A Developmental Model of Borderline Personality Disorder: Understanding Variations in Course and Outcome

The authors of A Developmental Model of Borderline Personality Disorder: Understanding Variations in Course and Outcome are Patricia Hoffman Judd, Ph.D., a clinical professor of psychiatry in San Diego, and Thomas McGlashan, M.D., a distinguished researcher on personality disorders and schizophrenia, now a professor at Yale. The book addresses the causes, treatment, and outcome of borderline personality disorder.

The first chapter presents a literature review and an integrated developmental model of the etiology of the disorder. This section is up to date, comprehensive, and convincing. The second chapter describes the Chestnut Lodge Follow-Up Study, which examined the long-term outcomes of patients with borderline personality disorder and other diagnoses after residential treatment. The next four chapters consist of lively case descriptions, outlining the background, symptoms, treatment history, and outcomes of four typical patients with borderline personality disorder. The last two chapters offer general conclusions about the treatment of this disorder. The approach to therapy recommended is highly eclectic and integrative.

I enjoyed reading this book. Its view of the field is state of the art, and the text is beautifully written. However, given that borderline personality disorder is my main interest, I found a few points to disagree with. For example, the authors recommend hospitalization as a "clinically necessary option" for patients with borderline personality disorder but do not present any data showing that it is indeed useful. However, I found the overall orientation of this book to be down to earth, practical, and broad minded. I would strongly recommend it to clinicians struggling with this patient population.

Dr. Paris is professor of psychiatry at McGill University in Montreal.