


- The Fall Guy: Part 1 (1981) TV Episode (as Cedrick Hardman) .... Righteous
# Frantic efforts to avoid real or imagined abandonment. [Not including suicidal or self-mutilating behavior covered in Criterion 5]''
# A pattern of unstable and intense [[interpersonal relationship]]s characterized by alternating between extremes of [[idealization and devaluation]].
# [[Identity]] disturbance: markedly and persistently unstable [[self-image]] or [[psychological identity|sense of self]].
# [[Impulse control disorder|Impulsivity]] in at least two areas that are potentially self-damaging (e.g., [[promiscuous sex]], [[eating disorder]]s, [[binge eating]], [[substance abuse]], [[reckless driving]]). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5]
# Recurrent [[suicide|suicidal behavior]], gestures, threats, or [[self-mutilation|self-mutilating behavior]] such as cutting, interfering with the healing of scars, or picking at oneself.
# [[Affect (psychology)|Affective]] instability due to a marked reactivity of [[mood]] (e.g., intense episodic [[dysphoria]], irritability, or [[anxiety]] usually lasting a few hours and only rarely more than a few days).
# Chronic feelings of [[emptiness]], worthlessness.
# Inappropriate [[anger]] or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
# Transient, [[Stress (medicine)|stress]]-related [[paranoia|paranoid]] ideation, [[delusions]] or severe [[Dissociation|dissociative]] symptoms


"Police Woman" .... Large Man (1 episode, 1975)
===Comparable diagnoses===
- Police Woman - The Company (1975) TV Episode (as Cedrick Hardman) .... Large Man


==References==
The [[World Health Organization]]'s [[ICD-10]] has a comparable diagnosis called [[Emotionally unstable personality disorder#F601_Borderline_type|Emotionally unstable personality disorder - Borderline type (F60.31)]]. This requires the following, in addition to the general criteria for personality disorder: disturbances in and uncertainty about self-image, aims, and internal preferences (including sexual); liability to become involved in intense and unstable relationships, often leading to emotional crisis; excessive efforts to avoid abandonment; recurrent threats or acts of self-harm; and chronic feelings of emptiness.
<references/>

The [[Chinese Society of Psychiatry]]'s [[CCMD]] has a comparable diagnosis of Impulsive Personality Disorder (IPD). A patient diagnosed as having IPD must display "affective outbursts" and "marked impulsive behavior", plus at least three out of eight other symptoms. The construct has been described as a hybrid of the impulsive and borderline subtypes of the ICD-10's Emotionally Unstable Personality Disorder, and also incorporates six of the nine DSM BPD criteria.<ref>Zhong, J.; F. Leung ([[2007-01-05]]). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17254494 Should borderline personality disorder be included in the fourth edition of the Chinese classification of mental disorders?]" ''Chin Med J'' (English) '''120''' (1): 77-82. Retrieved on [[2007-09-21]].</ref>

===Associated features===

It has been noted that there is probably no other mental disorder about which so many articles and books have been written, yet about which so little is known based on [[empiricism|empirical research]].<ref name="cogemo">Arntz, A. (September 2005). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16018875 Introduction to special issue: cognition and emotion in borderline personality disorder.]" ''J Behav Ther Exp Psychiatry'' '''36''' (3): 167-72. Retrieved on [[2007-09-21]].</ref>

Studies suggest that individuals with BPD tend to experience frequent, strong and long-lasting states of [[aversives|aversive]] tension, often triggered by perceived rejection, being alone, or perceived failure.<ref>Stiglmayr, C.E.; T. Grathwol, M.M. Leneham, et al. (May 2005). "[http://www.ncbi.nlm.nih.gov/pubmed/15819731?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Aversive tension in patients with borderline personality disorder: a computer-based controlled field study.]" ''[[Acta Psychiatrica Scandinavica]]'' '''111''' (5): 372-9. Retrieved on [[2007-09-21]].</ref> Individuals with BPD may show [[Affective lability|lability]] (changeability) between anger and anxiety or between depression and anxiety<ref>Koenigsberg H.W.; P.D. Harvey, V. Mitropoulou, et al. (May 2002). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=11986132 Characterizing affective instability in borderline personality disorder]". ''Am J Psychiatry'' '''159''' (5): 784-8. Retrieved on [[2007-09-21]].</ref> and temperamental sensitivity to emotive stimuli.<ref>Meyer, B.; M. Ajchenbrenner, D.P. Bowles (December 2005). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16553560 Sensory sensitivity, attachment experiences, and rejection responses among adults with borderline and avoidant features]". ''J Personal Disord'' '''19''' (6): 641-58. Retrieved on [[2007-09-21]].</ref>

The negative emotional states particularly associated with BPD have been grouped into four categories: extreme feelings in general; feelings of destructiveness or self-destructiveness; feelings of fragmentation or lack of identity; and feelings of victimization.<ref>Zanarini, M.C.; F.R. Frankenburg, C.J. DeLuca, et al. (1998). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10370445 The pain of being borderline: dysphoric states specific to borderline personality disorder]". ''Harvard Review of Psychiatry'' '''6''' (4): 201-7. Retrieved on [[2007-09-21]].</ref>

Individuals with BPD can be very [[Social rejection#rejection sensitivity|sensitive]] to the way others treat them, reacting strongly to perceived criticism or hurtfulness. Their feelings about others often shift from positive to negative, generally after a disappointment or perceived threat of losing someone. Self-image can also change rapidly from extremely positive to extremely negative. Impulsive behaviors are common, including alcohol or drug abuse, unsafe sex, gambling, and recklessness in general.<ref>American Psychiatric Association (2001). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=11726742&dopt=Abstract Psychiatric Services]". ''Psychiatr Serv'' (52): 1569-70. Retrieved on [[2007-09-21]].</ref> Attachment studies suggest individuals with BPD, while being high in intimacy- or novelty-seeking, can be hyper-alert<ref name="cogemo"/> to signs of rejection or not being valued and tend towards insecure, avoidant or ambivalent, or fearfully preoccupied patterns in relationships.<ref>Levy, K.N.; K.B. Meehan, M. Weber, et al. (March &ndash; April 2005). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15802944 Attachment and borderline personality disorder: implications for psychotherapy]". ''Psychopathology'' '''38''' (2): 64-74. Retrieved on [[2007-09-21]].</ref> They tend to view the world generally as dangerous and malevolent, and themselves as powerless, vulnerable, unacceptable and unsure in self-identity.<ref name="cogemo"/>

Individuals with BPD are often described, including by some [[mental health]] professionals (and in the DSM-IV),<ref name="criteria"/> as deliberately manipulative or difficult, but analyses and findings generally trace behaviors to inner pain and turmoil, powerlessness and defensive reactions, or limited [[coping]] and communication skills.<ref name="manipulative">Potter, N. (April 2006). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16643118 What is manipulative behavior, anyway?]" ''J Personal Disord.'' '''20''' (2): 139-56; discussion 181-5. Retrieved on [[2007-09-21]].</ref><ref>McKay, D.; C.A. Gavigan, S. Kulchycky (2004). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15224626 Social skills and sex-role functioning in borderline personality disorder: relationship to self-mutilating behavior]". ''Cogn Behav Ther'' '''33''' (1): 27-35. Retrieved on [[2007-09-21]].</ref><ref>Linehan, M. (1993). ''Cognitive-behavioral treatment of borderline personality disorder.'' New York: Guilford. [[Special:Booksources/0898621836|ISBN 0898621836]].</ref> There has been limited research on family members' understanding of borderline personality disorder and the extent of burden or negative emotion experienced or expressed by family members.<ref>Hoffman, P.D.; E. Buteau, J.M. Hooley, et al. (2003). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14979218 Family members' knowledge about borderline personality disorder: correspondence with their levels of depression, burden, distress, and expressed emotion]". ''Family Process'' '''42''' (4): 469-78. Retrieved on [[2007-09-21]].</ref> Parents of individuals with BPD have been reported to show co-existing extremes of over-involvement and under-involvement.<ref name="parents">Allen, D.M.; R.G. Farmer (January &ndash; February 1996). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=8770526 Family relationships of adults with borderline personality disorder]". ''Compr Psychiatry'' '''37''' (1): 43-51. Retrieved on [[2007-09-21]].</ref> BPD has been linked to somewhat increased{{Vague|date=September 2008}} levels of chronic stress and conflict in romantic relationships, decreased satisfaction of romantic partners, abuse, and unwanted pregnancy; these links may largely be general to personality disorder and subsyndromal problems,<ref>Daley, S.E.; D. Burge, C. Hammen (August 2000). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11016115 Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity]". ''J Abnorm Psychol'' '''109''' (3): 451-60. Retrieved on [[2007-09-21]].</ref> but such issues are commonly raised in support groups and published literature for partners of individuals with BPD.{{Fact|date=December 2007}}

