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Book Review   |    
Maureen A. Kaplan
Psychiatric Services 2007; doi: 10.1176/appi.ps.58.1.147
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by John G. Gunderson, M.D., and Perry D. Hoffman, Ph.D.; Arlington, Virginia, American Psychiatric Publishing, Inc., 2005, 192 pages, $32.95 softcover

Ms. Kaplan is a doctoral fellow at Smith College, Northampton, Massachusetts.

In Understanding and Treating Borderline Personality Disorder, the editors, both experts in this psychiatric specialty, collect adaptations of papers presented at the first annual conference of the National Education Alliance for Borderline Personality Disorder, which was held in 2002. Their goal was to bring to the widest audience possible, lay and professional, the most current information on borderline personality disorder.

The book is divided into two parts. The first addresses epidemiology, pharmacology, and the latest approaches to treatment. The second is devoted to helping families of people with borderline personality disorder, whom the editors describe as often forgotten. To increase accessibility, technical terms that might be unfamiliar to nonprofessionals are in boldface and defined at the end of each chapter. In addition, each chapter has a section titled "What Families Need to Know," which encapsulates the salient points of the chapter for easy reference.

Part I covers diagnosis, treatment, and prognosis. The chapters are clearly written, covering such topics as psychotherapy and pharmacotherapy specifically aimed at borderline personality disorder, as well as the controversies regarding diagnosis and suicidal and self-injurious behavior implicated in the disorder. The most current research is referenced.

As a clinician who both manages a residential program for adolescent girls with borderline personality traits and treats those girls and their families, I found the second part of this book more provocative. For example, the chapter on family perspectives closes with the declaration directed to the family, "You did not cause this illness any more than your child chose to have it." This hardly resonates with my own observations, however. Indeed, the etiology of borderline personality disorder is varied and complex, with risk factors ranging from brain structure to child abuse.

The issue of unsatisfactory parenting is raised in the book's first part as a potential cause of the disorder and is glossed over in the second part. This is a disservice to the families that struggle with how they can best understand their role in the life of a loved one with borderline personality disorder. What is not discussed are ways for the therapist and the family to explore together and without blame the idiopathic course of the afflicted individual's disorder and how it traces back through his or her development, including the family's influence and interactions.

Another concern is that the book is aimed at families of higher than average economic and educational standing, with the means to pick and choose different individual and family treatments without financial worry. The authors do not mention issues surrounding insurance, Medicaid, lack of resources in more rural areas, or lack of expertise on the parts of many practicing clinicians, who may not be familiar with the most recent outcome-based treatment.

These concerns notwithstanding, the book is a valuable resource replete with the most up-to-date information; it should be on the shelf of every clinician treating borderline personality disorder. As the editors note, "the work on borderline personality disorder is 20 to 30 years behind that of other major psychiatric disorders," making their ongoing dedication to borderline personality disorder—which crosses all races, socioeconomic classes, and cognitive abilities—admirable and significant.




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