PubMed · 8561224
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D H Frayn. 1996. Grief and object constancy.. https://doi.org/10.1176/ajp.153.2.aj1532297
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Highly suicidal, borderline patients are difficult to treat within the hospital and the community. The institution of managed care necessitates that care for these and other chronically hospitalized populations take place in the community. Psychotherapy has shown moderate success for some borderlines, however, treatment attrition is a significant problem. Without an intervention that successfully maintains suicidal borderline patients in therapy, either more costly methods of treatment must be used or death will result. A form of cognitive-behavioral therapy called dialectical behavior therapy has shown a high rate of effectiveness in reducing inpatient hospital days, suicide attempt frequency, and therapy attrition.
The concept of Borderline Personality Disorders was developed from North-American psychiatric and psychoanalytic thought. During recent years different contributions on this disorder emerged from several psychological paradigms. Four current trains of research are reviewed: Approaches based upon the five-factor-model of personality, Linehan's behavioristic approach, interpersonal concepts as shown by Benjamin and a self-developed subject-centered approach focussing on the patients' subjective theories of illness. These models converge into a concept which interprets Borderline Personality Disorders as disturbances of personal identity. The patients fail when attempting to overcome the tension between being a person and being a subject in their interpretation of the world and themselves. At the end of the article consequences for therapy are highlighted.
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