[[Suicide|Suicidal]] or [[self-harm]]ing behavior is one of the core diagnostic criteria in DSM IV-TR, and management of and recovery from this can be complex and challenging.<ref>Hawton, K.; E. Townsend, E. Arensman, et al. (1999). "[http://www.cochrane.org/reviews/en/ab001764.html Cochrane Collaboration Psychosocial and pharmacological treatments for deliberate self harm]". ''Cochrane Database of Systematic Reviews'' (4). Art. No.: CD001764. [[DOI: 10.1002/14651858.CD001764]]. Retrieved on [[2007-09-21]].</ref> The suicide rate is approximately eight to ten percent.<ref name=bpdtoday>[http://www.borderlinepersonalitytoday.com/main/facts.htm Borderline Personality Disorder Facts]. ''BPD Today''. Retrieved on [[2007-09-21]].</ref> [[Self-injury]] attempts are highly common among patients and may or may not be carried out with suicidal intent.<ref>Soloff, P.H.; J.A. Lis, T. Kelly, et al. (1994). "Self-mutilation and suicidal behavior in borderline personality disorder". ''Journal of Personality Disorders'' '''8''' (4): 257-67.</ref><ref>Gardner, D.L.; R.W. Cowdry (1985). "Suicidal and parasuicidal behavior in borderline personality disorder". ''Psychiatric Clinics of North America'' '''8''' (2): 389-403.</ref> BPD is often characterized by multiple low lethality suicide attempts triggered by seemingly minor incidents, and less commonly by high lethality attempts that are attributed to impulsiveness or comorbid major [[clinical depression|depression]], with interpersonal stressors appearing to be particularly common triggers.<ref>Brodsky, B.S.; S.A. Groves, M.A. Oquendo, et al. (June 2006). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16805659&query_hl=15&itool=pubmed_docsum Interpersonal precipitants and suicide attempts in borderline personality disorder]". ''Suicide Life Threat Behav'' '''36''' (3): 313-22. Retrieved on [[2007-09-21]].</ref> Ongoing family interactions and associated vulnerabilities can lead to self-destructive behavior.<ref name="parents"/> Stressful life events related to sexual abuse have been found to be a particular trigger for suicide attempts by adolescents with a BPD diagnosis.<ref>Horesh, N.; J. Sever, A. Apter (July &ndash; August 2003). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=12923705 A comparison of life events between suicidal adolescents with major depression and borderline personality disorder]". ''Compr Psychiatry'' '''44''' (4): 277-83. Retrieved on [[2007-09-21]].</ref>

===Differential diagnosis===
Borderline personality disorder and mood disorders often appear concurrently.<ref name="Robinson"/> Some features of borderline personality disorder may overlap with those of mood disorders, complicating the differential diagnostic assessment.<ref>Bolton, S.; J.G. Gunderson (September 1996). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8780426&dopt=Abstract Distinguishing borderline personality disorder from bipolar disorder: differential diagnosis and implications]". ''Am J Psychiatry'' '''153''' (9): 1202-7. Retrieved on [[2007-09-21]].</ref><ref name="APAguide">(2001). "[http://www.psych.org/psych_pract/treatg/pg/BPD_05-15-06.pdf Treatment of Patients With Borderline Personality Disorder]". ''APA Practice Guidelines''. Retrieved on [[2007-09-21]].</ref><ref>"[http://www.borderlinepersonalitytoday.com/main/diffdx.htm Differential Diagnosis of Borderline Personality Disorder]". ''BPD Today''. Retrieved on [[2007-09-21]].</ref>

Both diagnoses involve symptoms commonly known as "mood swings". In borderline personality disorder, the term refers to the marked [[Labile affect|lability]] and reactivity of mood defined as [[emotional dysregulation]].{{Fact|date=June 2008}} The behavior is typically in response to external [[psychosocial]] and [[intrapsychic]] stressors, and may arise or subside, or both, suddenly and dramatically and last for seconds, minutes, hours or days.{{Fact|date=June 2008}}

Bipolar depression is generally more pervasive with sleep and appetite disturbances, as well as a marked nonreactivity of mood, whereas mood with respect to borderline personality and co-occurring dysthymia remains markedly reactive and sleep disturbance not acute.<ref>Goodwin, F.K.; K.R. Jamison (1990). ''Manic-Depressive Illness''. New York: Oxford University Press, pp. 108-110. [[Special:Booksources/0195039343|ISBN 0-19-503934-3]].</ref>

The relationship between bipolar disorder and borderline personality disorder has been debated. Some hold that the latter represents a subthreshold form of affective disorder,<ref>Akiskal, H.S.; B.I. Yerevanian, G.C. Davis, et al. (1985). "The nosologic status of borderline personality: Clinical and polysomnographic study". ''Am J Psychiatry'' (142): 192-8</ref><ref>Gunderson, J.G.; G.R. Elliott (1985). "The interface between borderline personality disorder and affective disorder". ''Am J Psychiatry''. (142):277-288.</ref> while others maintain the distinctness between the disorders, noting they often co-occur.<ref>McGlashan, T.H. (1983). "The borderline syndrome: Is it a variant of schizophrenia or affective disorder?" ''Arch Gen Psychiatry''. (40): 1319-23.</ref><ref>Pope, H.G. Jr.; J.M. Jonas, J.I. Hudson, et al. (1983). "The validity of DSM-III borderline personality disorder: A phenomenologic, family history, treatment response, and long term follow up study". ''Arch Gen Psychiatry'' (40): 23-30.</ref>

Some findings suggest that BPD may lie on a [[bipolar spectrum]], with a number of points of phenomenological and biological overlap between the affective lability criterion of borderline personality disorder and the extremely rapid cycling bipolar disorders.<ref>Mackinnon, D.F.; R. Pies (February 2006). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16411976 Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders]". ''Bipolar Disord.'' '''8''' (1): 1-14. Retrieved on [[2007-09-21]].</ref><ref>Goldberg, Ivan MD (February 2006). "[http://www.psycom.net/depression.central.bordbipol.html MMEDLINE Citations on The Borderline-Bipolar Connection]". ''Bipolar disord.'' '''8''' (1): 1-14. Retrieved on [[2007-09-21]].</ref> Some findings suggest that the DSM-IV BPD diagnosis mixes up two sets of unrelated items&mdash;an affective instability dimension related to Bipolar-II, and an impulsivity dimension not related to Bipolar-II.<ref>Benazzi, F. (January 2005). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16019119 Borderline personality-bipolar spectrum relationship]". ''Prog Neuropsychopharmacol Biol Psychiatry'' '''30''' (1): 68-74. Retrieved on [[2007-09-23]].</ref>

===Comorbidity===

[[Comorbid]] (co-occurring) conditions in BPD are common. When comparing individuals diagnosed with BPD to those diagnosed with other kinds of personality disorders, the former showed a higher rate of also meeting criteria for:<ref>Zanarini, M.C.; F.R. Frankenburg, E.D. Dubo, et al. (1998). "[http://ajp.psychiatryonline.org/cgi/content/full/155/12/1733 Axis I Comorbidity of Borderline Personality Disorder]". ''Am J Psychiatry''. (155): 1733-9. Retrieved on [[2007-09-23]].</ref>

* [[anxiety disorders]]
* [[mood disorders]] (including [[clinical depression]] and [[bipolar disorder]])
* [[eating disorders]] (including [[anorexia nervosa]] and [[bulimia]])
* and, to a lesser extent, [[somatoform disorders]]
* [[dissociative disorders]]; if all DSM criteria are met, it is recommended that the person should also be tested to have [[Dissociative Identity Disorder]].{{Fact|date=July 2008}}

[[Substance abuse]] is a common problem in BPD, whether due to impulsivity or as a coping mechanism, and 50% to 70% of psychiatric inpatients with BPD have been found to meet criteria for a substance use disorder, especially alcohol dependence or abuse which is often combined with the abuse of other drugs.<ref>Gregory, R. (2006). "[http://www.psychiatrictimes.com/showArticle.jhtml?articleID=194500290 Clinical Challenges in Co-occurring Borderline Personality and Substance Use Disorders]". ''Psychiatric Times'' '''XXIII''' (13). Retrieved on [[2007-09-23]].</ref>

==Prevalence==
Figures from surveys of the [[prevalence]] of diagnosable BPD in the general population vary, ranging from approximately one percent to two percent.<ref name=PToverview/><ref>Swartz, M.; D. Blazer, L. George, et al. (1990). "Estimating the prevalence of borderline personality disorder in the community". ''Journal of Personality Disorders'' '''4''' (3): 257-72. Retrieved on [[2007-09-23]].</ref> The diagnosis appears to be several times more common in (especially young) women than in men, by as much as 3:1 according to the DSM-IV-TR<ref>(2000). "Diagnostic and Statistical Manual of Mental Disorders". Washington, D.C.: ''American Psychiatric Association'' '''4''' Text Revision.</ref> although the reasons for this are not clear.<ref>Skodol, A.E.; D.S. Bender (2003). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14686459&dopt=Abstract Why are women diagnosed borderline more than men?]" ''Psychiatr Q'' '''74''' (4): 349-60. Retrieved on [[2007-09-23]].</ref>

