Book Review
Borderline Personality Disorder 
Borderline Personality Disorder John G Gunderson, Perry D Hoffman, editors. Washington (DC): American Psychiatric Publishing; 2005. 171 p. US$29.95.
Reviewer
rating*: Excellent
Review by: John Livesley
Vancouver, British Columbia
The intent of this volume on borderline personality disorder (BPD) is laudable: it seeks to offer professionals and families information and education to reduce the confusion about the disorder. Such a guide is badly needed. Informative accounts of current ideas about the disorder are not readily available in a format that is appealing to general clinicians and families. This is unfortunate because few disorders are so misunderstood by professionals, family members, and patients alike. It is still common to hear it stated that treatment is not effective, patients rarely change, the disorder arises primarily from childhood abuse and adversity, and that these patients are attention-seeking and manipulative and do not want to change. There is clearly a niche for a readable text that explains BPD in ways that are helpful to families and patients. This volume begins to fill this niche and should help reduce false impressions, stigmatization of the disorder, and the blame heaped on patients and their families.
The editors have assembled an array of experts to describe contemporary ideas about the nature, origins, treatment, and impact of the disorder. The text is divided into 2 parts. Part 1 provides the basic information needed to understand current thinking on diagnosis, treatment, and prognosis. Specific chapters deal with diagnosis, psychotherapeutic options, pharmacotherapy, and longitudinal course. This section goes a long way toward correcting mistaken beliefs about treatment effectiveness and long-term outcome. Part 2 deals with family matters. The first few chapters are important reading for clinicians treating these patients. They describe what it is like to have this disorder and what it is like to have a family member with the disorder. The final chapters discuss the burden imposed on families and how to support families and involve them in treatment. The result is a readable overview of the DSM-IV concept of BPD that is already proving useful to both families and professionals.
Although the guide is undoubtedly useful and well worth reading, it is not without shortcomings. It suffers from being an edited volume and from trying to meet the needs of both a professional and a lay audience. There is some unevenness across chapters. Some are more detailed and use more jargon than needed to communicate basic ideas to lay individuals. The editors have done their best to make the volume readable to a wide audience by drawing on assistance from 2 writer-educators. This has improved the clarity of the text. There is a useful glossary that offers clear and straightforward definitions of technical terms. Key points are also summarized at the end of each chapter so that the message for families is clear. Despite these efforts, there is limited continuity across chapters, and one is left with the impression that the volume would have better served its purpose if written by a single author who could integrate ideas across chapters and explain how research on diagnosis and etiology inform treatment strategies. The needs of families would also have been better served if the sections related to helping families cope were expanded with more information about practical coping strategies and how to manage the emotional instability and crises.
The text also seems directed primarily toward the American reader. Little attention is given to the situation in other countries or to effective treatments developed elsewhere, for example, Bateman and Fonagy’s mentalizing-based treatment and Ryle’s interesting cognitive analytic therapy. Emphasis is also placed on describing the different available psychotherapies as if they were alternatives rather than potentially complementary ways to treat the disorder. The importance of eclectic and integrated treatments that select interventions on the basis of what works, as opposed to the dictates of a given theoretical model, is not recognized.
Perhaps most bothersome of all is the tendency to promote BPD as a distinct entity defined by a set of criteria that is beyond dispute. While there is little doubt about the importance of this form of psychopathology, there is still considerable debate about some of major features of borderline pathology and the best way to represent them. No part of this debate is conveyed to the reader. This is probably because the book originated at the first annual meeting of an advocacy-orientated organization and most of the authors accept rather than question the merits of the DSM model. The goals of advocacy are perhaps not well served by recognizing that the disorder in question has some contentious elements. Nevertheless, families deserve to know that important aspects of the diagnosis are being disputed and that borderline pathology is a fuzzy entity at best.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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