Borderline personality disorder: Formulation of a literature-based inpatient treatment protocol

In the past, controversy over the existence of Borderline Personality Disorder as a separate diagnostic entity has been intense. Recently, most of this has been laid to rest, as research has validated the concept and shown that it can be reliably diagnosed; culminating in the inclusion of Borderline Personality Disorder as a separate classification in the DSM-III (updated in the DSM-III-R). As yet, however, the etiology and contributing factors are unclear. Furthermore, current work has revealed a possible connection between the borderline disorder and a history of incest/sexual abuse and, in certain cases, a concomitant diagnosis of post-traumatic stress disorder. To date, however, there is no unified treatment approach to working with borderline patients. This deficiency is seen as more critical in the inpatient setting since these individuals almost invariably present in crisis. The first step in standardizing and validating inpatient care for the borderline is seen as the generation of a literature- based treatment protocol. To this end, an exhaustive review of the literature was undertaken, coupled with consultation from professionals working with this population on a regular basis. A protocol was then formulated based upon this information. The protocol included early diagnostic guidelines, continuing assessment, general ward management, the use of psychotropic medications, therapeutic issues and techniques, staff issues, and discharge planning. Finally, a critique of the protocol is given, and suggestions are made for its implementation and validation