==Etiology==
At least one researcher believes that BPD results from a combination that can involve a [[psychological trauma|traumatic]] childhood, a vulnerable temperament, and stressful maturational events during [[adolescence]] or adulthood.<ref>Zanarini, M.C.; F.R. Frankenburg (1997). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9113824 Pathways to the development of borderline personality disorder]". ''Journal of Personality Disorder.'' '''11''' (1): 93-104. Retrieved on [[2007-09-21]].</ref>

===Childhood abuse, neglect or separation===
Numerous studies have shown a strong correlation between [[child abuse]], especially [[child sexual abuse]], and development of BPD.<ref name=kluft>{{cite book|title=Incest-Related Syndromes of Adult Psychopathology |first=Richard P.|last=Kluft |year=1990 |publisher=American Psychiatric Pub , Inc.|pages=p83,89 |isbn=0880481609}}</ref><ref>Zanarini, M.C.; J.G. Gunderson, et al. (January &ndash; February 1989). "[http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=2924564&dopt=AbstractPlus Childhood experiences of borderline patients]". ''Comprehensive psychiatry'' '''30''' (1): 18-25. Retrieved on [[2007-09-21]].</ref><ref>Brown G.R.; B. Anderson (1991). "Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse]. ''Am J Psychiatry'' '''148''' (1): 55-61. PMID 1984707.</ref><ref name = "Herman91">Herman, Judith (1997). ''Trauma and Recovery: The Aftermath of Violence--from Domestic Abuse to Political Terror''. Basic Books. [[Special:Booksources/0465087302|ISBN 0465087302]].</ref><ref name="AxisOne/AxisTwo"/> Many individuals with BPD report having had a history of abuse, neglect, or separation as young children.<ref>Zanarini M.C.; F.R. Frankenburg (1997). "Pathways to the development of borderline personality disorder". ''Journal of Personality Disorders'' '''11''' (1): 93-104.</ref> Patients with BPD have been found to be significantly more likely to report having been verbally, emotionally, physically, and sexually abused by caregivers of either [[gender]]. They were also much more likely to report having caregivers (of both genders) deny the validity of their thoughts and feelings. They were also reported to have failed to provide needed protection, and neglected their child's physical care. Parents (of both sexes) were typically reported to have withdrawn from the child emotionally, and to have treated the child inconsistently. Additionally, women with BPD who reported a previous history of neglect by a female caregiver and abuse by a male caregiver were consequently at significantly higher risk for being sexually abused by a noncaregiver (not a parent).<ref name=failchild>Zanarini, M.C.; F.R. Frankenburg (2000}. "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11019749 Biparental failure in the childhood experiences of borderline patients]". ''J Personal Disord'' '''14''' (3):264-73. Retrieved on [[2007-09-21]].</ref> It has been suggested that children who experience chronic early maltreatment and [[attachment]] difficulties may go on to develop borderline personality disorder.<ref name="Dozier-1999">Dozier, M.; K. C. Stovall, et al. (1999). "Attachment and psychopathology in adulthood" in Cassidy, J.; P. Shaver (Eds.), ''Handbook of attachment'' pp. 497–519. New York: Guilford Press.</ref>

===Other developmental factors===

Some studies suggest that BPD may not necessarily be a trauma-spectrum disorder and that it is biologically distinct from the post-traumatic stress disorder that could be a precursor. The personality symptom clusters seem to be related to specific abuses, but they may be related to more persistent aspects of interpersonal and family environments in childhood.

[[Otto Kernberg]] formulated the theory of Borderline Personality based on a premise of failure to develop in childhood. Writing in the psychoanalytic tradition, Kernberg argued that failure to achieve the developmental task of ''psychic clarification of self and other'' can result in an increased risk to develop varieties of psychosis, while failure to ''overcoming splitting'' results in an increased risk to develop a borderline personality.<ref>Kernberg, O. (2000). ''Borderline Conditions and Pathological Narcissism''. New York: Aronson. [[Special:Booksources/0876687621|ISBN 0876687621]].</ref>

There is evidence for the central role of family in the development of BPD, including interactions that are negative and critical rather than supportive and [[empathy|empathic]], with parental and family behaviors transacting with the child's own behaviors and emotional vulnerabilities, although no prospective studies have been conducted.<ref>Fruzzetti, A.E.; C. Shenk, P.D. Hoffman (2005). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16613428 Family interaction and the development of borderline personality disorder: a transactional model]". ''Dev Psychopathol.'' '''17''' (4): 1007-30. Retrieved on [[2007-09-21]].</ref>

===Genetics===

An overview of the existing literature suggested that traits related to BPD are influenced by [[gene]]s, and if personality is indeed heritable, then BPD may very well be as well, but studies have had methodological problems and the links are not yet clear.<ref>Torgersen, S. (March 2000). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=10729927&query_hl=8&itool=pubmed_docsum Genetics of patients with borderline personality disorder]". ''Psychiatr Clin North Am'' '''23''' (1): 1-9. Retrieved on [[2007-09-23]].</ref> A major twin study found that if one identical twin met criteria for BPD, the other also met criteria in 35 percent of cases.<ref>Torgersen, S.; S. Lygren, P.A. Oien, et al. (November - December 2000). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11086146 A twin study of personality disorders]". ''Compr Psychiatry'' '''41''' (6): 416-25. Retrieved on [[2007-09-23]].</ref>
Twin, sibling and other family studies indicate a partially heritable basis for impulsive aggression, but studies of [[serotonin]]-related genes to date have suggested only modest contributions to behavior.<ref name=neurotrauma/>

===Neurofunction===

[[Neurotransmitters]] implicated in BPD include serotonin, [[norepinephrine]] and [[acetylcholine]] (related to various emotions and moods); [[GABA]], the brain's major inhibitory [[neurotransmitter]] (which can stabilize mood change); and [[glutamate]], an excitatory neurotransmitter.
Enhanced [[amygdala]] activation in BPD has been identified by some researchers as reflecting the intense and slowly subsiding emotions commonly observed in BPD in response to even low-level stressors.<ref>[http://www.nimh.nih.gov/health/publications/borderline-personality-disorder.shtml NIMH · Borderline Personality Disorder<!-- Bot generated title -->]</ref> It is thought by some researchers the activation of both the amygdala and prefrontal cortical areas can reflect attempts to control intensive emotions during the recall of unresolved life events.<ref>Beblo, T.; M. Driessen, M. Mertens, et al. (June 2006). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16704749 Functional MRI correlates of the recall of unresolved life events in borderline personality disorder]". ''Psychol Med'' '''36''' (6): 845-56. Retrieved on [[2007-09-23]].</ref> Impulsivity or aggression, as sometimes seen in BPD, has been linked to alterations in serotonin function and specific brain regions in the [[cingulate]] and the medial and orbital [[prefrontal cortex]] by some researchers.<ref name=neurotrauma>Goodman M.; A. New, L. Siever (2004). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15677398&query_hl=7&itool=pubmed_docsum Trauma, genes, and the neurobiology of personality disorders]". ''Ann N Y Acad Sci'' (1032): 104-16. Retrieved on [[2007-09-23]].</ref>

==Treatment==
The mainstay of treatment is various forms of [[psychotherapy]], although medication and other approaches may also improve symptoms.
===Psychotherapy===
There has traditionally been skepticism about the psychological treatment of [[personality disorders]], but several specific types of [[psychotherapy]] for BPD have developed in recent years. The limited studies to date do not allow confident claims of effectiveness but do suggest that people with a diagnosis of BPD can benefit on at least some outcome measures.<ref name ="Cochranepsychotherapy">Binks, C.A.; M. Fenton, L. McCarthy, et al. (2006). "[http://www.cochrane.org/reviews/en/ab005652.html Psychological therapies for people with borderline personality disorder]". ''Cochrane Database Systematic Reviews'' '''25''' (1): CD005652. Retrieved on [[2007-09-23]].</ref> Simple supportive therapy alone may enhance self-esteem and mobilize the existing strengths of individuals with BPD.<ref>Aviram, R.B.; D.J. Hellerstein, J. Gerson, et al. (May 2004). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15330220&dopt=Abstract Adapting supportive psychotherapy for individuals with Borderline personality disorder who self-injure or attempt suicide]". ''J Psychiatr Pract'' '''10''' (3): 145-55. Retrieved on [[2007-09-23]].</ref> Specific psychotherapies may involve sessions over several months or, as is particularly common for personality disorders, several years. Psychotherapy can often be conducted either with individuals or with groups. Group therapy can aid the learning and practice of interpersonal skills and self-awareness by individuals with BPD<ref name=AMN>Gunderson, J.G. MD ([[2006-04-10]]). "[http://www.health.am/psy/more/borderline_personality_disorder_psychotherapies "Borderline Personality Disorder - Psychotherapies]". ''American Medical Network''. Retrieved on [[2007-09-23]].</ref> although drop-out rates may be problematic.<ref>Hummelen, B.; T. Wilberg, S. Karterud (January 2007). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17266430 Interviews of female patients with borderline personality disorder who dropped out of group psychotherapy]". ''Int J Group Psychother'' '''57''' (1): 67-91. Retrieved on [[2007-09-23]].</ref>
====Dialectical behavioral therapy====
In the 1990s, a new psychosocial treatment termed [[dialectical behavioral therapy]] (DBT) became established in the treatment of BPD, having originally developed as an intervention for patients with suicidal behavior.<ref>Koerner, K.; M.M. Linehan (2000). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=10729937 Research on dialectical behavior therapy for patients with borderline personality disorder]". ''Psychiatric Clinics of North America'' '''23''' (1): 151-67. Retrieved on [[2007-09-23]].</ref>

Dialectical behavior therapy is derived from [[Cognitive-behavioral therapy|cognitive-behavioral techniques]] (and can be seen as a form of CBT) but emphasizes an exchange and negotiation between therapist and client, between the rational and the emotional, and between acceptance and change (hence [[dialectic]]). Treatment targets are agreed upon, with self-harm issues taking priority. The learning of new skills is a core component - including [[mindfulness]], interpersonal effectiveness (e.g. [[assertiveness]] and social skills), coping adaptively with distress and crises; and identifying and regulating emotional reactions.{{Fact|date=June 2008}}

DBT can be based on a biosocial theory of personality functioning in which BPD is seen as a biological disorder of emotional regulation in a social environment experienced as invalidating by the borderline patient.<ref name=promising>Murphy, E. T. PhD; J. Gunderson MD (January 1999). "[http://web.archive.org/web/19991014032825/http://www.mcleanhospital.org/psychupdate/psyupI-3.htm A Promising TreatmentBorderline Personality Disorder]". ''McLean Hospital Psychiatic Update''. Retrieved on [[2007-09-23]].</ref>

Dialectical behavioral therapy has been found to significantly reduce self-injury and suicidal behavior in individuals with BPD, beyond the effect of usual or expert treatment, and to be better accepted by clients.<ref>Verheul, R.; L.M. Van Den Bosch, M.W. Koeter, et al. (February 2003). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12562741&query_hl=3&itool=pubmed_docsum Dialectical behavioural therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands]". ''[[British Journal of Psychiatry]]'' (182): 135-40. Retrieved on [[2007-09-23]].</ref><ref>Linehan, M.M.; K.A. Comtois, A.M. Murray, et al. (July 2006). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16818865 Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder]". ''Archives of General Psychiatry'' '''63''' (7): 757-66. Retrieved on [[2007-09-23]].</ref> although whether it has additional efficacy in the overall treatment of BPD appears less clear.<ref name="Cochranepsychotherapy"/> Training nurses in the use of DBT has been found to replace a therapeutic pessimism with a more optimistic understanding and outlook.<ref>Hazelton, M.; R. Rossiter, J. Milner (February - March 2006). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16594889 Managing the 'unmanageable': training staff in the use of dialectical behaviour therapy for borderline personality disorder]". ''Contemporary Nurse'' '''21''' (1): 120-30. Retrieved on [[2007-09-23]].</ref>

====Schema therapy====
Schema therapy (also called schema-focused therapy) is an integrative approach based on cognitive-behavioral or skills-based techniques along with [[Object relations theory|object relations]] and [[Gestalt therapy|gestalt approaches]]. It directly targets deeper aspects of emotion, personality and [[Schema (psychology)|schemas]] (fundamental ways of categorizing and reacting to the world). The treatment also focuses on the [[Transference|relationship with the therapist]] (including a process of "limited re-parenting"), daily life outside of therapy, and traumatic childhood experiences. It was developed by Jeffrey Young and became established in the 1990s. Limited recent research suggests that it is significantly more effective than transference-focused psychotherapy, with half of individuals with borderline personality disorder assessed as having achieved full recovery after four years, with two thirds showing clinically significant improvement.<ref name="SFTvsTFT">Giesen-Bloo, J.; R. van Dyck, P. Spinhoven, et al. (June 2005). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16754838 Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy]". ''Archives of General Psychiatry'' '''63''' (6): 649-58. Retrieved on [[2007-09-23]].</ref><ref>Darden, M. ([[2006-10-10]]). "[http://www.eurekalert.org/pub_releases/2006-10/ppmr-nhf101006.php New hope for an 'untreatable' mental illness]". ''EurekAlert!'' Retrieved on [[2007-09-23]].</ref>{{Rs|date=October 2008}} Another very small trial has also suggested efficacy.<ref>Nordahl, H.M., T.E. Nysaeter (September 2005). "[http://cat.inist.fr/?aModele=afficheN&cpsidt=16983362 Schema therapy for patients with borderline personality disorder: a single case series]". ''J Behav Ther Exp Psychiatry'' '''36''' (3): 254-64. Retrieved on [[2007-09-23]].</ref>

====Cognitive behavioral therapy====
[[Cognitive behavioral therapy]] (CBT) is the most widely used and established psychological treatment for mental disorders, but has appeared less successful in BPD, due partly to difficulties in developing a therapeutic relationship and treatment adherence. Approaches such as DBT and Schema-focused therapy developed partly as an attempt to expand and add to traditional CBT, which uses a limited number of sessions to target specific maladaptive patterns of thought, perception and behavior. A recent study did find a number of sustained benefits of CBT, in addition to treatment as usual, after an average of 16 sessions over one year.<ref>Davidson, K.; J. Norrie, P. Tyrer, et al. (October 2006). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17032158 The effectiveness of cognitive behavior therapy for borderline personality disorder: results from the borderline personality disorder study of cognitive therapy (BOSCOT) trial]". ''Journal of Personality Disorders'' '''20''' (5): 450-65. Retrieved on [[2007-09-23]].</ref>

====Marital or family therapy====
Marital therapy can be helpful in stabilizing the marital relationship and in reducing marital conflict and stress that can worsen BPD symptoms. [[Family therapy]] or family [[psychoeducation]] can help educate family members regarding BPD, improve family communication and problem solving, and provide support to family members in dealing with their loved one's illness.{{Fact|date=June 2008}}

Two patterns of family involvement can help clinicians plan family interventions: overinvolvement and neglect. Borderline patients who are from overinvolved families are often actively struggling with a dependency issue by denial or by anger at their parents.{{Fact|date=June 2008}}

Interest in the use of psychoeducation and skills training approaches for families with borderline members is growing.<ref name=AMN/>

====Psychoanalysis====
The term dates 1884, it is C.Hugues who spoke about subjects oscillating throughout their whole life between the limits of about insanities and about the normality. A.Stern in 1938 takes back the term to describe a " hypersentimentality of the subjects, their defensive rigidity and them little self-respect." It is psychanalyse that the term " borderline " was developped to define an "oedipian intermédaire organization". [[Edward Glover (psychoanalyst)]] for example spoke about "transitional states " (1932).'' Addictions are réals states borderline in the sense that they are one foot in the psychoses and the other one in the neurosises. (...). It have their root in the paranoid states and, occasionally in the dominant melancolic state''.{{Fact|date=October 2008}} He had established a plan which placed very clearly the place of the borderline in touch with the other disorders'' <ref>ib. p. 838</ref>. Since, the works of [[Otto Kernberg]], the french Jean Bergeret developed the concept which adapted itself to the modern psychoanalysis. It is in the appartion of the DSM 4 that the term took two orientations: psychiatric one behavioral and the other, included in a psychoanalytical psychopathology. According to this split, the diagnosis takes on, or a character objectivizing with ascendancy of symptoms to be eradicated or it indicates a particular type of patients of psychoanalysts to treat in modalities different from those typical cures <ref>[[Harold Searles]]''My Work With Borderline Patients'', Publisher: Jason Aronson, 1994, ISBN 1568214014</ref>, <ref>John Steiner : ''Psychic Retreats: Pathological Organizations in Psychotic, Neurotic and Borderline Patients'', Publisher: Routledge; 1993, ISBN 0415099242</ref>, <ref>Bateman, A.; P. Fonagy (January 2001). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11136631 Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up]". ''American Journal of Psychiatry'' '''158''' (1): 36-42. Retrieved on [[2007-09-23]].</ref>, .

====Transference-focused psychotherapy====
{{see|Otto F. Kernberg#Transference-Focused Psychotherapy}}
Transference-focused psychotherapy (TFP) is a form of psychoanalytic therapy dating to the 1960s, rooted in the conceptions of [[Otto Kernberg]] on BPD and its underlying structure (borderline personality organization). Unlike in the case of traditional psychoanalysis, the therapist plays a very active role in TFP. In session the therapist works on the relationship between the patient and the therapist. The therapist will try to explore and clarify aspects of this relationship so the underlying [[object relations]] dyads become clear. Some limited research on TFP suggests it may reduce some symptoms of BPD by affecting certain underlying processes,<ref>Levy, K.N.; J.F. Clarkin, L.N. Scott, et al. (2006). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16470612 The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy]". ''Journal of Clinical Psychology'' (62): 481-501. Retrieved on [[2007-09-23]].</ref> and that TFP in comparison to [[dialectical behavioral therapy]] and supportive therapy results in increased reflective functioning (the ability to realistically think about how others think) and a more secure [[Attachment theory|attachment style]].<ref>Levy, K.N.; K.B. Meehan, K.M. Kelly, et al. (2006). "Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder". ''Journal of Consulting and Clinical Psychology'' (74): 1027-1040.</ref> Furthermore, TFP has been shown to be as effective as DBT in improvement of suicidal behavior, and has been more effective than DBT in alleviating anger and in reducing verbal or direct assaultive behavior.<ref>Clarkin, J.F. PhD; K.N. Levy, PhD, M. F. Lenzenweger, PhD, et al. (June 2007). "[http://ajp.psychiatryonline.org/cgi/content/abstract/164/6/922 Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study]". ''The American Journal of Psychiatry'' (164): 922-928. {{doi|10.1176/appi.ajp.164.6.922}}. Retrieved on [[2007-09-23]].</ref> Limited research suggests that TFP appears to be less effective than schema-focused therapy, while being more effective than no treatment.<ref name="SFTvsTFT"/>

====Cognitive analytic therapy====
[[Cognitive analytic therapy]] (CAT) combines cognitive and psychoanalytic approaches and has been adapted for use with individuals with BPD with mixed results.<ref>Ryle, A. (February 2004). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15061342&dopt=Abstract The contribution of cognitive analytic therapy to the treatment of borderline personality disorder]". ''J Personal Disord'' '''18''' (1): 3-35. Retrieved on [[2007-09-23]].</ref>

====Mentalization based treatment====
[[Mentalization based treatment]], developed by Peter Fonagy and Antony Bateman, rests on the assumption that people with BPD have a disturbance of [[Attachment theory|attachment]] due to problems in the early childhood parent-child relationship.<ref>Fonagy P George Gergely G and Target M (2007)The parent–infant dyad and the construction of the subjective self. Journal of Child Psychology and Psychiatry 48:3/4, 288–328
</ref> Fonagy and Bateman hypothesize that inadequate parental mirroring and attunement in early childhood lead to a deficit in mentalization, ''"the capacity to think about mental states as separate from, yet potentially causing actions"'',<ref>Bateman A and Fonagy P (2004) Psychotherapy for Borderline Personality Disorder: Mentalization based treatment. Oxford University Press p. 71</ref> in other words the capacity to intuitively understand the thoughts, intentions and motivations of others, and the connections between one's own thoughts, feelings and actions. Mentalization failure is thought to underlie BPD patients' problems with impulse control, mood instability and difficulties sustaining intimate relationships.
Mentalization based treatment aims to develop patients' self-regulation capacity through a [[psychodynamically]] informed<ref>{{cite journal |last=Sugarman |first=A |authorlink= |coauthors= |year=2006 |month= |title=Mentalization, insightfulness, and therapeutic action. The importance of mental organization |journal=International Journal of Psychoanalysis |volume=87 |issue=4 |pages=965-87 |id= |url= |accessdate=2008-07-04 |pmid=16877247 |doi= |quote= }}</ref> multi-modal treatment program which incorporates [[group psychotherapy]] and individual psychotherapy in a [[therapeutic community]], [[partial hospitalization]] or out-patient context.<ref>Bateman A and Fonagy P (2004) Psychotherapy for Borderline Personality Disorder: Mentalization based treatment. Oxford University Press Ch. 5</ref> In a [[randomized controlled trial]], a group of BPD patients received 18 months of intensive partial-hospitalization MBT followed by 18 months of group psychotherapy, and were followed up over five years. The treatment group showed significant benefits aross a range of measures including number of suicide attempts, reduced time in hospital, and reduced use of medication.<ref>Bateman A & Fonagy P (2008) 8-Year Follow-Up of Patients Treated for Borderline Personality Disorder. American Journal of Psychiatry, 165 (5)</ref>

===Medication===
A number of medications are used in conjunction with BPD treatments, although the evidence base is limited. As BPD has been traditionally considered a primarily psychosocial condition, medication is intended to treat co-morbid symptoms, such as anxiety and depression, rather than BPD itself.<ref name ="Cochranepharm">Binks, C.A.; M. Fenton, L. McCarthy, et al. (2006). "[http://www.cochrane.org/reviews/en/ab005653.html Pharmacological interventions for people with borderline personality disorder]". ''The Cochrane Database of Systematic Reviews'' (4). Retrieved on [[2007-09-23]].</ref>

====Antidepressants====
[[Selective serotonin reuptake inhibitor]] (SSRI) [[antidepressant]]s have been shown in [[randomized controlled trials]] to improve the attendant symptoms of anxiety and depression, such as anger and hostility, associated with BPD in some patients.<ref name ="Cochranepharm"/> According to ''[[Listening to Prozac]]'', it takes a higher dose of an SSRI to treat mood disorders associated with BPD than depression alone. It also takes about three months for benefit to appear, compared to the three to six weeks for depression.

====Antipsychotics====
The newer [[atypical antipsychotics]] are claimed to have an improved [[adverse effect]] profile than the [[typical antipsychotics]]. Antipsychotics are also sometimes used to treat distortions in thinking or false perceptions.{{Dead link|date=July 2008}}<ref>Siever, L.J.; H.W. Koenigsberg (2000). "[http://www.dana.org/pdf/cerebrum/art_v2n4sieverkoenigsberg.pdf The frustrating no-man's-land of borderline personality disorder]" (PDF). ''Cerebrum, The Dana Forum on Brain Science'' '''2''' (4). Retrieved on [[2007-09-23]].</ref> Use of antipsychotics is generally short-term.

One [[meta-analysis]] of two randomly controlled trials, four non-controlled open-label studies and eight case reports has suggested that several atypical antipsychotics, including [[olanzapine]], [[clozapine]], [[quetiapine]] and [[risperidone]], may help BPD patients with psychotic-like, impulsive or suicidal symptoms.<ref>Grootens, K.P.; R.J. Verkes (January 2005). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15706462&query_hl=4&itool=pubmed_docsum Emerging evidence for the use of atypical antipsychotics in borderline personality disorder]". ''Pharmacopsychiatry'' '''38''' (1): 20-3. Retrieved on [[2007-09-23]].</ref> However, there are numerous adverse effects of antipsychotics, notably [[Tardive dyskinesia]] (TD).<ref name=caseyde>Casey, D.E. (1985). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2860664&dopt=Abstract Tardive dyskinesia: reversible and irreversible]". ''Psychopharmacology Suppl'' (2): 88-97. Retrieved on [[2007-09-23]].</ref> Atypical [[antipsychotic]]s are known for often causing considerable weight gain, with associated health complications.<ref>Ruetsch, O.; A. Viala, H. Bardou, et al. (July - August 2005). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16389718 Psychotropic drugs induced weight gain: a review of the literature concerning epidemiological data, mechanisms and management]". ''Encephale'' (4 Pt 1): 507-16. Retrieved on [[2007-09-23]].</ref>

===Services and recovery===
Individuals with BPD sometimes use mental health services extensively. People with this diagnosis accounted for around 20% of psychiatric hospitalizations in one survey.<ref>Zanarini, M.C.; Frankenburg, F.R. (March - April 2001). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=11244151 Treatment histories of borderline inpatients]". ''Comprehensive Psychiatry'' '''42'''(2): 144-50. Retrieved on [[2007-09-23]].</ref> The majority of BPD patients continue to use outpatient treatment in a sustained manner for several years, but the number using the more restrictive and costly forms of treatment, such as inpatient admission, declines with time.<ref>Zanarini, M.C.; F.R. Frankenburg, J. Hennen, et al. (January 2004). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14744165 Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years]". ''J Clin Psychiatry'' '''65''' (1): 28-36. Retrieved [[2007-09-23]].</ref>; Experience of services varies.<ref>Fallon, P. (August 2003). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12887630&dopt=Abstract Travelling through the system: the lived experience of people with borderline personality disorder in contact with psychiatric services]". ''J Psychiatr Ment Health Nurs'' '''10''' (4): 393-401. Retrieved on [[2007-09-23]].</ref> Assessing suicide risk can be a challenge for mental health services (and patients themselves tend to underestimate the lethality of self-injurious behaviours) with typically a chronically elevated risk of suicide much above that of the general population and a history of multiple attempts when in crisis.<ref>Links, P.; Y. Bergmans, S. Warwar ([[July 1]] [[2004]]). "[http://www.psychiatrictimes.com/Suicidal-Behavior/showArticle.jhtml?articleId=175802408 Assessing Suicide Risk in Patients With Borderline Personality Disorder]". ''Psychiatric Times'' '''XXI''' (8). Retrieved on [[2007-09-23]].</ref>

Particular difficulties have been observed in the relationship between care providers and individuals diagnosed with BPD. A majority of psychiatric staff report finding individuals with BPD moderately to extremely difficult to "deal" with, and more difficult than other client groups.<ref>Cleary, M.; N. Siegfried, G. Walter (September 2002). "[http://www.ingentaconnect.com/content/bsc/ano/2002/00000011/00000003/art00007 Experience, knowledge and attitudes of mental health staff regarding clients with a borderline personality disorder]". ''Australian and New Zealand Journal of Ophthalmology'' '''11''' (3): 186-191. Retrieved on [[2007-09-23]].</ref> On the other hand, those with the diagnosis of BPD have reported that the term "BPD" felt like a [[pejorative]] [[labeling theory|label]] rather than a helpful diagnosis, that self destructive behaviour was wrongly perceived as manipulative, and that they had limited access to care.<ref>Nehls, N. (August 1999). "[http://ebmh.bmj.com/cgi/content/full/3/1/32#R1 Borderline personality disorder: the voice of patients]". ''Res Nurs Health'' (22): 285–93. Retrieved on [[2007-09-23]].</ref> Attempts are made to improve public and staff attitudes.<ref>Deans, C.; E. Meocevic "[http://www.contemporarynurse.com/21.1/21.1.7.html Attitudes of registered psychiatric nurses towards patients diagnosed with borderline personality disorder]". ''Contemporary Nurse''. Retrieved on [[2007-09-23]].</ref><ref>Krawitz, R. (July 2004). "[http://www.blackwell-synergy.com/doi/abs/10.1111/j.1440-1614.2004.01409.x?journalCode=anp Borderline personality disorder: attitudinal change following training]". ''Australian and New Zealand Journal of Psychiatry'' '''38''' (7): 554. Retrieved on [[2007-09-23]].</ref>

====Combining pharmacotherapy and psychotherapy====
In practice, psychotherapy and medication may often be combined but there are limited data on clinical practice.<ref name ="APAguide"/> Efficacy studies often assess the effectiveness of interventions when added to 'treatment as usual' (TAU), which may involve general psychiatric services, supportive counselling, medication and psychotherapy.

One small study, which excluded individuals with a comorbid Axis 1 disorder, has indicated that outpatients undergoing [[Dialectical Behavioral Therapy]] and taking the antipsychotic [[Olanzapine]] show significantly more improvement on some measures related to BPD, compared to those undergoing DBT and taking a [[placebo]] pill,<ref>Soler, J.; J.C. Pascual, J. Campins, et al. (June 2005). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15930077&query_hl=3&itool=pubmed_docsum Double-blind, placebo-controlled study of dialectical behavior therapy plus olanzapine for borderline personality disorder]". ''Am J Psychiatry'' '''162''' (6): 1221-4. Retrieved on [[2007-09-23]].</ref> although they also experienced weight gain and raised [[cholesterol]]. Another small study found that patients who had undergone DBT and then took fluoxetine ([[Prozac]]) showed no significant improvements, whereas those who underwent DBT and then took a placebo pill did show significant improvements.<ref name=dbtfluox>Simpson, E.B.; S. Yen, E. Costello, et al. (March 2004). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15096078 Combined dialectical behavior therapy and fluoxetine]". ''Journal of Clinical Psychiatry'' '''65''' (3): 379-85. Retrieved on [[2007-09-23]].</ref>

====Difficulties in therapy====
There can be unique challenges in the treatment of BPD, for example hospital care.<ref>Kaplan, C.A. (September 1986). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=3638699 The challenge of working with patients diagnosed as having a borderline personality disorder]". ''Nurs Clin North Am'' '''21''' (3): 429-38. Retrieved on [[2007-09-23]].</ref> In psychotherapy, a client may be unusually sensitive to rejection and abandonment and may react negatively (e.g., by harming themselves or withdrawing from treatment) if they sense this. In addition, clinicians may emotionally distance themselves from individuals with BPD for self-protection or due to the [[stigma]] associated with the diagnosis, leading to a self-fulfilling prophecy and a cycle of stigmatization to which both patient and therapist can contribute.<ref>Aviram, R.B.; B.S. Brodsky, B. Stanley (October 2006). "[http://taylorandfrancis.metapress.com/content/g886500785w755g6/ Borderline Personality Disorder, Stigma, and Treatment Implications]". ''Harvard Review of Psychiatry'' '''14''' (5). Retrieved on [[2007-09-23]].</ref>

Some psychotherapies, for example DBT, were developed partly to overcome problems with interpersonal sensitivity and maintaining a therapeutic relationship. Adherence to medication regimens is also a problem, due in part to [[adverse effects]], with drop-out rates of between 50 percent and 88 percent in medication trials.<ref>American Psychiatric Association (October 2001). "Practice Guideline for the Treatment of Patients With Borderline Personality Disorder". ''Am J Psychiatry''.</ref> Comorbid disorders, particularly substance use disorders, can complicate attempts to achieve remission.<ref>Zanarini, M.C.; F.R. Frankenburg, J. Hennen, et al. (2004). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15514413 Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission]". ''Am J Psychiatry'' '''161''' (11): 2108-14. Retrieved on [[2007-09-23]].</ref>

====Other strategies====
Psychotherapies and medications form a part of the overall context of mental health services and psychosocial needs related to BPD. The evidence base is limited for both, and some individuals may forego them or not benefit (enough) from them. It has been argued that diagnostic categorisation can have limited utility in directing therapeutic work in this area, and that in some cases it is only with reference to past and current relationships that "borderline" behavior can be understood as partly adaptive and how people can best be helped.<ref>Warner, S.; T. Wilkins (2004). "[http://www.springerlink.com/content/l440244686765312/ Between Subjugation and Survival: Women, Borderline Personality Disorder and High Security Mental Hospitals]". ''Journal of Contemporary Psychotherapy'' '''34''' (3): 1573-3564. Retrieved on [[2007-09-23]].</ref>

Numerous other strategies may be used, including [[alternative medicine]] techniques (see [[List of branches of alternative medicine]]), exercise and physical fitness, including team sports; occupational therapy techniques, including creative arts; having structure and routine to the days, particularly through employment - helping feelings of competence (e.g. [[self-efficacy]]), having a social role and being valued by others, boosting [[self-esteem]].{{Verify credibility|date=June 2008}}<ref>Flory, L. (2004). ''[http://www.mind.org.uk/Information/Booklets/Understanding/Understanding+borderline+personality+disorder.htm Understanding borderline personality disorder]''. London: Mind. Retrieved on [[2007-09-23]].</ref>

Some [[Evangelical Christians]], for example in regions of the [[United States]], state that the cause of Borderline personality disorder is [[demon possession]] and that therefore the best treatment is [[exorcism]].{{Fact|date=September 2008}}

Group-based psychological services encourage clients to socialize and participate in both solitary and group activities. These may be in day centers. [[Therapeutic communities]] are an example of this, particularly in Europe, although their usage has declined many have specialised in the treatment of [[severe personality disorder]].<ref>Campling, P. (2001). "[http://apt.rcpsych.org/cgi/content/full/7/5/365 Therapeutic communities]". ''Advances in Psychiatric Treatment'' (7): 365-372. Retrieved on [[2007-09-23]].</ref>

[[Psychiatric rehabilitation]] services aimed at helping people with mental health problems, to reduce [[psychosocial]] disability, engage in meaningful activities, and avoid [[stigma]] and [[social exclusion]] may be of value to people who suffer from BPD. There are also many mutual-support or co-counseling groups run by and for individuals with BPD. Services, or individual goals, are increasingly based on a [[recovery model]] that supports and emphasizes an individual's personal journey and potential.<ref>Michael T. Compton (2007) [http://www.medscape.com/viewarticle/565489 Recovery: Patients, Families, Communities] Conference Report, Medscape Psychiatry & Mental Health, October 11-14, 2007</ref>

Data indicate that the diagnosis of BPD is more variable over time than the DSM implies. Substantial percentages (for example around a third, depending on criteria) of people diagnosed with BPD achieve [[remission]] within a year or two.<ref name=PToverview/> A longitudinal study found that, six years after being diagnosed with BPD, 56% showed good psychosocial functioning, compared to 26% at baseline. Although vocational achievement was more limited even compared to those with other personality disorders, those whose symptoms had remitted were significantly more likely to have a good relationship with a spouse/partner and at least one parent, good work/school performance, a sustained work/school history, good global functioning and good psychosocial functioning.<ref>Zanarini, M.C.; F.R. Frankenburg, J. Hennen, et al. (February 2005). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15899718 Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years]". ''J Personal Disord'' '''19''' (1): 19-29. Retrieved on [[2007-09-23]].</ref>

==Controversies==
===Gender===
The concept of BPD has been criticised from a [[feminist]] perspective.<ref>Shaw and Proctor (2005). "[http://fap.sagepub.com/cgi/reprint/15/4/483 Women at the Margins: A Critique of the Diagnosis of Borderline Personality Disorder]" (PDF). ''Feminism & Psychology'' '''15''': 483-90. Retrieved on [[2007-09-21]],</ref> and the question has been raised of why BPD is diagnosed somewhat more commonly in women than in men. Some think that people with BPD commonly have a history of sexual abuse in childhood,<ref>Zanarini M and Frankenburg F (1997) Pathways to the development of borderline personality disorder. Journal of Personality Disorders 11(1) , 93-104</ref> and since girls are much more commonly sexually abused than boys, it is inevitable that BPD would be more common in women. BPD is a stigmatizing diagnosis which evokes negative responses from health care providers (see below), so it is suggested that women who have survived sexual abuse in childhood are in this way re-traumatized by abusive mental health services.<ref>Nehls, N (1998) Borderline Personality Disorder: Gender stereotypes, stigma, and limited system of care. Issues in Mental Health Nursing, 19:2, 97 — 112 DOI: 10.1080/016128498249105 accessed 13 June 2008</ref> Some feminist writers have suggested that it would be better to give these women the diagnosis of a post-traumatic disorder as this would acknowledge their abuse, but others have argued that the use of the PTSD diagnosis merely medicalizes abuse rather than addressing the root causes in society.<ref>Becker, D (2000) When she was bad: Borderline personality disorder in a posttraumatic age. American Journal of Orthopsychiatry, 70(4) 422-432</ref> Clinicians respond differentially to men and women presenting with the same symptoms, for example women presenting with angry, promiscuous behaviour are likely to be diagnosed with BPD, whereas men presenting with identical symptoms will be diagnosed with [[Antisocial personality disorder]]. Women may be more likely to receive a personality disorder diagnosis if they reject the female role by being hostile, successful, or sexually active; alternatively if a woman presents with psychiatric symptoms but does not conform to a traditional passive [[sick role]], she may be labelled as a 'difficult' patient and given the stigmatizing diagnosis of BPD.<ref>Simmons, D (1992) Gender issues and borderline personality disorder: Why do females dominate the diagnosis? Archives of Psychiatric Nursing, 6(4), 219-223</ref>

===Stigma===
The features of BPD include emotional instability, intense unstable interpersonal relationships, a need for relatedness and a fear of rejection. As a result, people with BPD often evoke intense emotions in those around them. Pejorative terms such as “difficult”, “treatment resistant,” “manipulative,” “demanding,” and “attention seeking" are often used, and may become a self-fulfilling prophecy as the clinician's negative response triggers further self-destructive behaviour.<ref>Aviram, Ron B., Brodsky, Beth S. and Stanley, Barbara (2006) Borderline Personality Disorder, Stigma, and Treatment Implications, Harvard Review of Psychiatry, 14:5, 249 - 256</ref> In psychoanalytic theory, this [[Stigma (sociological theory)|stigmatization]] may be thought to reflect "[[countertransference]]" (when a therapist projects their own feelings on to a client), as people with BPD are prone to use [[defence mechanism]]s such as [[Splitting (psychology)|splitting]] and [[projective identification]]. Thus the diagnosis "often says more about the clinician's negative reaction to the patient than it does about the patient ... as an expression of countertransference hate, borderline explains away the breakdown in empathy between the therapist and the patient and becomes an institutional epithet in the guise of pseudoscientific jargon" (Aronson, p 217).<ref name="autogenerated1" /> This inadvertent countertransference can give rise to inappropriate clinical responses including excessive use of medication, inappropriate mothering, and punitive use of limit-setting and interpretation.<ref>Vaillant G (1992) The beginning of wisdom is never calling a patient Borderline. Journal of Psychotherapy Practice and Research 1(2) 117-34</ref> People with BPD are seen as among the most challenging groups of patients, requiring a high degree of skill and training in the psychiatrists, therapists and nurses involved in their treatment.<ref>Hinshelwood RD (1999) The difficult patient. British Journal of Psychiatry 174:187–90</ref> People [[labeling theory|labeled]] with "Borderline Personality Disorder" also often feel it is unhelpful and stigmatizing as well as simply inaccurate, supporting and adding to calls for a name change.{{Verify credibility|date=June 2008}}<ref>Bogod, E. "[http://www.mental-health-matters.com/articles/article.php?artID=338 Borderline Personality Disorder Label Creates Stigma]". ''mental-health-matters.com''. Retrieved on [[2007-09-21]].</ref>

===Terminology===
Because of the above concerns, and because of a move away from the original theoretical basis for the term (see [[Borderline_personality_disorder#History|history]]), there is ongoing debate about renaming BPD. Alternative suggestions for names include ''Emotional regulation disorder'' or ''Emotional dysregulation disorder''. According to TARA, (Treatment and Research Advancement Association for Personality Disorders) this terminology has "the most likely chance of being adopted by the American Psychiatric Association."{{Verify credibility|date=June 2008}}<ref>Porr, Valerie (November 2001). [http://www.tara4bpd.org/ad.html How Advocacy is Bringing Borderline Personality Disorder Into the Light]. ''tara4bpd.org'' Axis II. Retrieved on [[2007-09-21]].</ref> Emotional regulation disorder is the term favored by [[Marsha Linehan]], pioneer of one of the most popular types of BPD therapy.{{Fact|date=July 2008}} ''Impulse disorder'' and ''Interpersonal regulatory disorder'' are other valid alternatives, according to John Gunderson of [[McLean Hospital]] in the United States. ''Dyslimbia'' has been suggested by Leland Heller{{Verify credibility|date=June 2008}}<ref name=heller>Heller, L. MD. "[http://www.biologicalunhappiness.com/21a.htm A Possible New Name For Borderline Personality Disorder]". ''Biological Unhappiness''. Retrieved on [[2007-09-21]].</ref> and ''Mercurial disorder'' has been proposed by McLean Hospital's [[Mary C. Zanarini|Mary Zanarini]].{{Verify credibility|date=June 2008}}<ref>Hunter, Aina ([[2006-01-24]]). "[http://www.villagevoice.com/people/0604,hunter,71916,24.html Personality, Interrupted]". ''The Village Voice''. Retrieved on [[2007-09-21]].</ref> Another term advanced (for example by psychiatrist Carolyn Quadrio) is ''Post Traumatic Personality Disorganisation'' (PTPD), reflecting the condition's status as (often) both a form of chronic [[Post Traumatic Stress Disorder]] (PTSD) and a [[personality disorder]] in the belief that it is a common outcome of developmental or attachment trauma.<ref name="AxisOne/AxisTwo">Quadrio, C. (December 2005). "Axis One/Axis Two: A disordered borderline". ''Australian & New Zealand Journal of Psychiatry'' '''39''' (Suppl. 1): 141-156.</ref>

==Sociological and cultural aspects==
===Cultural references===
Several films have portrayed characters either explicitly diagnosed or with traits strongly suggestive of the diagnosis which have been the subject of discussion by psychiatrists and film experts alike. The films ''[[Play Misty for Me]]''<ref>{{cite book |title=Reel Psychiatry:Movie Portrayals of Psychiatric Conditions|author=Robinson, David J. |year= |publisher=Rapid Psychler Press |location=Port Huron, Michigan |isbn=1-894328-07-8|pages=p. 234}}</ref> and ''[[Fatal Attraction]]'' are two cited examples,<ref name="RobinsonFG">{{cite book|last = Robinson|first = David J.| title = The Field Guide to Personality Disorders| publisher = Rapid Psychler Press| date = 1999| pages =p. 113| isbn = 0-9680324-6-X}}</ref> as well as the book and movie ''[[Girl, Interrupted]]''; all highlight the emotional instability of the disorder and the frantic attempts to avoid abandonment. However, each case shows a person more aggressive to others than to herself; the latter is a more usual outcome in these situations.<ref>{{cite book |title=Movies and Mental Illness: Using Films to Understand Psychopathology |author=Wedding D, Boyd MA, Niemiec RM |year=2005 |publisher=Hogrefe |location=Cambridge,MA |isbn=0-88937-292-6 |pages=p. 59}}</ref> The 1992 film ''[[Single White Female]]'' highlights different aspects of the disorder, as the character Hedy, suffering from a markedly disturbed sense of identity, adopts wholesale the attributes of her flatmate. A chronic emptiness is implied and, as with the last two films, abandonment leads to drastic measures.<ref>Robinson (''Reel Psychiatry:Movie Portrayals of Psychiatric Conditions''), p. 235</ref> Other films cited as depicting prominent characters with the disorder include ''[[The Crush (1993 film)|The Crush]]'', ''[[Malicious (film)|Malicious]]'', ''[[Presumed Innocent (film)|Presumed Innocent]]'', and ''[[The Hand That Rocks the Cradle (film)|The Hand That Rocks the Cradle]]''.<ref name="RobinsonFG"/>

On stage, BPD was a central theme of [[Joe Penhall]]'s 2000 play '[[Blue/Orange]]' in which to psychiatrists do battle over the future treatment of a black patient suffering from the condition.

The character of Laura Montag in HBO's cable-television series ''[[In Treatment]]'' also displays key symptoms of the Borderline personality disorder.

==Footnotes==
{{Reflist|2}}

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* Fonagy, P.; A.W. Bateman (April 2006). "Mechanisms of change in mentalization-based treatment of BPD". ''J Clin Psychol'' '''62''' (4): 411-30.
*Gunderson, John G. (1984). ''Borderline Personality Disorder''. Washington DC American Psychiatric Press.
*Gunderson, John G. (2000). ''Borderline Personality Disorder: A Clinical Guide''. Washington, DC. American Psychiatric Press, Inc.
* Horowitz, M.J. (May 2006). "Psychotherapy for Borderline Personality: Focusing on Object Relations". ''The American Journal of Psychiatry'' '''163''' (5): 944-5.
* Linehan, M.M.; D.A. Tutek, H.L. Heard, et al. (December 1994). "Interpersonal Outcome of Cognitive Behavioral Treatment for Chronically Suicidal Borderline Patients". ''The American Journal of Psychiatry'' '''151''' (12): 1771.
* Petronix, K.M. (2007). "Petronix Chronicles - Birth of a Sociopath". ''Sociopathic.net eBook'' (1): 1-52.
* Reynolds, S.K.; Lindenboim, N., Comtois, K.A., et al. (February 2006). "Risky Assessments: Participant Suicidality and Distress Associated with Research Assessments in a Treatment Study of Suicidal Behavior". ''Suicide & Life - Threatening Behavior'' '''36''' (1): 19.
* Twemlow, S.W.; P. Fonagy, F. Sacco (2005). "A developmental approach to mentalizing communities: I. A model for social change". ''Bulletin of the Menninger Clinic'' '''69''' (4): 265.
* Vinocur, D. (2005). ''Mental representations, interpersonal functioning and childhood trauma in personality disorders''. Long Island University: The Brooklyn Center. AAT 3195364.
* Zeigler-Hill, V.; J. Abraham (June 2006). "Borderline personality features: Instability of self-esteem and affect". ''Journal of Social & Clinical Psychology'' '''25''' (6): 668-687.

==See also==
*[[Emotional dysregulation]]
*[[Post-traumatic stress disorder]] (PTSD)
*[[Complex post-traumatic stress disorder]] (C-PTSD)
*[[Bipolar disorder]]
*[[Depressants]]
*[[DSM-IV Codes#Personality Disorders]]
*[[Structured Clinical Interview for DSM-IV]]
*[[Dissociative disorders]]


==External links==
==External links==
* [http://www.cedrickhardman.com Cedrick Hardman's Official Website]
* {{PDFlink|[http://www.nimh.nih.gov/publicat/NIMHbpd.pdf NIMH]|241&nbsp;[[Kibibyte|KiB]]<!-- application/pdf, 247225 bytes -->}} National Institute of Health - Borderline Personality Disorder
* [http://www.imdb.com/name/nm0362442/ Cedrick Hardman on IMDB.com]
* {{dmoz|Health/Mental_Health/Disorders/Personality/Borderline/}}
* [http://www.tv.com/cedric-hardman/person/128609/summary.html Cedrick Hardman on TV.com]
* [http://www.BPDCentral.com BPDCentral] - Information and support for families and individuals dealing with BPD.
* [http://www.bpdworld.org BPDWORLD] - UK-based charity for people with BPD
* [http://www.personalityone.com/borderline-personality-disorder-quiz.html Borderline Personality Disorder (BPD) Quiz]


{{1970 NFL Draft}}
{{DSM personality disorders}}
{{Super Bowl XV}}


{{DEFAULTSORT:Hardman, Cedrick}}
[[Category:Personality disorders]]
[[Category:Abnormal psychology]]
[[Category:1948 births]]
[[Category:Living people]]
[[Category:American football defensive ends]]
[[Category:San Francisco 49ers players]]
[[Category:Oakland Raiders players]]
[[Category:National Conference Pro Bowl players]]
[[Category:United States Football League players]]
[[Category:North Texas Mean Green football players]]


{{defensive-lineman-1940s-stub}}
{{Link FA|es}}
[[ar:اضطراب الشخصية الحدي]]
[[ca:Borderline]]
[[da:Borderline-personlighedsforstyrrelse]]
[[de:Borderline-Persönlichkeitsstörung]]
[[es:Trastorno límite de la personalidad]]
[[fa:اختلالات شخصیتی مرزی]]
[[fr:Trouble de la personnalité borderline]]
[[it:Disturbo borderline di personalità]]
[[he:הפרעת אישיות גבולית]]
[[hu:Borderline személyiségzavar]]
[[nl:Borderline-persoonlijkheidsstoornis]]
[[ja:境界性人格障害]]
[[pl:Osobowość borderline]]
[[pt:Transtorno de personalidade limítrofe]]
[[sr:Гранични поремећај личности]]
[[fi:Epävakaa persoonallisuus]]
[[sv:Borderline]]
[[uk:Межовий розлад особистості]]
[[zh:边缘性人格障碍]]

Revision as of 16:36, 10 October 2008

Template:NFLretired Cedrick Ward Hardman (born October 4, 1948 in Houston, Texas) is a former American Football defensive end who played for the National Football League's San Francisco 49ers and Oakland Raiders and the United States Football League's Oakland Invaders. Hardman's thirteen year professional football career lasted from 1970 to 1983 in the National Football League and ended as a player/coach in 1983 with the USFL's Oakland Invaders. Since 2002, Hardman has worked closely with sports attorney Don West, Jr.

Biography

College years

Hardman played college football at North Texas State University, (renamed the University of North Texas in 1988). Hardman was an All-Missouri Valley Conference football defensive lineman. In a historic manner, Hardman recorded 38 sacks in his senior season at North Texas State[1] and represented North Texas State in the Blue-Gray and Senior Bowl all-star games in 1970. Cedrick started playing college football as a defensive back, then moved to linebacker in his sophomore season. His final two college years were spent playing defensive end. Hardman was drafted with the ninth overall selection in the first round of the 1970 NFL Draft by the San Francisco 49ers.[2]

NFL career

Hardman is the current all-time sack leader for the San Francisco 49ers franchise, recording 112.5 sacks between 1970 and 1979.[3] Hardman was a two-time Pro Bowler in 1971 and 1975[4] and he was a member of the Oakland Raiders Super Bowl XV winning team.[5] Cedrick's lifetime stats are borderline NFL Hall of Fame.

USFL career

On October 20, 1982, Hardman was the first player ever signed by the Oakland Invaders of newly formed United States Football League.[6] Hardman served as a player/coach during the team's inaugural 1983 division winning 9-9 season.

Acting career

Movies[7]

House Party (1990) .... Rock

Stir Crazy (1980) .... Big Mean

The Candidate (1972) .... Actor

Television

"The Fall Guy" .... Righteous (1 episode, 1981) 

- The Fall Guy: Part 1 (1981) TV Episode (as Cedrick Hardman) .... Righteous

"Police Woman" .... Large Man (1 episode, 1975) 

- Police Woman - The Company (1975) TV Episode (as Cedrick Hardman) .... Large Man

References

  1. ^ "The North Texan Online - Homecoming 2001". Retrieved 2007-03-07.
  2. ^ "DraftHistory.com 1970". Retrieved 2007-03-07.
  3. ^ "Official Site of San Francisco 49ers - Career Stat Leaders". Retrieved 2007-03-07.
  4. ^ "Official Site of San Francisco 49ers - Pro Bowlers". Retrieved 2007-03-07.
  5. ^ "The Red Zone -Super Bowl XV". Retrieved 2007-03-07.
  6. ^ "Sports People; Comings and Goings". Retrieved 2007-02-17.
  7. ^ "New York Times Cedrick Hardman Filmography". Retrieved 2007-03-07.

External links

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